Payment can promote care coordination by providers or by entities that work with providers and patients. For example, states can prospectively pay providers for coordinating care or hold providers accountable for costs that could be avoided by coordination.

*Milestone details:

*Full name: Identify opportunities to promote care coordination through reimbursement strategies used in Medicaid, CHIP, and state employee programs.

*Relevance to the ACA:

The ACA provides states with tools and potential funding to pilot and deploy new payment systems that reward providers for coordinating care. These reimbursement systems may take many forms, such as making care coordination codes billable, paying monthly care coordination fees, or tying payment to outcomes that are dependent on coordination with other providers. Many of the ACA provisions encouraging the use of medical homes and accountable care organizations offer states options for reimbursing for care coordination. Several additional opportunities are worth noting:

§2704 – Up to eight Medicaid programs to participate in bundled payment demonstration. The demonstration will emphasize hospital discharge planning.

§2705 – Up to five Medicaid programs to join global payment system demonstration.

§3021 – The mandate of the new Center for Medicare and Medicaid Innovation includes testing comprehensive payments to groups of providers.