CMS Waiver Answers Safety Net's $64M Question

Philip Betbeze, for HealthLeaders Media , February 22, 2013

"We reasoned that if we invested more in primary care and care coordination, that if we applied that PCMH team approach and care coordinators, we could over time reduce utilization of the ED and inpatient portion of the hospital," says Corlett.

"Because we were in effect, the insurer, that benefit could accrue to us. After a year or so, we noticed our patients enrolled in Partners in Care did use less ED, and when they went for inpatient care, their costs weren't as high."

MetroHealth also started to see better health outcomes around diabetes and hypertension, for example, and all of its 15 local primary care "health centers" are now certified as Level III medical homes by the NCQA.

Corlett predicts enrollment will ramp up rather quickly. One of the unique features MetroHealth negotiated with CMS was the ability to auto-enroll a large number of patients at the beginning. Patients previously in the system's DSH program who had completed an application in past 90 days could be auto-enrolled.

"That was about 7,500 patients," says Corlett. "They can disenroll if they want, but they have to opt out."

He says the initial reaction from the uninsured has been such that it won't take long to hit the 30,000-member ceiling.

"It's in our interest to."

Corlett says although Ohio is expanding Medicaid, which means its waiver will be short-lived, he encourages safety net hospitals in other states to look into something similar, if they have the wherewithal and meet the requirements.

"If a state chooses not to expand, the waiver exists, and I would think that in states that choose not to expand and that also have large urban public hospitals, it would be an alternative they might want to look at."

Philip Betbeze is senior leadership editor with HealthLeaders Media.
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