MHN ACO STRATEGIC PARTNERSHIP FOR IMPROVING COST AND CARE OF HIGH-RISK BEHAVIORAL HEALTH PATIENTS

  • The Bidder’s Conference was held on October 23rd, 2019. Below is the recap from the Question and Answer Session. Presentation and Selection Criteria Scoring Rubric  available for download: 

Q&A

Q: What volume of patients that would be in this partnership are already being care managed?

A: Many of these patients have at least been provided a health risk assessment (HRA) or have been engaged in care management, yet they still remain our most expensive and highest utilizing patients. Supporting this partnership through use of real time hospital activity alerts, we hope that it will provide an opportunity to catch this group of patients while they are in the hospital.

Q: Most of the select hospitals are on the west side. Where are these patient’s residences located in comparison?

A: Many of the patients are spread out across the city. However, these patients are showing up  in the target  hospitals and ED frequently providing an opportunity to identify and engage.

Q: Is there a scoring rubric for the written proposal that can be shared?

A: Yes. The rubric will be posted to the webpage along with the Q&As and presentation from today.

Q: Is there any idea of a start date for the program?

A: We are looking to first quarter of 2020. Part of this decision will be a discussion with the chosen partner to understand when they will be properly ready to go live. We are expecting dedicated staff to run this program and so we are expecting the funds to be solely spent on this partnership.

Q: For staff designated to this partnership, are there any expectation with staffing vs. patient ratio?

A: It will be left to the chosen partner to recommend this ratio. It needs to be decided with the ROI in mind. Keep in mind, if there are services being provided to the patients enrolled that can be billed to the MCO, that would be a source of revenue on top of the bundle payment.

Q: While there are some patients that will have a PCP relationship, there will be patients with an assigned PCP but no engagement or relationship. If a connection is made with a patient who has not engaged with the PCP but the agency is able to engage them, how would that be navigated?

A: When there are efforts to engage the patients with a PCP there will be tools to easily communicate with the assigned medical home to get the patient into the clinic. We are looking for an agency to support the medical home care management team and develop/maintain that relationship.

A: If the agency provides a service that the medical home does not have available, the patient can be engaged in those services with the expectation that there will be ongoing communication and a maintained relationship between the patient and the medical home.

Q: Can you further define mobile crisis services?

A: Having the ability go out into the community to engage a patient. When someone is admitted or shows up in the ED, being able to go directly to the facility and engaging or working with the hospital staff to avoid an admission or assist the patient at the time of discharge to connect them with the appropriate level of care.

Q: How would the total savings be split amongst the organizations?

A: We are not asking the partnerships to take downside risk. MHN ACO is in discussions as to how the savings will be split between the agency, MHN, and potentially with the Payor (pending).