Treatment access and effectiveness are increasingly measured by engagement, adherence and retention to reduce acute or urgent care needs. The focus on Healthy People 2020 can drive success for providers not yet in the fold of Medicaid Redesign models. While Centers for Medicaid and Medicare (CMS) moves forward with testing practice models that work across service sectors and special needs, the common focus is on improved health outcomes with integrated care for the highest impact to address avoidable hospital conditions that require aggressive prevention and intervention strategies. For providers not facing a Medicaid Redesign Plan, or looking for a fit within the varying practice models, the impetus for change is to stay clinically relevant, demonstrate effectiveness, and re-tool to strategically grow a sustainable and competitive model of care is crucial at this time. Not participating in a Medicaid Redesign Plan does not mean that your service designs can remain static.

An appraisal of your service competitiveness and relevance to population health goals requires action at several levels:

• Be knowledgeable about your community’s needs, risks, and expected outcomes; if needed, commit to a strategic community needs assessment that analyzes the medical, physical, emotional and social determinants contributing to your community populations’ health and morbidity across the life span as compared to national and local levels.
• Compare your community’s results with goals set forth for Healthy People 2020, your State’s Prevention Agenda Goals, and the CMS chronic disease management goals linked to the Health Effectiveness Data Information Set (HEDIS) measures.
• Identify best practices models congruent with your population variables.
• Facilitate service collaborations needed to build a care continuum that addresses acute care diversion models for complex care populations identified from the community needs assessment.
• Build a data infrastructure that captures points of entry across systems; maps encounters; and documents diagnosis, prevention, and gaps in care models.
• Utilize your data to aggressively address integrative care, parity access, treatment retention, care coordination, and high impacting/low cost care interventions that include pay-for-performance measures.
• Leverage impact data to negotiate competitive service model rates.
• Utilize internal revenue management processes to identify strategic growth potentials that may involve shared risk environments.
• Identify and support staff with knowledge acquisition to stay current and to equip them to be population-based health champions.