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JPS & MedStar Patient Navigation Funding Approach

JPS & MedStar Patient Navigation Funding Approach. March 25, 2014. Patient Navigation Overview. Goals Reduce Avoidable Admissions Improve access to care in the right setting and right time Decrease 30 day readmissions (CHF). Section 1115 Research and Demonstration Projects.

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JPS & MedStar Patient Navigation Funding Approach

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  1. JPS & MedStar Patient NavigationFunding Approach March 25, 2014

  2. Patient Navigation Overview Goals Reduce Avoidable Admissions Improve access to care in the right setting and right time Decrease 30 day readmissions (CHF)

  3. Section 1115 Research and Demonstration Projects Section 1115 of the Social Security Act gives the Secretary of Health and Human Services the authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs. In general, section 1115 demonstrations are approved for a five-year period and can be renewed, typically for an additional three years. Demonstrations must be “budget neutral” to the Federal government, which means during the course of the project Federal Medicaid expenditures will not be more than Federal spending without the waiver.

  4. 1115 Waiver – 5 year process

  5. Payment Mechanics 1115 Waiver payment to Providers from CMS are based on: Payments from JPS to MedStar are based on: • Per patient payment - monthly • Shared outcome pool - yearly

  6. Project Vision Why Did JPS partner with MedStar? Proven results on small scale pilot Shared values of getting patients the right care in the right setting Existing infrastructure of 24x7 response within the community Through collaboration we can better impact patient outcomes for shared patients

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