Care1st Health Plan Arizona, a WellCare Health Plans, Inc. (NYSE: WCG) company, signed a value-based agreement with Maricopa Integrated Health System (MIHS) on Oct. 1, 2018 to launch the Hepatitis C Center of Excellence program to treat Medicaid members in Maricopa County with the infectious liver disease under a unique value- based bundled payment arrangement. Experts at the Institute for Strategy and Competitiveness at Harvard University estimate that this is the first time a Medicaid plan in the U.S. has offered bundled payments as part of a value-based agreement for hepatitis C treatment.
Approximately 90,000 individuals are living with hepatitis C in Arizona, making it one of the state’s most commonly reported infectious diseases. Through the partnership, Care1st Health Plan Arizona will collaborate with MIHS hepatologists at Maricopa Medical Center to evaluate and treat 100 members with hepatitis C by administering anti-viral medication targeted at the hepatitis C virus. The medication, which is taken daily for approximately 12 weeks, is covered by Care1st Health Plan Arizona and is available to Medicaid members at no cost.
Participating members will also work with MIHS navigators and community health workers to ensure program compliance and to help connect them to needed social and human services such as food, housing, transportation and more.
Under the value-based contract, participating MIHS providers receive bundled payments to help drive quality health outcomes. Bundled payments are identified as one of the more advanced levels of compensation in value-based contract payment structures under the Centers for Medicare and Medicaid Services’ (CMS) Learning Action Network (LAN). These payments help contain costs and promote better health outcomes while allowing for innovation at the clinical practice level.
“Hepatitis C is a highly infectious liver disease that, without proper management or treatment, can lead to potentially fatal outcomes,” said Gerard Quigley, DNP, director of the hepatitis C clinic at MIHS. “By collaborating with Care1st Health Plan Arizona, we can help treat the disease sooner and potentially help mitigate the spread of the disease across our state.”
“Hepatitis C impacts thousands of Arizonans each year,” said Scott Cummings, state president, Care1st Health Plan Arizona. “As a health plan serving thousands of Medicaid members across our state, we’re excited to partner with MIHS to launch this innovative initiative and help our members access quality, affordable care and treatment.”
“This unique bundled payment approach tied to quality outcomes allows the provider to seek innovative and more efficient care processes than the current fee-for-service payment model permits,” said Dr. Satya Sarma, chief medical officer, Care1st Health Plan Arizona. “Becoming more efficient and more focused on quality will allow us to improve access and maximize the effectiveness of care for our members who have this serious condition.”
During the yearlong Hepatitis C Center of Excellence initiative, Care1st Health Plan Arizona will measure quality and utilization outcomes from the program and will assess whether to expand the program.