The National Governors Association (NGA) recently chose Puerto Rico to participate in a pilot project to develop state-level capacity to support so-called Medicaid “super-utilizers,” along with six other states: Alaska, Colorado, Kentucky, Nuevo Mexico, West Virginia, and Wisconsin.
The project awarded a grant to the Puerto Rico Health Insurance Administration (ASES, for its Spanish acronym).
“We are very honored to be selected by the NGA to participate in such an important project,” said ASES Executive Director Ricardo A. Rivera-Cardona. “The goal of this project is to assist Puerto Rico in developing a comprehensive strategic action plan that will guide how the Commonwealth improves the quality and financing of care for Medicaid ‘super-utilizers’.”
“Simply put, super-utilizers are people who frequently use emergency departments and hospital inpatient services, making more visits to those facilities in a month than some people make in a lifetime, because of their social-economic background and chronic health conditions,” he said.
This first of four retreats took place Monday focusing on: data analytic infrastructure and patient identification methodology, improving care delivery, creating payment incentives and designing a care coordination outreach strategy, designing appropriate payment incentives, program evaluation and metrics for success, project management, work plan and timeline development, among other topics.
NGA staff, along with Juan Montañez, principal of Health Management Associates, led the workshop.
“It is important that our personnel are trained effectively to properly provide health care services to the 1.7 million lives under the Puerto Rico Government Health Plan. This population suffers many chronic health conditions, many with physical and mental problems, and many of them live in extreme poverty with no home or jobs,” Rivera-Cardona said.
“These social and economic barriers limit them to receive proper healthcare from a primary physician or home base care, resulting in extremely dangerous health conditions, thus increasing health insurance costs to the government,” he added.
Retreat participants include several government agencies, namely the Puerto Rico Health Department, the Transportation Department, Puerto Rico Water and Sewer Authority, Puerto Rico Power Authority, companies serving the the Puerto Rico Health Insurance Plan, the Housing Department, and several of the governor’s representatives.