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Sellers Dorsey collaborated with a long-standing provider coalition, including the University of Louisville School of Medicine and University of Louisville Health (collectively “UofL”), as well as the Norton Children’s Medical Group (NCMG) and University of Kentucky (UK), to implement a directed payment program (DPP). By raising Medicaid funding levels from the Medicare equivalent to the average commercial rate (ACR), the program has expanded access and improved patient outcomes for both UofL Health, one of Kentucky’s most significant health systems, and NCMG, the area’s largest pediatric provider.
This program is critical to the health of Kentucky’s future generations due to providing primary and vital pediatric specialty care to one in five Kentucky Medicaid child beneficiaries. The Medicaid managed care program supports statewide access to UofL’s health care system – a physician group of over 700 providers with 80 subspecialties at 200 practice locations.
The team has worked with the coalition over three program years to:
- Preserve and enhance the existing supplemental funding stream of UofL.
- Achieve double-digit improvement on several of 14 equality measures.
- Qualify providers for 100% of the at-risk quality performance-based payments.
The funding made possible through this DPP is having the following impacts in Kentucky:
Prevented the closure of a failing health system and critical hospital in the state
Improved access by opening an urgent care clinic in a medically underserved neighborhood.
Increased well child visits by 56% for children one to 15 months.
Exceeded the national 90% benchmark for diabetes care.
Changed workflows and programs to increase focus on preventive care metrics
Enhanced staffing levels for care coordination and engagement.
Sellers Dorsey worked closely with the coalition from strategy development through program execution to:
- Design a transformative, value-based program.
- Educate key leaders on innovative methodologies and approaches.
- Increase the hospital payment methodology to the commercial equivalent for all coalition members.
- Developed relationships with key coalition stakeholders, State officials, and vendors.
- Ensured program participation for all entities of UofL’s acquisition of the Kentucky One system.
- Secure CMS approval for a multiyear program.
- Facilitate implementation.