South Dakota Medicaid will serve as the lead organization for this community transformation opportunity. South Dakota Medicaid is one of the state?s largest healthcare purchasers, providing health care coverage for over 140,000 of South Dakota?s approximately 884,000 residents. The Medicaid agency provides health care coverage across all 66 counties in the state, 60 of which are considered rural according to HRSA?s Federal Office of Rural Health Policy. The CHART model in South Dakota will initially consist of three counties: Brown, Custer, and Lawrence and the State will seek to include additional counties in the pre-implementation period.
South Dakota?s rural, frontier landscape presents unique challenges for health care service delivery. Rural and frontier communities face difficulties maintaining a healthcare workforce. Rural regions cannot easily compete with wages and amenities available to physicians and other professionals in more urban areas. South Dakota has shortages of certain health care providers and access to some specialty care providers is limited to South Dakota?s two metropolitan communities in the Sioux Falls and Rapid City areas. In some cases, patients must travel 100s of miles to access health care specialists. In addition, South Dakota?s rural nature has also been prohibitive to payment reform and resulted in the state remaining largely fee-for-service. Participation in the CHART model will both help address access to care issues in rural areas of the state and accelerate the state?s transition to more innovative payment methodologies and value-based purchasing.
Enhancing Access to Care in Rural South Dakota
South Dakota?s proposed healthcare redesign includes four health reform concepts: enhancing access to care through utilization of telemedicine services, implementing remote patient monitoring to manage chronic conditions, utilizing of community health workers to identify and manage chronic conditions, and the utilizing pharmacogenomic testing to increase medication adherence and reduce unnecessary travel associated with trial and error approaches. Implementation of these concepts will allow healthcare providers in South Dakota to enhance the services that are offered to rural residents thus improving health outcomes and reducing barriers to accessing care.
Accelerating Payment and Quality Innovation in South Dakota Medicaid
Implementing a capitated payment methodology will allow participating hospitals to focus on implementation of new and innovative healthcare delivery methods and reduce focus on volume.
South Dakota is requesting $4,987,600.00 over the seven-year three-month grant period. Grant funding will be used to assist participating hospitals to implement health reform projects that enhance access to care in rural South Dakota. Additionally, funding will be used to hire three contractors to assist the state to implement the health reform concepts and transition participating hospital to a capitated payment. Finally, funding will be used to make necessary updates to the State?s MMIS system to accommodate the capitated payment methodology.