Fee-for-Service

Hospital readmissions are a large source of wasteful healthcare spending, and current care transition models are too expensive to be sustainable. One way to circumvent cost-prohibitive care transition programs is complement nurse-staffed care transition programs with those staffed by less expensive nonmedical workers. A major barrier to utilizing nonmedical workers is determining the appropriate time to escalate care to a clinician with a wider scope of practice.

This Primer is a design guide for state policy makers who are considering acuity-based resource allocation. Included in the report is: background information on different HCBS case mix approaches, the steps in the development of a case-mix resource allocation system, essential decision points to consider during the state policy development process, and best practice recommendations. This Primer is recommended as a tool for policy makers, state staff, and stakeholders.