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Texas Medicaid official outlines how the state ties hospital payments to safety and the data gaps that remain
Summary
Texas Medicaid described mandatory hospital quality-based payments that tie bonuses and penalties to potentially preventable complications and readmissions, using Solventum (formerly 3M) scoring and requiring MCO uptake of alternate payment models; state official urged improved interoperability and technical assistance for smaller providers.
Jimmy Blanton, deputy director for quality and program improvement at Texas Health and Human Services, walked PTAC through how his state operationalizes patient-safety incentives within Medicaid. He said Texas uses a hospital quality‑based payment program that scores potentially preventable complications and readmissions, runs actual-to-expected rankings, and shares registries with managed care organizations to support internal quality improvement.
"We use software from Solventum, formerly 3M," Blanton said, and described a system in which managed care organizations receive metrics and then incorporate them into alternative payment models that push accountability down into provider networks. Texas, he said, has 16 managed care organizations and serves "about 4.5 million people," with programs that include directed payments, pay-for-quality dashboards, and five-star MCO ratings.
Blanton emphasized implementation challenges: smaller and rural hospitals may need safeguards in mandatory programs, risk adjustment is essential, and states require technical assistance and flexible models because "one size fits all isn't something that we're able to do often." He encouraged the committee to consider how CMS-level levers, QIOs, and AHRQ resources might support states and providers implementing safety‑oriented payment reforms.
