— Many governors are accepting the expansion of Medicaid health care programs for the poor in their states as the law of the land through the Affordable Care Act, but many are also rightly taking advantage of the opportunity to reform the program at the state level.
Many governors are getting waivers from the Obama administration that allows them to partially manage the program through private insurers and include other reform measures that encourage people to seek preventive services and take more responsibility for their own health.
The goal of the Obama administration to expand the Medicaid program to cover more people may be met, but officials need to give state a lot of flexibility in how best to serve those people.
Of course, details matter. The programs must — private sector participation or not — have measurable outcomes that provide better care at a lower cost.
So far, the Obama administration seems open to granting waivers to the states, many of whom have Republican governors. Florida Gov. Rick Scott, for example, only agreed to expand the Medicaid program in his state after Florida received approval of its waivers that will move all of the Medicaid patients into privately managed plans.
Republican Gov. Robert McDonnell of Virginia has proposed more private management of Medicaid and a new cost sharing idea for higher income beneficiaries. An Indiana plan seeks a waiver as well as it aims to create cost-sharing the encourages patients to make healthier lifestyle choices.
Minnesota is one of the leading states in attempts to reform Medicaid delivery into an model coordinated among providers through care and payments. It received $45 million from the federal government to set up such a model that has already been proven effective in an earlier pilot program.
The program pays providers to keep Medicaid patients healthy and not just treating them when they are sick. The will encouraged to recommend preventive treatment to avoid costly emergency room visits.
If at the end of the year Medicaid payments are lower than expected, the state and the provider will split the savings. The plan turns current system on its head by paying for patients to do more for their own health versus paying providers to perform more procedures.
Already, six providers have signed up for the Minnesota program, and one, Children’s Hospitals and Clinics of Minnesota, has already shown some positive results in a pilot program with Medicaid patients. A prevention program that enhanced patient education and offered a coordinated network of care reduced hospital visits for those in the program.
Many of these reform efforts can be replicated elsewhere. The Obama administration is right to be granting the states the flexibility to provide new care models. It will help them achieve their goal of more access to health care and deliver it in ways that are more efficient.