I guess this qualifies as being under the heading of: Ya know, you really should go out and get a life. One perfectly sunny and pleasant day in July, I sat and watched two hours of the National Governors Association annual meeting on C-SPAN. Yes, the NGA annual meeting. I can feel you shaking your heads woefully.
What was so spellbinding? Well, the health care panel presentations, of course, featuring pilot programs, mostly around the Medicaid population. On the heals of the Supreme Court ruling and in the midst of ongoing fears of state budget deficits, this was the hot topic.
Clearly, the degree of understanding of health care issues varied. Some governors definitely got the complexity of the problem — others, not so much. But all were looking for a new formula that added up to savings, but multiplied benefits — not the usual subtraction of the rolls. The programs showcased that day were relatively modest, but bigger ideas now are being played out in some states.
Look at North Carolina's Medicaid medical home. It covers about two-thirds of the state's 1.5 million enrollees. The coordinated care approach is led by 14 nonprofit, physician-directed regional networks that have the authority to set quality improvement goals.
The strategy resulted in $984 million in savings from fiscal 2007 to fiscal 2010. And they got better over time. Total savings increased each year. Risk-adjusted spending for participants in 2010 was 15 percent lower than for others in the Medicaid program.
Most of the savings came from reduced hospital care for adults and children. Of note: The majority of enrollees are 20 years old and younger. Managing the care of dual eligibles and the chronically ill in the medical home proved more difficult, more time-consuming and sometimes expensive. But participants felt that they made progress with these patients.
On to Colorado's medical home, case-management approach. More than 128,000 Medicaid beneficiaries are enrolled in seven case-management regions. Providers receive a per-member fee and a "bonus" for reaching quality and cost goals via preventive and follow-up care. The total Medicaid population is 656,000.
Preliminary data for the first six months of billing show a 14 percent drop in inpatient hospital stays for children. The program also had some success with more complex cases. Inpatient hospital stays among adults with disabilities and the chronically ill dropped 9 percent compared with those in the traditional Medicaid program. Adult emergency department visits dropped 5 percent.
Many eyes will turn to Oregon in the coming months where Gov. Kitzhaber just launched 13 risk-bearing, coordinated care organizations comprising hospitals, physicians, counties and community organizations, to cover an initial 500,000 Medicaid enrollees after the state received a waiver and a $1.9 billion grant.
Other pockets of similar experimentation are out there. But clearly the signature strategy trend of all these efforts is not cutting care, but coordinating care. [See page 36.] That's where people see the future.
Well, I'm off. Have to spend some hours reading The Chicago Manual of Style. It's a real page-turner. Who says I don't know how to have fun?
— Let me know what you think. You can reach me at firstname.lastname@example.org