Panel Finds that Coordinated
Care Programs Offer Significant Medicaid Savings
October 17, 2003 - The House Energy and Commerce Health
Subcommittee continued to debate the future of Medicaid at
an Oct. 15 hearing. The third in a series of hearings devoted
to Medicaid improvements, witness
testimony focused on the potential for program savings
via coordinated healthcare for beneficiaries with chronic
health problems.
The witnesses represented both disease management contractors
and state health administrators. While different in structure
and management, the coordinated care models created by both
groups generated significant cost-savings and utilization
reductions among certain Medicaid populations. Chris Selecky,
CEO of LifeMasters Supported SelfCare Inc., testified that
their program for congestive heart failure patients (in both
FFS and managed care) reduced spending by $4.5 million and
cut emergency department visits by 40 percent. Similarly,
Dan Hilferty, president and CEO of Keystone Mercy Health Plan,
reported that his program in Kentucky produced a 4-year savings
of $92.4 million for the Medicaid program.
Dr. Rhonda Meadows from Florida's Agency for Health Care
Administration and Melanie Bella from the Indiana Office of
Medicaid Policy and Planning addressed the resources needed
to support a shift from "crisis care" to coordinated
care. Staffing 24-hour call centers for patients, coordinating
transportation and translators, and integrating with community-based
services (e.g., women's church groups) were vital, as was
an extensive, community-based primary care network.
Explaining that momentum was vital to the successful development
of community-based networks, the witnesses argued that the
Medicaid waiver process delayed program implementation and
should not be mandated. To assure a sustainable, long-term
shift to coordinated care, Ms. Bella encouraged the use of
existing public health infrastructures when developing a network
of case managers, providers, and administrators. Dr. Meadows
added that private-public partnerships with organizations
such as Pfizer have greatly benefited Florida's own coordinated
care initiatives. Such partnerships allow Medicaid programs
to expand their resources (esp. data collection) without increasing
the burden on state Medicaid programs. All five witnesses
warned that changing Medicaid beneficiary behavior took time
and that states should not expect immediate returns on investments.
While the state program officials presented coordinated care
models that did not utilize outside contractors, they agreed
that such partnerships would greatly enhance the level of
information technology available for case management and outcomes
research. They also reported that their chronic care models
had been/could be applied to uninsured patients that received
their care via the Community Access Program (CAP).
Information:
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
.
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