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Akron
Beacon Journal Editorial...
Ambitious for Medicaid
Published on Sunday, Apr 03, 2011
John Kasich wants to save money. He also has a plan to improve quality
and outcomes
If budgets are a statement of priorities, the first item on John
Kasich’s agenda for Ohio Medicaid is to restructure the delivery and
financing of the program’s services. The goal, as the governor often
states, is to better align services with consumers’ needs. He wants to
improve quality and outcomes and squeeze excess costs in the health
program for low-income families, poor seniors and the disabled.
Medicaid spending in Ohio is notoriously skewed and has been for
decades. The program spent $15.8 billion last year on 2.2 million
clients. State data indicate a mere 4 percent of beneficiaries
accounted for 51 percent of the spending. The bulk of Ohio Medicaid
spending (a much higher percentage of the funds than in most other
states) goes to hospital and nursing home care for seniors and the
disabled.
Previous governors struggled, with limited success, to correct the
systemic imbalances and spiraling costs. A severe budget crisis and
federal initiatives in health-care reform now offer Kasich the impetus
to finish the task. It is heartening that he has taken on the problem
with the necessary seriousness.
To his credit, Kasich resisted the low-hanging fruit — rolling back
basic services, such as dental and vision care, for savings that are
marginal at best but affect the health and quality of life of the least
expensive of Medicaid recipients, children and families.
Instead, the governor’s budget plan targets the areas of excess cost
and inefficiency. It takes a bold approach to reshape how services are
delivered and paid for, in particular for the segment of Medicaid
clients whose care costs the most: the disabled and seniors who need
long-term care in institutions or community settings; those with
multiple chronic diseases (such as diabetes, respiratory and
cardiovascular diseases) and those with severe mental illnesses.
One example of the budget’s carefully targeted approach is evident in
how it tackles the persistent complaint that Medicaid services are
fragmented. As it is, a client who needs, say, medical and behavioral
health services receives care through two separate systems, with little
coordination and case management. Another client moving to long-term
care may have to navigate several alternatives to nursing home care,
each with different requirements.
A fragmented system promotes confusion, unsatisfactory outcomes and
overuse of services in settings that are inappropriate for the
patient’s needs. To correct such flaws, Kasich proposes a system of
care that is coordinated and integrated, enabling an individual’s needs
— social, physical, behavioral and long-term care — to be delivered in
single setting. A similar emphasis on coordinated care can be seen in
the requirement that each Medicaid client with a chronic illness have a
‘’health home’’ providing comprehensive services and care management to
reduce the frequency and cost of hospitalizations and errors.
The governor is right. The trend in Medicaid costs is unsustainable.
The remedy he offers is ambitious, tough — and necessary.
Read it at the Akron Beacon Journal
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