Marcy Doderer: Understanding The ACA And Private Option In Arkansas

Editor’s note: Marcy Doderer, Arkansas Children’s Hospital President & CEO, is the author of this guest commentary. It first appeared in the most recent magazine edition of Talk Business Arkansas, which you can read at this link.

In the seven short months that I have been serving as the leader for Arkansas Children’s Hospital (ACH), I’ve had the opportunity to share with many business leaders, government leaders, staff, donors and friends, that there is one constant that will never change at ACH: We always put our children’s health first. Now, more than ever, it is critical that we do so as health reform initiatives such as the Affordable Care Act roll out and we begin to fully understand the law and the associated challenges ahead for children’s healthcare.

As we enter our 102nd year of service to our state, ACH is dedicated to providing the highest quality of care our patients and families expect and deserve. We are committed to improving children’s health by providing integrated patient care, research, education and prevention. We serve every Arkansas child who needs us, regardless of the family’s ability to pay. In order to continue our mission, we are taking a contemporary look at how healthcare is funded and how we can navigate in the new world of healthcare financing.

Some background for you: In 2013, ACH had 334,821 patient visits from all 75 counties across Arkansas. Sixty-two percent (62%) of our patients are funded through the state Medicaid and ARKids First programs. Medicaid serves children whose family income is less than 100 percent of the poverty level (a family of four making $23,050 or below); and ARKids First, which started in 1997, serves children whose parents’ income is 100-200 percent of poverty (a family of four making $23,050-$46,100). Given the number of children we serve, ACH is the largest recipient of Medicaid reimbursement in this state.

Arkansas is on the cutting edge of healthcare financing reform with the new Private Option. Created in the 2013 legislative session, the Private Option will allow Arkansans from 19-64 years old, who make less than 138 percent of the poverty level ($15,860 for an individual or $32,500 for a family of 4), to enroll in health insurance plans offered by private health insurance companies. This is a unique program for Arkansas allowing the state to use federal funds to purchase private health insurance for this group of citizens.

ACH supports the new Private Option program for many reasons. First, it helps the families whose children are on Medicaid or ARKids First. Of the 200,000+ people who are eligible for the Private Option, 80,000 of them are parents of the children currently being served by Medicaid or ARKids First. Multiple national studies show that when parents take care of their own healthcare needs, they are more attentive to their child’s needs. In fact, because of the efforts to enroll adults in the Private Option, the state has discovered over 3,000 children who were already eligible for ARKids First, but were not registered. In the same vein, our certified application counselors at ACH are licensed by the Arkansas Insurance Department and trained to assist our patients’ families with consumer enrollment in the Private Option whenever possible.

Another reason ACH supports the Private Option is financial. Although our focus is serving children, many Arkansans may not be aware that there are two areas in our hospital where adult patients are treated on a regular basis: The Burn Center and Cardiology Unit. We have the only comprehensive burn center in the state, where our patient ratio is 1/3 pediatric to 2/3 adult patients. The ACH Burn Center sees over 2,200 outpatients and 400 severe burn patients annually. Our Cardiology Unit sees patients with congenital heart disease, diagnosed as infants or children. ACH continues to see these individuals throughout their adult lives. Because of these treatments, both the Burn Center and the Cardiology Unit may have patients who could qualify for Private Option coverage.

In order to maintain our “open door” policy, we must also continue to operate our hospital efficiently and be responsive to a host of opportunities and challenges affecting our financial viability. That includes not only the Affordable Care Act, but also changes to our state Medicaid program, particularly the Payment Improvement Initiative, an effort to standardize costs while also rewarding providers based on the quality of care they provide rather than the volume.

Initially, this was an effort promoted by the current Medicaid payment system, but Medicare and most private providers are applying it, too. Along the same lines, we need to have more consumer input in the delivery of healthcare. As a parent of a child being served in our hospital, I am well aware of the maze the health system can be and understand parents and patients need to have a more active role in their healthcare choices. So speak up, be your child’s advocate and have a clear and mutual understanding of your child’s care at all times. You are the most important voice on your child’s care team.

As we look to the future of healthcare in Arkansas and this country, we need to remember that our children’s health always comes first. Even though the dollars for healthcare will be limited, the number of children we serve will no doubt continue to grow so our delivery model will have to evolve and be more efficient. In business, strong outcomes are required to succeed. Healthcare in the 21st century will need to follow suit. Arkansas Children’s Hospital stands ready to meet the challenges of healthcare’s future while continuing to care for every Arkansas child who needs us.

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Marcy Doderer, FACHE, is the President and CEO of Arkansas Children’s Hospital. A 20-year veteran of the health care profession, Doderer joined ACH in July 2012.