A Win-Win in Medicaid (Opinion)

In a March Center on Budget & Policy Priorities report, 44 states and the District of Columbia are projecting budget shortfalls for 2012.

Arkansas, meanwhile, faced a shortfall in 2010, but has not projected gaps for subsequent years.

Gov. Mike Beebe has masterfully led our state through an unprecedented period of economic uncertainty. That includes a mid-February proposal to Secretary Kathleen Sebelius of the U.S. Department of Health & Human Services for a new framework for health care.

Titled “Transforming Arkansas Medicaid,” this is much bigger than that. This is a statewide payment reform initiative — dubbed the first of its kind in the U.S. — that will, most likely, encompass Medicaid, Medicare and private insurance plans.

One of the tenets of the plan is moving to a medical home model for care. It essentially puts the patient and primary care physician together to better coordinate care.

The second tenet is shifting reimbursement from fee-for-service to payment for episodes of care. Episodes of care are a single payment for physician, hospital, home health agency, outpatient center, etc., for specified outcomes for a medical condition for a defined period of time.

This proposal encourages care coordination among health care providers, promotes evidence-based practice, eliminates over-utilization, aligns incentives among payer, provider and patient, and reduces costs to the individual, employer and state. To line up against this is like arguing against baseball, hot dogs and apple pie.

This moves health care more than ever before — to truly focus on delivering measurable quality, service and safety to the patient. It’s about time.

July 2012 is a short timeframe to get this rolling, but there is something bigger at stake: the financial health of our state. Yes, the medical home sounds like the 1990s “gatekeeper” primary care model that no one liked and didn’t work, but bundled payments have been piloted elsewhere and it can work. We should try it here.

The elephant in the room is that this is really about money and control. Who gets the dollar from Medicaid (or Medicare) and who controls the medical home model and who decides how the bundled payment is going to get distributed?

From where I sit, the money is going to be less, not more, and control is something we actually gave up decades ago. I’ve been underwhelmed by our ability, as an “industry” of experts, to develop meaningful alternative solutions to truly overhaul the system. Gov. Beebe put on his pads and helmet, ran onto the field and has taken his share of hits while we’ve been hanging out with our friends in the stands playing Monday-morning quarterback.

I’m ready to get in the game and I’m ready for a win-win. Who’s with me? 

Peter Banko is president and CEO at St. Vincent Health System, based in Little Rock. He can be reached at [email protected].