Wednesday, July 23, 2014





Column-Michael Douglas: Did someone say Medicaid 'reform'?


August 24. 2013 2:26AM
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John Kasich now must know how Barack Obama frequently feels. Republican lawmakers just won’t take yes for an answer.



First, the Ohio House and then the state Senate declared that the governor’s proposed expansion of Medicaid wouldn’t be part of the new two-year state budget. Particularly revealing was the explanation provided by Keith Faber, the Senate president. Instead of expansion, he told reporters, the Republican majority wants to explore “reform.”



Faber used the word repeatedly. “Our members want to review and work on Medicaid reform,” he said. “We believe that there is a path to Medicaid reform. … “



At another turn, he added: “What that reform will be will depend in large part on the flexibility the federal government agrees to give us, and the initiatives and ingenuity that our members and the administration and [Greg] Moody can come up with. That may include adding more people to the Medicaid system, but it has to include flexibility to reform and frankly transform a system that works better for Ohio.”



Greg Moody happens to be the director of the Governor’s Office of Health Transformation. He and John McCarthy, the head of the state’s Medicaid program, have spent most of the past two years and more reshaping Medicaid in dramatic, ambitious and smart fashion.



Want reform? Moody and McCarthy have been all over the concept.



Medicaid provides health coverage to individuals and families with low incomes. It is jointly funded by the federal government and the states, Washington picking up roughly 63 percent of the $19 billion tab in Ohio. What is too rarely mentioned is that states do have broad flexibility in managing Medicaid. That explains the significant variation in the program from state to state.



The Kasich team has been pressing the opportunity. The governor led the way in confronting the nursing home lobby, linking a share of what the state pays to the quality of care. Actually, such payment reform has been applied widely, the system driven less by volume and more by value.



Moody and McCarthy reorganized the managed care portion of Medicaid. They consolidated the regions from eight to three. They increased competition by ensuring that five health plans operate in each region.



More, they designed contracts that ensure the out-of-state competitors have a presence in Ohio. Call centers, for instance, must be located here. So, too, does the care management have a more human touch. The premium is on face-to-face contact with those covered, more caregivers and care coordinators in communities. The bet is, the contact will produce better health outcomes, the initial cost yielding long-term savings.



This presence also translates into jobs. The health plans must ramp up to meet the more intensive brand of care management, adding hundreds of staff members, the positions typically higher paying.



Ohio is just one of three states to reach agreement with the federal government to begin integrating the health coverage of those who are eligible for Medicare (over age 65 or disabled) and Medicaid (low income). The programs developed separately. They have had little connection or coordination, diminishing health outcomes and increasing costs. Now the opening is there to make improvements on both fronts.



These are merely some highlights of what has been an aggressive effort to reshape Medicaid, many of the steps reflecting ideas long put forward yet left for others to implement. In his budget plan unveiled in February, the governor proposed to build further on the makeover.



Medicaid would be elevated to a unified, cabinet-level department, no longer scattered across a handful of agencies, streamlining offices, improving performance and transparency. So, too, would the Department of Mental Health and the Department of Alcohol and Drug Addiction Services become one. The $3 million in administrative savings deployed to advance collaboration between the department and the criminal justice system.



Another initiative — Recovery Requires Community — would help residents of nursing homes with a primary diagnosis of mental illness move back into the community.



The governor’s budget plan calls for a much-needed update of the three-decade-old automated eligibility system. It proposes promising ways to fight fraud and abuse, tools for curbing drug costs, even co-payments for using an emergency room for non-emergency conditions.



Look at the full list of changes completed, launched or in the works, and it is hard to imagine Republican lawmakers adding significant “reform,” both practical and effective.



Medicaid is part of a larger, troubled health-care system. Thus, in many ways, the whole must be repaired to produce a better Medicaid. What the governor, Greg Moody and John McCarthy have done is pursue exhaustively what a state can do to make improvements.



Which is what is so disappointing about the response of Republican lawmakers. The Kasich team, with its knowledge, experience and effort, and it doesn’t get the benefit of the doubt on expanding Medicaid?



Michael Douglas is the Beacon Journal editorial page editor. He can be reached at 330-996-3514, or emailed at mdouglas@thebeaconjournal.com.





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