Learning from the Innovations of Medicaid (Yes, Medicaid!)

by Tim Foley

categories: Medicare and Medicaid, State and Local Efforts

Published July 09, 2009 @ 07:18PM PT

Medicare has a golden reputation for security and stability, particularly as you inch closer to 65.  It’s not by accident that the candidates for president described their public health insurance option as being “similar to Medicare.”  By contrast, Medicaid has no such glister in the popular imagination.  People generally hear of Medicaid in terms of “Medicaid cuts,” particularly in this economic climate, or think of the stigma reinforced by the various hoops required to prove your eligibility for Medicaid.  But cutting Medicaid and making it harder for people to get in it aren’t the only way to save costs.  You can also make the system better.

The New America Foundation blog has a follow-up on the North Carolina Medicaid Medical Home model.  We’ve talked before about the medical home model – a way of arranging the delivery of health care in a coordinated fashion, with one point-person, be it a primary care provider or social worker, who is tasked with making sure all of a patient’s doctors and caregivers are on the same page.  That same point-person is also in charge of instructing the patients on caring for themselves, as well as giving helpful reminders and follow-ups.  Medicare has experimented with the medical home, and is set to run a number of additional pilot programs since it's learned that the model saves money.  Healthy San Francisco uses this model for its citywide universal coverage program, and has the lowest cost per person of any health delivery system in California – yes, even Kaiser.   The Sustinet universal coverage plan in Connecticut, if it’s ever implemented, would do the same.  Even private insurance has dabbled in the medical home – if a major customer holds a gun to their head.

You can add North Carolina Medicaid Medical Home to the list of success stories.  In one year, it saved an estimated $244 million in Medicaid costs.  The model is based on the same sense of community and teamwork we’ve seen in other medical homes, with a $3 per patient per month capitated payment on top of normal compensation rates that’s purely to pay for coordination tasks.  The staff involved are a primary care physician who has primary responsibility for the patient and is always available, plus a social worker to particularly focus on patients with chronic diseases.  The final component is data collection and strict adherence to best practices – you know, the stuff conservatives say will inevitably lead to a Soviet-style rationing.  In practice, it’s led to much better health outcomes for patients with asthma, diabetes, or congestive heart disease, to say nothing of decreased hospitalization and ER benefits.

Let’s push pause a second – this means if you’re on Medicaid in North Carolina, you’re getting some of the best, coordinated care in the country.  And it actually costs less than the private managed care plans that over 60% of Medicaid patients receive coverage through.

Drew Altman from the Kaiser Foundation hammers home the point that “Medicaid, often characterized in public debate like other public programs as lagging behind the private sector in its ability to innovate, can be a leader in demonstrating how to improve care and lower costs through delivery system changes.”  If we’re serious about reforming not just how health care is paid but how it’s received in order to truly improve quality, we’ve got a lot to learn from Medicaid.

It’s a shame no one seems to ever hear about it.

(Photo credit:  J. Stephen Conn on Flickr.)