Article John Baackes

The Health Care Industry Must Lead the Way on Medicaid Reform

More than 70 attempts to repeal the Affordable Care Act failed, but the groundbreaking legislation is still facing death by a thousand cuts, and it’s clear we cannot depend on Washington to fix what ails the health care system. The health care industry must step up and develop reforms that will ensure the most vulnerable continue to have access to quality care.

The Trump Administration has done everything it can to sow confusion in a sabotage campaign that didn’t require full repeal of the ACA. It started by shortening the 2018 enrollment period and cutting funding for advertising and outreach. It followed by ending the cost-sharing reductions that were designed to lower deductibles and co-pays. Then came the repeal of penalties associated with the ACA’s individual mandate, followed by the CMS decision to allow states to institute Medicaid work requirements. Each move has weakened the legislation, and left many worrying about whether it can survive.

Of course, destroying the ACA is not enough for many lawmakers. They want to follow up by attacking one of the bedrock social programs of our country – Medicaid. With more than 74-million people dependent on Medicaid for their health care, it must be saved. We in the health care industry can offer suggestions based on what is already working around the country. Among the strategies that could make a difference:

  • Value-based care – Instead of paying for the quantity served, Medicaid should focus on quality or patient outcomes. To do this properly, we will have to develop a way to measure the outcomes, but as two former Medicaid Administrators have suggested, it could be based on, among other things, early diagnosis of illness, incidence of low-birth-weight infants, and efficiency of care.
  • Coordination of programs for dual-eligibles – About 11-million people in the U.S. qualify for both Medicare and Medicaid. They are seniors and people with disabilities, who often require some of the most complex and costly care. In fact, their care can cost twice as much or more compared to the average Medicaid patient. Coordinating services for this group of people just makes sense. Streamlining their health care processes, would leave to less confusion and better outcomes.
  • Address the social determinants of health – When it comes to social determinants of health, the health care industry is going to need help from all segments of society. Medicaid serves people living in poverty, so issues surrounding housing, nutrition, education, and safety are of paramount importance. Much like health care itself, addressing these social issues will require a coordinated effort. But the industry can play a very important role.
  • Improve technology and analytics – Investment in technology is critical if Medicaid is going to serve patients effectively and efficiently. It should be used for continuous coordination of care that can anticipate problems and help individuals remain in their homes and communities for a longer period. Improving analytics can also help detect fraud and waste.
  • Invest in physicians – If implemented, the strategies already outlined would certainly result in cost savings for the Medicaid program. That savings should be used to increase pay to primary care physicians, which could increase the number of physicians willing to see Medicaid patients. That would help ensure that patients are seeing experienced doctors, who are better equipped to prevent future costly health problems.

The vast majority of Americans support Medicaid, even the majority of Republicans. They don’t want to see funding cut. Yes, the program faces some serious challenges, but those challenges can and must be met. Low-income, disabled and elderly Americans are depending on meaningful Medicaid reform that ensures they will continue to receive quality health care. Medicaid health plans across the nation stand ready and willing to work with Congress on meaningful improvements to the program.

John Baackes is Chief Executive Officer of L.A. Care Health Plan, the nation’s largest publicly operated health plan serving more two million members. L.A. Care is dedicated to providing access to quality and affordable health care for Los Angeles County residents through a variety of health coverage programs, including Medicaid, L.A. Care Covered™, L.A. Care Cal MediConnect, and the PASC-SEIU Homecare Workers Health Care Plan.  

Commands