Sunday, September 15, 2013

'Hey, Mikey! He Likes It!'

We have alluded to the issue of managed care being an integral part of any Medicaid reform going forward in North Carolina as it is now being done in 19 other states around the nation.

So this is not something that is brand-new, untried and untested by any means on the ground in any state which is where any public policy question really matters. In truth and in fact.

We just received the following data from some folks in Mississippi who are now administering managed care for Medicaid in the Magnolia State.

Take a good look at not only the savings but the higher degree of quality healthcare delivery across the state. These are below poverty level people in Mississippi, not normally the folks that the big insurance companies and health systems cater to simply because they don't have the money to pay for a lot of health care in the first place and secondly, they typically have a lot of health problems that are costly to correct:

Medicaid Managed Care in Mississippi has the following savings:

  • 2011 Outpatient Savings of $33,655,478 over the projected costs for the population
  • 2011 Inpatient Savings of $14,458,995 over the projected costs for the population (This is final data.)
  • 2011 Total Savings of $48,114,473 over the projected costs for the population
  • 2012 Outpatient Savings of $14,289,317 over the projected costs (This was prior to the expansion)
  • 2012 Inpatient Savings of $8,059,668 over the projected costs (This is using only prelim data.  No final data available yet.)

Total projected savings for 2011 and 2012 from Magnolia alone $118,577,931. ($118.57 million)

From a Quality standpoint, Managed Care for Medicaid patients:

  1. Improvement in almost all HEDIS measures over the baseline year.
  2. 84.3% of patients appropriately monitored for medication adherence
  3. 43% increase in women screened for breast cancer
  4. 15% increase in women screened for cervical cancer
  5. 72% increase in LDL cholesterol screening for members with Cardiovascular Disease
  6. 31% increase in diabetics with control of their diabetes
  7. 12% increase in diabetics who received the appropriate eye exams
  8. 44% increase in the number of diabetics with blood pressure control
  9. 46% increase in members with High Blood Pressure who had the blood pressure under control
  10. 34% increase in the appropriate follow-up of children with ADHD who just started medication therapy
  11. 27% increase in the appropriate follow-up of children who had been on ADHD medication.
  12. 81% improvement in members with Asthma using appropriate medication
  13. 35% increase in the number of members counseled for appropriate nutrition
  14. 24% increase in the number of members counseled for physical activity.

From an access to care standpoint:

  • Medicaid Managed Care meets all contractual standards for access to care for members.
  • Case management staff works regularly with all provider types to ensure appropriate access for all of our members

It is important to note that prior to Medicaid Managed Care being implemented in the great state of Mississippi, there was a protracted fight to keep managed care operators out of the state. None were more adamant in their opposition that the African-American medical society of Jackson, Mississippi.

Today, representatives of the African-American medical society of Jackson, Mississippi are among the most ardent advocates of Medicaid managed care in the state.

Just take a look at the numbers above! Medicaid recipients, heretofore somewhat ignored and forgotten until they entered the emergency room with advanced stages of diabetes, obesity, heart disease or cancer, are now receiving tons of preventive care, counseling and training to take care of their own health before it becomes a huge burden on the state Medicaid program.

It stands to reason that if a government program, or any private program, can help keep people healthy that their health costs will stay in check, doesn't it?

Well, that is what Medicaid Managed Care ultimately aims to do. What could be more fair, just and compassionate than that to every affected party?

The Medicaid patient receives quality health care and lives healthier, happier lives. The hospitals are released to treat people with acute care and not the routine health care of Medicaid clients who might only have a cold or the flu. And the state taxpayer is relieved of double-digit annual increases in Medicaid costs which only strips money away from the state public education and higher public ed budgets almost dollar-for-dollar in some cases.

We have had health care experts at the very top of their game and their profession tell us point-blank when we were serving in the US Congress:

'35-50% of all health care costs in America could be avoided if the following actions were taken:
  • People quit smoking.
  • Quit over-drinking. 
  • Stopped overeating and lost maybe 10-20 pounds on average. (Obese people would have to lose more).
  • Walked or exercised at least 30 minutes per day or climbed stairs at work.'
Well, ladies and gentlemen, saving 50% of all health care costs in America today would be close to an astounding $1.4 TRILLION per year! We currently spend close to 18% of our entire GDP on health care in America!  The federal government 'only' spends about 23% of GDP today and close to 3/8th's of that is in Medicare and Medicaid alone! (when state spending for Medicaid is added in)

We do know this based on facts, statistics and empirical evidence over the past 48 years since Medicaid was put into place in the LBJ 'Great Society' programs of the '60's:

As well-intentioned as it may have been and the good that Medicaid has done for millions of poverty-stricken people in the USA, it is currently unsustainable in its current form and operation.

Needless to say, Medicaid Managed Care has a lot of positives going for it. We think North Carolina should be the next state to try it. We might 'like it', as the old Life cereal commercials with 'Mikey' used to say:

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