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Published: Monday, 12/24/2012

EDITORIAL

Healthier Ohio

The Kasich administration’s plan to streamline health care for Ohioans who receive both Medicare and Medicaid benefits promises to contain the cost of care while enhancing competition.

This month, the federal Centers for Medicare and Medicaid Services approved a three-year demonstration project that aims to provide better-coordinated and more-effective services to some of Ohio’s neediest residents.

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The Integrated Care Delivery System will launch in seven urban regions, including the Toledo area. It will affect 114,000 Ohioans who are eligible for Medicare and Medicaid benefits, out of a statewide total of 180,000.

The federal Medicare program for elderly and disabled people and the federal-state Medicaid program for low-income recipients generally operate independently of each other. For dual-enrollees, that often results in poor health-care coordination, diminished quality of care, and poor health outcomes — all at higher costs to taxpayers. Dual-eligible individuals make up 10 percent of Ohio Medicaid enrollees, but consume 40 percent of the state agency’s budget.

Gov. John Kasich has made improving Medicaid a priority. Last week, Ohio received $17.9 million in federal bonus grants in recognition of the state’s success in enrolling and retaining eligible children in Medicaid.

The Integrated Care Delivery System is part of the governor’s commitment to improving quality of care for dual-eligible Ohioans, while controlling or reducing costs. Ohio is the third state to deliver such a proposal, and the second to use a managed-care approach.

The plan will create a single point of contact for dual enrollees for physical and mental health services and long-term care. It provides incentives for people to be cared for at home rather than in institutions whenever that’s practical.

Five health insurance plans will work with hospitals and medical specialists to emphasize consumer education and preventive and primary care, lessening the need for more-expensive care in emergency rooms or nursing homes. The payment structure will blend Medicare and Medicaid funding, to discourage the perverse financial incentives that sometimes cause the programs to operate at cross purposes.

The demonstration is a test, designed to exhibit the benefits of the Integrated Care Delivery System. It also will help identify what doesn’t work before the program is expanded across Ohio.

If the project delivers as promised, it will fulfill the federal Affordable Care Act priority that states innovate in delivering Medicare and Medicaid services in ways that could become national models. The project will have to be monitored carefully to ensure that it meets the needs of providers and patients, and that it keeps the promise that integrated-care recipients can keep their current doctors, health aides, services, and medical and long-term-care benefits.

Containing the cost of public and private medical care is an urgent goal. The Kasich administration’s plan to improve quality of care without limiting access is a healthy — and progressive — addendum to that objective.



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