Healthier Ohioans, lower costs

OHIO'S Medicaid program covers about 173,000 people who need long-term care. These Ohioans account for 7 percent of Medicaid enrollment, but 41 percent of its annual spending.

Gov. John Kasich's administration seeks to reform this system by replacing the current approach to long-term care management, which focuses on providers, with an approach that is centered on the people who get that care.

Recipients of long-term care include senior citizens as well as adults and children with disabilities, many of whom need physical and behavioral health care. These people now must navigate three separate service-delivery systems within Medicaid, with little guidance or coordination.

Many people who receive long-term care are enrolled in both Medicaid and Medicare. These programs are designed and managed with little coordination. At times, they duplicate services and create a confusing bureaucracy that is hard for patients and providers to navigate.

For example, Medicare pays for the first 100 days in a nursing facility, but Medicaid can pay for those 100 days and beyond. Medicare will pay for nursing services and some home health aide services, but so will Medicaid.

Such redundancy leads to confusion among doctors and home health agencies about which service should be ordered and which program should be billed.

When care is person-centered, people have access to the services they need in the setting they choose. They move seamlessly among settings and programs as their needs change.

Person-centered care gives people a single point of contact to coordinate all needed services. The reformed system the Kasich administration seeks will also include incentives for better health outcomes, better care, and greater cost savings.

Another Medicaid population that needs better coordination of care consists of people with chronic health problems such as diabetes, obesity, and high blood pressure. The disjointed, provider-centered health system does not serve these patients well and offers low value to the state and taxpayers.

Our administration proposes a home health initiative that will assure coordination of services through a single point of contact. The model is for people who may not be eligible for Medicaid and Medicare, but have multiple chronic conditions.

The initiative will take advantage of a new federal provision that allows states to claim a 90 percent federal funding match for comprehensive case-management services.

Finally, the administration is working to improve coordination of care for the 37,500 children in Ohio's Medicaid program who are disabled.

These children now are served through Medicaid's fee-for-service program. They often have complicated and long-term medical challenges, but get little help in gaining access to and coordinating the care they need.

At times, the result is both an undesirable health outcome and a major avoidable cost to taxpayers. In response, the governor's budget proposal creates pediatric accountable care organizations.

Several children's hospitals in our state are developing such organizations, which can meet the complex physical and behavioral health-care needs of disabled children. These programs are likely to take a year or two to carry out.

Meanwhile, Governor Kasich's budget calls for existing managed-care plans to bridge that gap by developing pediatric accountable care organizations that can quickly assume responsibility for care coordination.

All three of these initiatives will provide quality-driven, cost-effective, culturally appropriate, person-centered services. They will link to other community and social supports.

They will integrate clinical and non-clinical health-care services. They will use electronic health records to coordinate care from multiple providers.

Coordination of care will help bring Ohio's Medicaid spending under control.

More important, it will promote better health outcomes for deserving citizens who must deal with significant — but not insurmountable — health-care challenges.

John McCarthy is Ohio Medicaid director.