COMMENTARY

Better care for less money from Ohio's Medicare, Medicaid

3/18/2012

Ohio is making needed reforms to Medicaid, the state and federal health-care program for low-income residents. These changes will improve the quality of care for the 2.2 million Ohioans served by Medicaid, and save taxpayers $1.5 billion over the next two years.

Better care for less money might seem to defy experience. But if Medicaid improves how it delivers care, especially for the 4 percent of beneficiaries who account for more than half of the program's spending, the result is often better health and reduced rates of avoidable and costly services, such as hospital readmissions and emergency-room visits.

One of the most important tools for transformation that the state budget gives us is the authority to develop and execute a new way of coordinating care for Ohioans who are enrolled in both Medicaid and Medicare, the federal program that provides health-care coverage to people who are 65 or older or disabled. Many of the people enrolled in both programs have complex and chronic conditions.

The two programs are designed and operated with virtually no connection to each other. As a result, the long-term care services and supports and behavioral and physical health services that dual enrollees receive are poorly coordinated.

The result is a diminished quality of care that leads to poor health outcomes for enrollees and high Medicaid costs for taxpayers. Dual enrollees make up fewer than 10 percent of all Ohioans on Medicaid, yet they consume 46 percent of Medicaid spending on long-term care.

To address this issue, the federal government is inviting states to propose three-year demonstration projects to integrate care between Medicare and Medicaid. Ohio's solution is an Integrated Care Delivery System, which will provide dual enrollees with one point of contact for their Medicare and Medicaid-funded health-care needs.

The system will be seamless and easy to use. It will improve care by coordinating the activities of multiple health professionals who serve the same person.

We are building the ICDS program in consultation with dual enrollees, family caregivers, and other stakeholders. AARP Ohio, the National Alliance on Mental Illness of Ohio, the Ohio Olmstead Task Force, and other advocacy groups hosted a series of regional meetings -- including one in Toledo in January -- to provide feedback on the proposed model. We heard from many enrollees who want to make sure their benefits are protected.

Last month, Ohio Medicaid released a demonstration proposal that states clearly that ICDS is about better coordination of services, not cutting services or denying care. We propose increasing the availability of home and community-based services and supports to keep people safe and healthy in their own homes for as long as possible, to avert unnecessary medical interventions, and improve their quality of life.

This care-coordination approach to services offered through the ICDS program will look familiar to many Ohioans who are enrolled in a Medicare Advantage plan. More than a third of Ohio Medicare enrollees belong to such plans -- one of the highest rates in the nation. The Toledo area stands out as a leader in this regard.

The ICDS proposal divides Ohio into seven regions. The northwest region consists of Lucas, Wood, Ottawa, and Fulton counties. Because at least three Medicare Advantage plans operate in these counties, the area is well prepared to hit the ground running when Ohio begins enrolling individuals in the ICDS program next January.

The care-management approach will give dual enrollees a choice of coordinators for their benefits, without changing how those benefits are administered. Through contracts Ohio Medicaid signs with care-management providers, we will be better able to base payments on whether providers meet targeted performance goals that are tied to improving care for dual enrollees.

We will submit a final ICDS program design to the federal government this month. Meanwhile, we will continue to work with all stakeholders to develop the best plan to improve care for the people we serve, and to make wise use of taxpayer dollars.

John McCarthy is Ohio's Medicaid director.