A large part of curbing the growth in the country’s health-care spending involves improved organization, making advances in coordination and collaboration. Ohio took a big leap forward on this front last week. The federal government approved the state’s promising proposal to coordinate care for those people eligible for both Medicaid and Medicare.
Medicaid provides health coverage for families with lower incomes. It also covers nursing home care for the indigent elderly. Medicare is the health insurer for those age 65 and older, including visits to the doctor, hospital care and prescription drugs. The programs long have operated separately, each applying its own rules and processes. That becomes a headache for those eligible for both programs, roughly 180,000 Ohioans.
The dual tracks also result in costly inefficiencies and excess spending. What Ohio has won is permission to launch a pilot program involving a substantial portion of the “dual eligibles” (about 114,000). The effort aims to tear down barriers and develop a more integrated system, the managed care approach seeking to streamline the process, achieving improved care and real savings.
John McCarthy, the state Medicaid director, Greg Moody, the director of the Governor’s Office of Health Transformation, and Gov. John Kasich deserve high marks for pressing this cause. Ohio is just the third state to receive approval for such a project, following Washington and Massachusetts. The Kasich team worked with stakeholders, the plan becoming stronger as a result.
The dual eligibles no longer will encounter two separate health-care worlds. The state wants a single continuum of care, in effect, one set of rules, processes and procedures. The significance shouldn’t be missed. If the dual eligibles make up just 14 percent of Medicaid enrollment, they account for 40 percent of the overall $18 billion in Medicaid spending, the feds picking up 63 percent of the cost, the state the rest.
Estimates are the pilot will yield savings of $243 million over three years, seemingly small, until matched against ever-rising health costs.
One measure of the benefit is the requirement that the participating managed-care plans have one person as a point of contact for a patient, promoting continuity and coordination.
At times, the complexity of the health-care system can be overwhelming for patients and policy-makers. For all the governor’s boasting, his team has yet to make the necessary strides in trading nursing home care for the elderly staying in their residences, enhancing their quality of life and saving the state money. Still, that focus, along with the pilot for the dual eligibles, are just what the state needs to slow the rise in health-care spending and liberate resources to invest in key priorities.
The governor often has jabbed the federal Affordable Care Act, yet in these instances, he is acting in its worthy spirit to do better.