75/25, Medicaid, and a Single Payer Model

The Virginian-Pilot ran a story on July 13 about a new managed care approach to Medicaid.  Included in the story was a statistic that stood out to me:

Approximately 25% of Medicaid enrollees use approximately 75% of all allocated Medicaid funds.

This 25% figure is mostly comprised of the elderly and the disabled requiring skilled nursing care, rehabilitation, and specialized medications.  

The Tidewater area is a test region for a new single stream approach to medical care for these most vulnerable populations. It is called Commonwealth Coordinated Care. (http://www.dmas.virginia.gov/Content_pgs/mltss-home.aspx)

From what I understand, this is not an HMO model where care is meted out by a board of doctors focused on profit.  It is simply looking to eliminate duplicate services and help disabled people access services like in home nursing care, adaptive retrofits to their apartments, and home delivery of medications that would allow them to live at home, seek employment, and manage their condition in way that makes it possible for them enjoy independence.  It seems like a comprehensive offshoot of the mid-2000s federal Disability Program Navigator initiative.

Forward thinking policies like this Commonwealth Coordinated Care program created under the leadership of the Virginia Governor and a bipartisan committee in the General Assembly are what is needed to lead us into a single payer system. Cooperation, compromise and creative thinking will go far in helping turn this ship portside in the coming years.

I know many of us want a single payer system right now. As in today. Campaign slogans are easy; public policy is not.  This program will test the waters on how a single payer type of system could work in partnership with existing insurance companies working as claim processors.

I, for one, am aware of the number of jobs, pension investments, and economic impacts that would be lost if insurance companies were to be shuttered right away.  We must find a way to incentivize insurance companies to move to a processor model rather than a managed care for profit model.  Insurance companies could become processors in a single payer system.

Rather than cut care to people who are in critical need of medical care, creative solutions like this single stream managed care approach are what is needed to control medical costs and transition the industry in a way that mitigates negative impacts on the economy.  I believe this new program is a step in the right direction and will lead us to a single payer system in the coming years.

~ by S. Martin
stethoscope around house graphic