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The idea of using a fee and incentive structure to motivate consumer behavior change, as Arizona is attempting to do with a proposed $50 fee on smokers and obese Medicaid clients, is certainly appealing, says Donna Friedsam, MPH, health policy programs director at the University of Wisconsin Population Health Institute in Madison.
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All of the accountable care principles that are integrated into the Affordable Care Act (ACA) require a clinical approach to the sickest, most complex and costliest patients, says Diane E. Meier, MD, FACP, director of the Center to Advance Palliative Care at the Mount Sinai School of Medicine in New York City, because they all begin to move the system away from the fee-for-service model.
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A formal scientific assessment of Pennsylvania's multipayer medical home program is under way, reports David K. Kelley, MD, MPA, chief medical officer for the Pennsylvania Department of Public Welfare Office of Medical Assistance Programs.
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Medicaid patients facing serious or life-threatening illnesses incurred $6,900 less in hospital costs if they received palliative care, compared with a similar group of patients who received usual care, according to a new study1. Palliative care recipients also spent less time in intensive care units (ICUs), and were more likely to receive hospice referrals.
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Without the cost savings generated by various programs, including a successful medical home initiative, Pennsylvania Medicaid "would have been in a much worse position than what we're in," says David K. Kelley, MD, MPA, chief medical officer for the Pennsylvania Department of Public Welfare Office of Medical Assistance Programs.
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While South Carolina's governor has given a directive to find ways to spend money more productively in Medicaid, says Tony Keck, the state's Medicaid director, she has also given the directive to present credible alternatives to allow the state to opt out of federal health care reform.
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Plans' lack of experience is one concern as states move their Aged/Blind/Disabled (ABD) and Supplemental Security Income (SSI) populations into Medicaid managed care, according to James Verdier, a senior fellow in the Washington, DC, office of Mathematica Policy Research, a nonpartisan research firm.
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When West Virginia experimented with penalty-based systems that withdrew some Medicaid benefits if beneficiaries didn't comply with certain behaviors, focus groups were done to gauge the public's reaction to this.
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The fundamentals of teach-back need to be taught to staff members who educate patients, says Eileen Brinker, RN, MSN, heart failure program coordinator at the University of California, San Francisco Medical Center. Brinker learned these fundamentals at the Institute for Healthcare Improvement in Cambridge, MA.
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At St. Luke's Hospital in Cedar Rapids, IA, the essential information that will help patients manage their heart failure and prevent hospital admissions is provided in the form of questions.
