Marc 30, 2011 ch 1

Me edicaid plan a bi step forward for prim p ig f mary car re

By R Ronda Kotelchuck Gov Andrew M. Cuomos Medicaid Redesign Team came up with a plan that co v. M s R T e ould not only save us billio of dollars now and in the future, but prov ons d vide better care to We estern New Yorks mos st vuln nerable residents and build the foundation fo a more in b or ntegrated, s sustainable health care delivery e syst tem. The heart of the problem is that we have a very fragmente uncoord h y ed, dinated, yet expensive health care system that serves none of us very well, but poor peo e n v ople with multiple health and soci ial prob blems least of all. Fully 75 percen of Medica funding $31 bi y nt aid or illion statew wide is sp pent on 20 perc cent of patie ents with multiple chro m onic illnesse HIV/AID mental health and substance abuse es, DS, prob blems an often all of the abov nd ve. Few than hal of these high-cost pa wer lf h atients have a dedicat primary care provid and ca for most e ted y der, are t patie ents is spor radic, react tive and unc coordinated Indeed, a Medicaid patient with diabetes and mental d. h illness may visi four differ it rent health providers, each presc e cribing medications, or rdering tests, yet neve commun er nicating with each othe If the pat h er. tient is hosp pitalizeda they of and ften are t there is no easy way for th doctor an hospital to share in y he nd nformation. This lack o coordinat of tion is costly both in y dolla and the toll it takes on patient In Weste New Yo nearly 2 percent o all hospit ars s ts. ern ork 20 of talizations cost ting $47.3 million could have bee avoided. New York State spen an estim m d en nds mated $1.4 billion per year on avoidable hospita r alizations, and has the highest rat in the co a tes ountry. The Medicaid Redesign Team plan calls for enr R T c rolling 1 milllion Medica patients in a medi aid s ical home, whe a physic ere cian is part of a care team that takes active responsib e bility for the patients health even when the patient isnt in the doc n ctors office Informatio is shared among providers thr e. on rough elec ctronic healt records, and patients have acc th cess to clin ical advice 24 hours a day. The p payoff coul be enorm ld mous. North Carolinas Medicaid program h s less than o one-quarter the size of New r f York reduc asthma hospitaliza ks ced a ations by 40 percent a saved t state alm 0 and the most $600 million over five years. r The medical ho ome is an im mportant fir step tow rst ward an inte egrated hea care sys alth stem with n new roles and responsibilities in the work force Right now workers w have the most co e. w, who ontact with p patients have the least responsibility for their health. Home care wo e orkers, for iinstance, ha more p ave patient cont tact than an nyone else, yet little interaction with the patie w cian or care coordinat the e tor, ents physic leas amount of training an the lowe wages. st nd est The Medicaid Redesign Team plan charts a cou R T c urse to mor rational h re health care decisions, new dels of care that emphasize preve ention and coordinatio and a mo accountable, afford c on ore dable mod heal care sys lth stem that will benefit patients acro the stat w p oss te. Ron Kotelchuck is exec nda cutive director of the Primary Car Developm P re ment Corp., a nonprof group fit that expands primary care in underse p e erved comm munities.