Former US Health and Human Services Secretary Tommy Thompson has released a comprehensive plan to revamp the nation's health insurance program for the poor, urging that the federal government takes increased responsibility for planning, delivering and paying for services to the elderly, especially long-term care services, while the US states take on greater responsibility for caring for those aged under 65.
By realigning responsibility to the federal government, the states can focus on providing care to the other segments of the Medicaid population, including pregnant women, children and the disabled. Further, the realignment enables the federal government to provide services to the population they know best.
Mr Thompson, who over the past several months has convened summits nationwide with Medicaid experts, health advocates and government leaders, proposes these major changes in Medicaid Makeover: Four Challenges and Potential Solutions on the Road to Reform. He discussed his plan in an address to the National Governors Association's annual meeting in Charleston this month.
Medicaid now a 'failing program'
'Medicaid right now is a failing program,' said Mr Thompson, adding: 'it is costing too much. It does not adequately meet the health care needs of the diverse population it is meant to serve. And what's more, lines of responsibility are so crossed between the federal government and the state government that no one really knows who is in charge.'
The report lays out the four key challenges facing Medicaid and what must be done to overhaul the program, noting that:
- Medicaid does not adequately meet the health care needs of the diverse populations served by the program. We must realign responsibility for Medicaid so that the federal government assumes a larger role in planning, delivering and paying for services for the elderly while allowing the states to take on greater responsibility for caring for those under 65;
- it does not efficiently encourage individuals to play an active role in their health care. Barriers must be identified and overcome so that individuals can take control of their own health;
- its payment structures and technologies are outdated. States must be encouraged to recognize and reward high-quality care and improved outcomes and to deploy health information technologies; and
- it must do more to address the problem of the uninsured. States must be encouraged to expand Medicaid coverage to lessen the strain on the health care safety net.
Instead of fine-tuning the current one-size-fits-all Medicaid program, Mr Thompson's plan advocates developing a Medicaid system that is more effective and efficient in meeting the needs of the vastly different populations it serves.
The report contends that the most critical step towards addressing this challenge is to change the focus of health care in America from treatment to prevention, with a greater emphasis on encouraging individuals to play an active role in their own conditions.
'We need to manage health more than just manage care,' said Mr Thompson, the former four-term Governor of the state of Wisconsin noted for welfare reform.
Focus on prevention and wellness
The report supports encouraging states to develop innovative Medicaid programs designed to empower individuals to play a more active role in their health. Several states have already created such programs aimed at achieving cost savings by encouraging preventive care. For example, in West Virginia, some individuals will only be eligible for enhanced benefits packages if they sign an agreement to comply with health improvement programs as directed by his or her health care provider.
Notably, increased health literacy can also play an important role in improving people's health. Furthermore, the Medicaid infrastructure must be improved so that each individual has a health care home and receives care in a less fragmented manner. Mr Thompson believes that encouraging competition among states could further improve the health of residents and the quality of care. For example, states could strive to reach health goals, such as vaccinating the most children or reducing the number of smokers.
Expand coverage and improve quality
To help rein in health care costs, states should shift Medicaid recipients that qualify for private insurance into commercial health insurance plans. Also, states should offer Medicaid families more options to meet their health care needs, such as providing subsidies to cover the cost of obtaining commercial insurance through employer-based programs. Additionally, the report notes that Medicaid payment structures and technologies are outdated. Introducing new technologies, such as electronic medical records in health provider settings, can lead to greater efficiency and an improved quality of care, it says.
