Mitchell: Guide for improving, not just cutting, Medicaid


At issue | Various articles, editorials and commentary on proposed Medicaid changes

The health care landscape is changing and in Kentucky those changes will impact significant portions of our population. There is little argument something must be done to save money and reduce waste in our state's Medicaid program. However, quality patient care must come first. The best way to manage health care costs is to ensure each patient is provided the correct course of care from the beginning.

Kentucky ranks 47th in per capita income, meaning Medicaid is a vital link to health services for more than 800,000 who participate.

The health status of Kentuckians is a cause of considerable concern. Kentucky has a high rate of cancer and cardiovascular disease and a high prevalence of obesity and smoking. Preserving a robust Medicaid program with adequate funding from the federal government is essential if we are to meet these health challenges.

As Kentucky looks to implement a statewide Medicaid managed care system, it is critical the provider—patient relationship be protected to ensure the best patient outcomes. Whichever vendors are chosen and however the new system is organized, the professional, clinical judgment of health care providers must always be honored.

Providers should have the freedom to care for their patients. We must trust providers have made educated decisions for the patient based on data available and not necessarily on cost-saving mandates that can lead to long-term serious unintended consequences for patients.

Medicaid managed care holds promise to improve both the quality of care and the efficiency of the program's administration. Toward that end, some basic principles should guide the implementation of Medicaid managed care:

■ Kentuckians should have access to high-quality, affordable, effective health care regardless of poverty status or disability. The state should require plans to implement consumer involvement, representation and protections; including adequate appeal rights for denial of services to ensure a health care program that is responsive and accountable to the public.

■ Plans should cover prevention and early intervention, emphasize a recovery orientation, and provide for health education and promotion of healthful lifestyles.

■ The state should engage in vigorous oversight and management to assure the highest quality of care; eliminate waste, fraud and abuse, and achieve administrative efficiency at all levels. Implementation of cost-containment and cost-sharing measures should be grounded in evidence-based practices and should not create a barrier for individuals to access necessary care.

■ Provider rates should be set appropriately to assure participation and access. Provider networks must be sufficient in number, distribution and variety of health care professionals to serve participants in a timely and convenient manner.

■ The health care program should be comprehensive in benefit structure and promote the integration of mental, dental and vision care with physical health care to meet all of the health needs of Kentuckians in the Medicaid program.

■ Administrative costs should be limited in a manner similar to the medical loss ratios required by the Affordable Care Act to ensure that funds for the provision of services will not be unnecessarily diverted to profits for managed care plans. The state should require transparent record keeping affording the public easy access to key information about the cost and quantity of services provided in each county, utilization trends, quality indicators, patient satisfaction and health care outcomes. And all contractors receiving state funds should be required to comply with the Kentucky Open Records Act.

Kentucky Medicaid and its new managed care partners should incorporate these principles to protect and serve our most vulnerable citizens, for whom the program is truly a lifeline. We need to work together to ensure that patient care is not sacrificed for potential cost savings. The best way to reduce costs is to get patients healthy and keep them that way.