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Health Policy and Winnie-the-Pooh

BALTIMORE — How health care is like A Bear of Very Little Brain:

Here is Edward Bear, coming downstairs now, bump, bump, bump on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.”

            — A.A. Milne, Winnie-the-Pooh    

“That is what we are here to do — think of another way of doing things,” said Richard Gottfried, chair of the New York State Assembly Committee on Health and moderator of a well-attended panel on payment reform Tuesday at the National Academy for State Health Policy’s annual conference.

Gottfried’s session, “Pay it Forward: Innovative State Payment Reforms,” attracted an overflow crowd of about 200 policy leaders in a room designed for 150. They heard representatives from three states explain new approaches to paying for health care. Arkansas Surgeon General Joseph Thompson explained his state’s initiative to use episode-based payments for certain conditions. Sarah Iselin, president of the Blue Cross and Blue Shield of Massachusetts Foundation, talked about her state’s new legislation aimed at slowing the rise of health care costs. And Jeanene Smith, administrator of the Office for Oregon Health Policy and Research, talked about her state’s global budgeting approach for coordinated care organizations (CCOs).

“We’re doing this rather rapidly,” Smith said. “We’ve had 75 public meetings and we’ve had every possible stakeholder at the table. We’ll have a CCO in every county as of November, impacting 90% of the Medicaid population.”

“Why are we rushing?” Smith asked. “We can’t afford not to. Things are moving quickly, and we have to be prepared.”

Oregon’s plan is to have a single budget for each Medicaid beneficiary.

“Instead of handing out separate money for mental and dental and other kinds of care, we’re setting up one budget that will include all those funding streams,” Smith said.

Oregon officials predict quality of care will increase and the state will save about $1 billion over the first three years and more than $3.1 billion over five years.

In another one of the more than a dozen sessions Tuesday, representatives from California, Tennessee and Minnesota gave overviews of the evolution of managed Medicaid in their states.

Leonard Finocchio, associate director of California’s Department of Health Care Services, offered the main lesson learned in California’s establishment of three kinds of managed care plans for beneficiaries of Medi-Cal, California’s Medicaid program:

“You can never do enough outreach,” Finocchio said. “We’ll be responsible for 10, 11 maybe 12 million Californians after 2014. We have to get the word out.”

California’s managed Medi-Cal programs fall into three categories — geographic plans, two-plan models in which a private and public plan co-exist and county-run plans.

“The scale of everything in California is much greater,” Finoccho said, explaining the diverse offerings after a Tennessee health official had explained her state’s program.

NASHP’s three-day conference ends today.

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