Making Budget Pill Easier To Swallow

If you were to say last week’s California State Legislature trailer bills on health care were pulling a large load, you might be accused of putting the cart before the horse. The cart, in this case, is orchestrating cuts and ways to preserve health care programs before voting on the final state budget, which — to carry the analogy — would be the horse.

Having been approved by both houses and ready for Gov. Jerry Brown’s (D) signature, the Senate and Assembly budget proposals include enough money for the state In-Home Supportive Services program to remain in operation, helping to keep aged, blind and disabled persons living at home instead of being institutionalized.

Part of the fiscal maneuvering to keep the program alive is a little-talked-about provision — the Medication Dispensing Pilot Project slated to launch July 1.

Targeting Medi-Cal recipients identified as high-risk for medication non-adherence, the voluntary pilot will purchase, install and monitor automated medication dispensing machines in participants’ homes. Net annual savings for the first year are estimated at $153.1 million, said Karen Keeslar, executive director of the California Association of Public Authorities.

Some of the savings will be attributed to cost offset — prevention of disease exacerbation otherwise leading to a hospital admission, emergency room visit or entry into a nursing home.

“Instead of waiting for the doctor to prescribe the machine, our proposal calls for a more proactive approach to improving medication noncompliance,” said Debra Roth, special projects director and legal counsel for Service Employees International Union, which represents 240,000 home health care workers. She calls the dispensing device “a plastic pill box on steroids.” Not only does it dispense medications at the appropriate time and in the correct dose, but the device also alerts caregivers if patients are negligent.

An SEIU report shows that fewer than 15% of at-risk seniors adhere to their medication schedule. The hope is dispensing machines will change all that. Studies show patient compliance increasing to about 98% when the machine is in use.

(David Gorn is on vacation.)

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