Wednesday, March 31, 2010

Medicaid and Healthcare in Florida

Currently, we focus on healthcare insurance reform expanding access to million of uninsured Amercian's but we fall short in reforming healthcare delivery. We MUST focus on cost containment, quality and outcome improvement too.
Unfortunately, many of my colleagues in organized medicine focus on the "panacea" called Tort Reform to reduce to costs resulting from "defensive medicine." I seriously doubt that this approach will provide the cost reduction needed to save our healthcare system. Meanwhile, Florida Senate members call for

" a federal Medicaid waiver to permit the state, through legislative enactment, to limit annual spending on the Medicaid program to the amount appropriated in the state budget. The waiver request shall include authorization for the legislature to make changes to optional eligibility groups and services in order to prevent spending more in any fiscal year than is appropriated. In addition the waiver shall request authority to revise the benefit structure and delivery system to allow Medicaid recipients to be integrated into the private insurance market through the use of state vouchers. The wavier shall include a provision to require Medicaid recipients with higher incomes to participate in program costs through coinsurance and deductibles and to be provided incentives for cost effective utilization of the health care system."

This serves as an example for "soft" rationing by capping Medicaid and "allowing" Medicaid recipients to seek coverage on the private "market" utilizing vouchers. . This will jeopardize Medicaid and force patients to hunt for benefits among private HMOs, which can control and limit services as they want.
Instead, the medical home model is a viable alternative moving the savings back to the physicians in the Medical Home.
A good friend of mine got it right, " Someday, when nothing is left but employed physicians attached to corporate HMOs then maybe docs will get the message that the Medical Home was a good idea."
Unfortunately, many don't get it because they are (mis)lead by ideologues who set politics before policy.