The just-failed U.S. Senate Affordable Care Act (ACA) repeal legislation would have repealed the entitlement to Medicaid, and millions would have lost coverage while doing nothing to get health care costs under control.
As a former Ohio Medicaid director, I’m more sensitive than most to the challenge of rising Medicaid costs. That’s why I hope we can turn our attention to cost-reduction strategies that could reduce short- and long-term spending without repealing the entitlement or kicking patients off the program. Here are 10 ideas on how we might do that.
1. Nearly half of working-age Ohio Medicaid beneficiaries smoke — many of them even while pregnant. Massachusetts Medicaid implemented an evidenced-based cessation plan that reduced beneficiary smoking by 26% in two years. For every $1 they spent, they saved $3.12.
2. Ohio’s Medicaid managed care plans have average or below average performance when compared to other similar plans nationally. Let’s increase the percentage of their premiums withheld by the state so they’re even more incentivized to perform at or above national standards.
3. Ohio Medicaid should expand access to long-acting reversible contraception. Other states have done this and have cut unintended pregnancy and abortion rates nearly in half, saving state taxpayers millions in Medicaid and other human service costs.
4. Carving behavioral health into managed care is an important first step, but unless we fully integrate behavioral and physical health at the provider level and invest in building their capacity, savings won’t ever materialize.
5. Forty percent of health outcomes are driven by non-medical factors. Medicaid should explore focusing on the social determinants of health by expanding coverage to include payment for social services clearly linked to the health of Medicaid enrollees.
6. Nearly all inmates released from Ohio’s jails are eligible for Medicaid, but not all of them get connected to coverage and care upon release. Access to health care following release or parole can reduce recidivism and reduce costs for local and state governments.
7. More clearly incentivize providers to deliver value instead of volume through the creation of provider-based accountable care organizations as an alternative to Medicaid managed care in some parts of the state. Ten states already have done this and have achieved considerable savings.
8. The fastest cost-driver in Medicaid today is pharmacy, and it will likely only get worse. We should consider developing a value-based drug payment system that is more closely tied to health outcomes or give states the ability to narrow their formularies.
9. Rework Ohio Medicaid’s Hospital Care Assurance program. Put less emphasis on reimbursing Medicaid reimbursement shortfalls, which incentivizes high-cost providers, and put more emphasis on hospital programs addressing social determinants of health.
10. Aggressively sign up eligible seniors for the Supplemental Nutrition Assistance Program (SNAP) and increase their monthly benefit. Research shows seniors on SNAP have lower hospital costs and are less likely to need nursing home care.