Medicaid Modernization

The promise of change has yet to flow into the Kentucky Medicaid Program. The Kentucky Department for Medicaid Services, for all intents and purposes, functions as claims payment engine for Kentucky’s growing Medicaid population. In the same manner as our nation’s Medicare system, the Department provides little value in improving the health of Kentucky’s most vulnerable.

In other states, such as North Carolina, focus is shifting from claims payment systems to innovative models such as a Community Care Model (http://www.kff.org/medicaid/upload/7899_ES.pdf). Within these models, members are assigned primary care physicians under a “Medical Home.” Then RN case managers work with the recipient’s Medical Home Primary Care physician to identify and mange high medical cost recipients.

The goals of such programs are not to restrict access to healthcare. Instead, the goal is to promote the effective coordination of care, reduce waste in the healthcare system, reduce the impact of chronic diseases, and to improve the overall health of the recipient.

Receiving the right care, the right way, the first time is the model Kentucky needs to adopt. Each year we receive news the Medicaid budget is running hundreds of millions in the red. There is a simple reason: escalating trends cannot be broken unless you address the root causes. One such cause is Kentucky is not doing enough to improve the health of our Medicaid recipients through simple models such as care coordination ad disease management. We can and should do more.