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BLOG: The importance of Medicaid
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In revising the American health care system, it is critical to look at current delivery systems and determine what has worked and what has failed.
In looking at our track record, we have several models to review. These include the programs of Medicare and Medicaid as well as the Veteran’s Administration health care system.
The Medicare system might be the first to consider. According to CMS, there are roughly 55 million members in the system. Although this is a large sampling, the inherent nature of a program for seniors is going to have a disproportionate number of medical problems, hospitalization and poorer outcomes.
The Veteran’s Administration has almost 9 million enrollees and serves a wider age range. However, it’s a uniquely integrated system of 150 hospitals, 820 community-based outpatient centers and 300 special service centers that take this program away from the mainstream of health care delivery.
The June 2017 report from CMS shows just a little more than 68.5 million enrollees in the Medicaid program, making it the largest. The program serves a broad age range and overlaps Medicare with about 10 million members that are dual eligible. The program is also unique in that it is a federal-state partnership that has allowed for the programs to evolve differently in each state.
Medicaid is also a unique program in that it serves a diverse population and has more opportunity to look at the social determinants of health. Population health research has found that access to health care services is not the strongest correlation for best health outcomes. Health behaviors such as smoking, diet and exercise are the most important factors in longevity. Social, economic and environmental factors can also be a barrier to healthy lifestyles (Heiman et al.).
Medicaid has more experience in developing social services that integrate with medical services, and several state programs have the data to demonstrate the importance of this link for diverse populations (Witgert).
Optometry has played a key role in many states where contracts are written to “scope of licensure” rather than the traditional “vision benefits.” This has led to better integrated care where pathology found in the routine eye examination is diagnosed and treated without complex barriers to care.
In my work as the chief medical officer at March Vision Care, a company that works exclusively with government-sponsored health plans, we initiated the first collection of vital signs as an integral part of the eye examination. This program has moved optometry out of the eye care silo and into the primary health care team.
Medicaid programs are always in transition. Each state is looking for unique and better ways to manage this diverse population and improve outcomes. Look for these programs to lead the way in the shift away from volume-based care to value-based care, where the focus and reward is on health outcomes. Be a part of these programs to pave your way to America’s evolving health care system.
References:
Heiman HJ, et al. Beyond health care: The role of social determinants in promoting health and health equity. The Henry J. Kaiser Family Foundation. November 4, 2015.
Witgert K. Why Medicaid is the platform best suited for addressing both health care and social needs. Health Affairs Blog. September 7, 2017.