State Health Care Reform
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As the country ages, the number of Medicaid beneficiaries will grow. Already Medicaid accounts for one-third of state expenditures — the single-largest expense category. Ineffective management tools and increasing concerns about the quality of care are hindering states’ attempts to control soaring costs.
State leaders need to give program managers the tools required to convert voluminous data flowing through Medicaid and its information systems into meaningful content, whereby they can assess current Medicaid outcomes, technology and administration to make informed decisions about which program each administers.
When it comes to overall state health care reforms, it is imperative that sustained health care reforms, instead of incremental changes, are carried out. There are four focus areas that can build a solid foundation for systemic reform to improve care and reduce cost:
- Health care information technology (HCIT). Promotes e-prescribing and technology-enabled care coordination, and makes administrative cost efficiencies possible.
- Comparative effectiveness. Strategies to steer incentives away from rewarding simply doing more things to doing the right things that are evidence-based and cost-effective.
- Coordination of care. New approach to delivering and paying for primary care health services. The goal is to reduce demand for more expensive acute services and to improve population-based health outcomes.
- Enlightened consumerism. Utilize previous three focal areas. This means combining Primary Care 2.0 with incentives and technologies that support consumer engagement could dramatically reduce costs while improving health outcomes.
The four areas should be viewed as an integrated whole. Excluding any component program will limit potential savings and dilute systemic impact. The health care reform pyramid reflects systemic reforms to the U.S. health care system. Given the uncertainty of the economy and the ever-increasing demands for health care services, stakeholders might consider this a model for creating a truly reformed system.
