With attention focused on attempts by Congress and the Trump administration to repeal and replace the Affordable Care Act, another major effort to reform health care gets overlooked.
New York is midway through a monumental initiative begun in 2011 to redesign the costly Medicaid program, the largest purchaser of health services in the state for its 6.2 million beneficiaries.
Jason Helgerson, director of the state's Medicaid program, stopped in Buffalo on Wednesday to talk about the effort. He also repeated his warnings that the GOP health care bill that has advanced to the Senate, the American Health Care Act, could have a dire impact on patients, hospitals and taxpayers.
"The Republican plan is a massive step backward in social justice and the core objective of expanding coverage in this country's history," Helgerson said. "I get the main point of reducing spending on health care. But there are far better ways to address that."
New York received a waiver in 2015 from the federal government that allows the state to keep $8 billion of $17.1 billion in savings the state expects to see over five years from Medicaid reform. The state plans to reinvest the money in projects that seek to reduce avoidable hospital use by 25 percent and that transition most hospital and doctor Medicaid payments from fee-for-service to a value system tied to performance goals.
Twenty-five groups, including Millennium Collaborative Care and Community Partners of Western New York, have formed across the state to establish projects to cut avoidable hospital stays and emergency room visits. The groups have members such as public hospitals, health centers, nursing homes and safety-net providers.
Helgerson said the groups have made progress, but now face the much more difficult task of actually achieving their goals, including reducing costs, improving health care outcomes and moving to value-based payments. Some of the groups at the end of the initiative in 2020 will have qualified for as much funding as possible for their projects and will be done with their work, he said. Others, he added, will use money from the Medicaid redesign initiative to achieve a broader goal of working toward reform of the larger health system in their communities.
"You have to view the funding as a potential once-in-a-lifetime opportunity to create more cost-effective care," said Helgerson, who also oversees the Medicaid redesign.
Helgerson spoke Wednesday at a conference organized by Millennium Collaborative Care.
He offered some optimistic notes. Among them, he noted that the cost per Medicaid enrollee in the state has declined, and the gap between the cost in New York and the national average has dwindled. Overall, New York spends more than $60 billion a year on its Medicaid program, second only to California.
Medicaid is a public insurance program that provides health coverage to low-income children and adults, and the blind and disabled, as well as long-term care to the elderly. In New York, the federal government pays about 51 percent of the cost, with the state and county governments picking up the rest. Most of the money in the program is spent on the elderly and disabled.
Helgerson said it's uncertain what Congress will do about health care, but a clear message is that federal money for government health programs is likely to decline. What will New York do?
"We're not developing contingency plans," he said. Instead, Helgerson said the best response is to move forward with reforms within the state with even greater urgency.
"The best thing we can do is move to value-based payments and become more cost-effective," he said. "We need to coalesce around a vision about how to improve the health system so that we have the ability to absorb the loss."
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