Today, Gov. Bobby Jindal (R-LA) is expected to propose restructuring the state’s Medicaid program by steering “hundreds of thousands of low-income Louisiana residents into private managed-care plans.”
The Jindal ‘concept paper’ establishes “managed care” networks of physicians, hospitals and other medical care providers to improve patient health, eliminate duplications or unnecessary services and generally reduce cost by better managing and coordinating an individual’s care.
Under the proposal, the government would “pay a per-patient fee that would vary by the health status of its patients” and “doctors and hospitals would receive incentive payments if they meet certain performance criteria.”
While Jindal’s efforts to coordinate care and reform the poor fee-for-service payment model are laudable, the governor has yet to detail his proposal.
It could go one of two ways: the governor could either be introducing a truly effective ‘medical home model‘ — as is required by a 2007 state law — or a more industry-friendly approach that allows insurers to make short-term profits without focusing on long term investments (or value of care).
Some have indicated that Jindal has chosen the latter. Louisiana Hospital Association president John Matessino, for instance, has described Jindal’s plan as “a very top-heavy, managed care’ assignment of patients” that would actually take money out of the Medicaid system to fund more insurance bureaucracy. The primary care physician would act as a gatekeeper, limiting care and keeping costs low, without coordinating patients’ care to ensure that each individual patient receives efficient, timely, and effective treatment. These plans have difficulty changing the behavior of physicians because they pay for episodic care and not value of care.
In a medical home model, conversely, health service providers help coordinate care and manage success primarily through improved health outcomes and patient satisfaction. Medical homes reconfigure the delivery of primary care to involve interdisciplinary teams of doctors, advanced information technology, care coordination, patient outreach, and other techniques designed to improve quality of and access to services.” This approach can actually reduce costs and improve health outcomes.