New details about Gov. Bobby Jindal’s (R-LA) proposed overhaul of Louisiana’s Medicaid system suggest that the ‘new leader’ of the conservative movement is moving away from McCain-like principles of one-size-fits-all health care coverage.
Under Jindal’s proposal, patients currently receiving Medicaid benefits will have three choices: 1) the current Medicaid fee-for-service benefits package, 2) state-designed benchmark benefits package 3) or, if they live in one of the four pilot areas, a coordinated care network of medical homes (CCN).
The third choice is crucial. Jindal is looking to design a network of medical homes — a model of care that allows a patient to receive all medical treatment in one location and encourages the primary care physician to take responsibility for providing for all the patient’s health care needs by arranging care with other qualified professionals — that could lower costs and increase care quality.
While regulatory details are still sketchy, Jindal recognizes what McCain never did: sick people require more care than healthy people and can find more affordable coverage within coordinated managed care networks that operate under a pay-for-performance model.
The CCNS would be required to ensure all beneficiaries have a medical home within the coordinated system and Jindal would prefer to reimburse the network at a risk-adjusted prepaid premium that will reflect the enrollee’s health status and anticipated utilization. The plan’s network of hospitals, physicians, and specialists could then spend that amount of money on treatment. This prioritizes efficiency, and promotes evidence-based practices and improved coordination between providers
For patients with serious health needs, Jindal is proposing up to three special needs statewide case management networks that would provide intense specialty services and case management services for families with special needs.
In addition to injecting coordinated care networks into the Medicaid system, Jindal is simultaneously expanding Medicaid (government) coverage. The plan calls for “a statewide expansion of coverage to low-income parents and caretakers relatives with incomes from 13 percent of the FPL [Federal Poverty Level] to 50 percent of FPL ($5,200 in 2008). Moreover, the state will run a pilot program — Access to Affordable Care — in Southwest Louisiana that will extend coverage for parents and caretaker relatives with incomes from 51 percent of the FPL up to and including 200 percent of the FPL ($20,800 in 2008) as well as childless adults with incomes up to $20,800.
In some ways, the medical home and payment reforms that Jindal proposes fly in the face of conservative free-market dogma. Patients with more health needs aren’t left at the mercy of the market. More Louisianians qualify for insurance through government health care. But most importantly, Jindal is recognizing that with prudent payment reform, the government can play an important role in encouraging providers to deliver health care services.