House Energy and Commerce Subcommittee on Health Hearing
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My name is
In my testimony I would like to describe for you the decision process
State consideration of the
Lack of insurance is a significant problem for many Arkansans. One-quarter (25%) of 19-64 year olds are uninsured. This leads to problems in accessing and affording needed health care: 16.5% of Arkansans recently reported being unable to see a doctor due to cost.
DHS estimates that expanding
Medicaid Expansion in
The decision of whether to expand
Note: DHS' estimates do not include inflation in either the costs or the savings items. Since inflation would tend to increase virtually all cost estimates as well as macroeconomic (tax) effects, its inclusion in the estimates would tend to make all of the dollar amounts in the estimates larger, thereby inflating the nominal value of the projected savings in the out years. To better communicate the impact of expansion to policy makers in
Estimated (gross) costs of the
Enrollment: Arkansas DHS's estimates of the size of the
Costs per person: DHS's estimates of costs per new enrollee in
There are likely to be some relatively high cost newly-eligible expansion enrollees who have significant physical or behavioral health needs, but are not (yet) disabled. However, there are a limited number of these individuals - and they are only in the new eligible category until they obtain a federal disability status. They will be dramatically outnumbered by low-income workers who are expected to have lower costs (as described above). Costs for these individuals should be incorporated into the
DHS's estimates or participation and costs per person interact. The most likely new eligibles to enroll are those with the highest costs, i.e., those who most frequently seek services, incur costs, and come into contact with providers who are motivated to help the individual enroll in
Woodwork effect: Health needs and medical bills are assumed to increase the likelihood of enrollment. Those currently enrolled in
Administrative costs: Administrative costs: Costs also include administrative expenses associated with both groups of new enrollees (new eligibles and woodwork enrollees).
The state general revenue impact for administrative costs would be
Estimates of Savings and increases in State General Revenue due to Medicaid Expansion: There are also expected savings for the
Transition populations: A number of populations currently served through traditional
ARHealthNetworks is a healthcare benefits program designed for small businesses and self-employed individuals without medical coverage. The population currently on the program will be able to receive coverage in the future via
ARKidsB - enhanced FMAP -
AFDC Medically needy spend-down:
Pregnant women: In Arkansas,
Achieving fiscal sustainability in
State innovation in
Our goal is to fully develop this system within the next 3-5 years by adopting a model that integrates two complementary strategies for promoting clinical innovation on a multi-payer basis across the entire state: population-based care and episode-based care.
Population-based care delivery. Within 3-5 years, most Arkansans will have access to a medical home that offers a local point of access to care and proactively looks after his or her health on a "24-7" basis. Special needs populations with developmental disabilities (DD), those requiring long-term services and support (LTSS), and those with serious behavioral health (BH) needs will also have access to health homes.
- The medical home will support patients to connect with the full constellation of providers who together form their health services team, customized for their personal care needs and with a focus on prevention and management of chronic disease. For patients with chronic conditions, the medical home will assist with monitoring their progress and coordinating care among what will often be a multi- disciplinary provider team. The medical home will bear responsibility for coordinating care to address the complete health needs of a population.
- The health home will be accountable for the full experience of individuals with special needs--the frail elderly, those with developmental disabilities, those with severe and persistent mental illness, and other high needs behavioral health clients. Accountability will include health outcomes, streamlining care planning, and ensuring each person has a single integrated plan across all types of care. To accomplish this, health home providers will work closely with consumers, their families, and other direct service providers, offering support and coaching in a community setting. The health home complements the medical home: the medical home will continue to retain responsibility for diagnosis, treatment, and referral, while the health home will help to ensure proper follow-up, treatment adherence, and communication between providers, individuals receiving services, and their families.
Episode-based care delivery. Within 3-5 years, substantially all acute care and complex chronic conditions (50-70% of total health care spending) will be proactively managed by a principal accountable provider (PAP), who will embrace their role as the "quarterback" responsible for quality, access, and efficiency of all services delivered in response to a patient's immediate needs. PAPs will be evaluated on their performance over entire episodes of care, with an expectation of coordinated, team-based management of services. Better data will help PAPs to understand and improve their performance over time, thus enhancing quality and outcomes and increasing cost-effectiveness of care.
Reduced state spending on uncompensated care for the uninsured: If Medicaid expansion is approved, approximately 250,000 additional Arkansans will have a payer for their care; consequently, uncompensated care provided by state agencies outside of
Additional tax revenue:
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