Gov. Chris Gregoire grabbed some headlines last week by restating her belief that taxes must be raised by her successor, but that news overshadowed her important health care announcement.
The state has been granted a federal waiver so it can tackle the vexing problem of “dual eligibles” – people who qualify for Medicaid and Medicare. Dual eligibles use Medicare for some health problems and Medicaid for others.
This fragmentation makes it difficult to coordinate the care of a population – estimated to be about 115,000 people – that runs up disproportionately high medical bills.
Just as 5 percent of patients are responsible for 50 percent of overall health care costs, dual-eligibles account for 32 percent of the state’s Medicaid costs even though they only make up 13 percent of the program’s patients.
That’s due, in part, to the fact that they are elderly, disabled and have more chronic conditions, but it’s also because they are covered by different provider networks with different payment sources.
Thanks to the federal waiver, the state will be able to move 30,000 of these patients into a program called Health Path Washington that will give them a “medical home.”
The state believes it can save $14 million over the next five years because it already has effective long-term care programs for the elderly.
Health Path Washington will provide patients with a guide who can help them with health care decisions, which is vital for a population that struggles with developmental disabilities, mental health problems and substance abuse. The state’s plan also includes more efficient payment methods that avert the fee-for-service model that is behind higher costs in other states.
The strategies of Health Path Washington align with some of the more positive precepts of the Affordable Care Act: coordinated care with a focus on outcomes and best practices.
The state is increasing the potential cost-savings by making sure this population is handled efficiently.
Too often the most expensive patients are those who are treated as accounting entries and shifted around to make budgets balance. Meantime, their maladies grow worse.
While only about one-fourth of dual eligibles will be enrolled, the program could expand if it gets the expected results.
We’d expect all states to try something similar if our innovations prove to be fruitful.
Our state continues to show its commitment to delivering health care more efficiently without hurting quality.
The federal government was wise to step aside and let us take the lead.