Senate Aging Committee Focuses on Medicaid Managed Care
September 15, 2006 - On September 13, the Senate Special
Committee on Aging held a roundtable discussion focusing on
opportunities for expanding Medicaid managed care to serve high-need,
high-cost populations including dual eligibles, the disabled,
and persons with multiple chronic conditions.
Sen. Gordon Smith (R-OR), chairman of the committee, indicated
that this was the first in a series of roundtable discussions
that will focus on developing solutions for strengthening the
Medicaid program. While Smith is not planning to pursue legislation
this year, he urged the panelists and other interested parties
to work with his staff in the coming months to develop a legislative
proposal that will encourage states to expand managed care for
vulnerable populations, while also ensuring that necessary safeguards
are in place.
Daniel Hilferty, President and CEO of the AmeriHealth Mercy and
Keystone Mercy Health Plans, was one of the panelists in the
September 13 forum. Hilferty's
testimony emphasized that the AmeriHealth Mercy Family of Companies has been serving
the Medicaid population for 23 years and has improved quality
of care, access to care, and efficiency through innovative approaches
to care management, collaborative provider arrangements, community
outreach, and enhanced technology.
Hilferty discussed his company's PerforMEDSM initiative, which
uses predictive modeling to determine which Medicaid beneficiaries
will be high utilizers of health care services and intervenes
pro-actively to reduce preventable acute care episodes for these
individuals. Another AmeriHealth Mercy Family of Companies initiative, Healthy HoopsSM,
helps asthmatic children and their families manage their condition
through appropriate medication usage, proper nutrition, monitored
exercise, and recreational activities. In 2004, this initiative
reduce emergency room admissions by 63 percent and sleep disturbances
by 70 percent.
While reviewing the positive impact of these and other Medicaid
managed care initiatives, Hilferty pointed to a study by The
Lewin Group, which concluded that Pennsylvania has received
$2.7 billion in cost savings over five years through the innovative
practices of Medicaid managed care plans. He noted that another
Lewin study projects that expanding managed care capitation
to Medicaid on a nationwide basis would yield savings of $83
billion over ten years.
Other participants in the roundtable discussion included representatives
of the Arizona Health Care Cost Containment System, Families
USA, the Health Policy Institute of Georgetown University, the
National Association of Community Health Centers, and CareOregon.
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