Medicaid, a program for low-income Americans, is one of the largest health programs in the country and is jointly administered by the Federal Government and the States. With passage of the Affordable Care Act, Medicaid in many states will be adding millions of new beneficiaries to a program that is typically the first or second largest line item in the State’s budget.
It’s well-known that Medicaid has always struggled with poor payment and provider networks, managed care plans that sometimes work, and ever-increasing expenditures. A recent study released by Gallup points to another problem known for years by those involved with Medicaid but which the current Medicaid system has little or no ability to address; the ever-increasing rate of preventable chronic diseases.
The Gallup Wellbeing Survey documents the issue clearly if you look at the data for Diabetes, Obesity, High Blood Pressure or High Cholesterol. The reported rates of these conditions are higher than just about any other group surveyed and the rate of Obesity is the highest of any group. Medicaid beneficiaries also report very high rates of smoking, exercise less often and are less likely to eat fruits and vegetables. As the article points out, there is a link between poor health and poverty. We have heard of the issues of “food deserts” and getting exercise or feeling safe doing outdoor activities is not always possible in certain neighborhoods. Furthermore, access to physicians and other health services are a problem that has been well documented in many Medicaid programs.
To begin to solve this issue we must make a concerted effort to integrate Prevention into the Medicaid programs and expand our thinking about what it takes to “create health” versus what we do to “treat illness.” Medicaid today is structured to treat illness; you get sick, you go the doctor, you get treated, the doctor gets paid, and as is often the case in Medicaid, this does not occur well at any point in the process for a myriad of reasons. But more importantly why should we be accepting of a higher rate of preventable chronic diseases, the costs of which will continue to grow and impact state budgets, while we narrowly focus on improving Medicaid’s “care system?”
The time is now, before we add millions of new beneficiaries, to revamp Medicaid to create a comprehensive program targeting the lifestyle issues that create these higher rates of preventable chronic diseases while continuing efforts to improve the sick care system. The way to do this is not to start by adding more funding to Medicaid but to lead by having Medicaid convene a community in which it operates, invite the beneficiaries, not for profit organizations, schools, religious institutions, providers, government agencies and employers and develop a broad-based plan to address the issues impacting these lifestyle related diseases.
There are a myriad of disparate resources available throughout these communities that if harnessed, focused and integrated could create the synergies needed to improve upon the communities health and reverse these trends. These groups need to be brought together, held accountable for their results and incentivized by offering a percentage of the savings. This type of Accountable Health system would create a healthier community.
To learn more or set up this process in your state or local community, contact me.