Gazette opinion: Getting more value from Medicaid money

2013-02-07T00:10:00Z Gazette opinion: Getting more value from Medicaid money The Billings Gazette
February 07, 2013 12:10 am

The state’s biggest health care program isn’t a savvy shopper. Montana Medicaid generally pays a preset rate for services, regardless of the quality of that service. There’s little monetary incentive for health care providers to deliver better care.

A bill requested by the Interim Select Committee on Efficiency in Government aims to chart a better course. House Bill 100, sponsored by Ron Ehli, R-Hamilton, proposes a pilot project that would link provider payments to treatment outcomes.

This pilot project would involve services to Montana children with serious mental illnesses. These youngsters have high needs and can generate high costs for Montana Medicaid.

HB100 summarizes its rationale: “New approaches to funding social services may result in lower costs and better outcomes over the course of time.

“Research in other states indicates that linking provider payments to desired outcomes and quality improvements results in improved access to care, better care integration and coordination, family-focused planning, earlier and less restrictive intervention and a reduced number of treatment days.”

The bill would require the Department of Public Health and Human Services to set up a pilot project, monitor it and collect data to determine its effectiveness and whether the use of performance-based payment should be expanded.

A task force of 17 people, 13 of whom would not be DPHHS employees, would be appointed by the governor and the Legislature to work with the department to establish this pay for performance pilot.

At a hearing last month, proponents of the bill included representatives of Yellowstone Boys and Girls Ranch, Intermountain Children’s Home, Billings Clinic, National Alliance on Mental Illness-Montana and Montana Children’s Initiative. There were no opponents.

The House Human Services Committee unanimously approved HB100 and sent it to the floor where it won 94 votes out of 100 before being referred to the Appropriations Committee.

The fiscal note estimates this project will add $10,634 a year in state general fund costs for the expenses of task force meetings and travel. Considering that the health care expenses of just one child with serious emotional disturbance can be tens of thousands of dollars per year, the cost is small.

We urge the House Appropriations Committee to approve this smart idea and send it on its way to the Senate for approval.

The Montana health care providers who support HB100 as well as the interim committee members recognize that business as usual won’t sustain Medicaid as state and federal governments try to control their costs. It’s smart to get more value for the money. Let’s make sure the care taxpayers are buying does the most good for these children.

Copyright 2014 The Billings Gazette. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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