Apr. 24: Medicaid Reform

In this Sunday Edition, KSL's Richard Piatt explores Medicaid reform in Utah with Sen. Daniel Liljenquist, R-West Bountiful, and Shanie Scott, Medicaid policy director with the Utah Health Policy Project.

The Utah State Legislature recently unanimously passed SB180, a bill to reform Medicaid. Liljenquist sponsored the legislation. His plan has widespread support within Utah and nationally. Advocates say it will improve care and control costs.

Segment 1:

Before discussing Medicaid reform, Piatt asks Liljenquist about a possible run against Sen. Orrin Hatch in 2012.

"I appreciate the nearly four decades of service that Orrin's given the state of Utah. He's been a marvelous ambassador. I am considering a run but I am focused on Medicaid reform right now -- we've got a lot of work to do," says Liljenquist.

Medicaid is a federal health care program for low-income individuals.

"Medicaid is a program that is administered by the state in partnership with the federal government to care for the low income and indigent populations in our state. It's primarily been focused on our disabled, our mentally ill communities, but over the years has expanded to other constituencies," Liljenquist explains.

The majority of Medicaid recipients are children, Scott says. The next largest groups are disabled and elderly, and pregnant women.

SB 180 activates the federal waiver application process to allow Utah to make changes to the way health care providers are paid when caring for Medicaid recipients.

"We are optimistic that we will get a waiver because no one has been able to solve the challenges of the rising costs in healthcare. It's affecting our economy in multiple areas. With respect to Medicaid we're just out of money and we want to provide the appropriate care for people in a safety net system, but do so with the lowest cost. As a policy statement, SB180 sets that firmly in state policy," Liljenquist explains. "It will take us some time to redesign our Medicaid delivery system but we are affirmatively saying this is how much money we have for Medicaid and we're headed in this direction and trying to bring some clarity to this market that has struggled."

Liljenquist explains the change SB180 brings to Medicaid in Utah.

"Our current system is like a taxi cab system where a person gets on to Medicaid and they can waive down a cab and go where ever that cab driver or they direct the cab driver to go for their health care. Unfortunately they often end up in the emergency room where up to 60 percent of our emergency room visits on Medicaid are for non-emergent issues, they are for colds or other things because it's convenient and the way the system is structured incents that type of behavior," Liljenquist says. "Going forward, our new Medicaid program will be when you get into the Medicaid program you will be assigned a primary care physician and they will help coordinate and manage your care. We want, if you need to go to the emergency room, to go to the emergency room for appropriate visits. But the preventative care should be done at the primary care setting instead of in our most expensive environments."

Liljenquist says Medicaid is the "Pac-Man" of our budget and puts other items such as education in danger. Everyone agrees that something must be done to curb Medicaid spending.

"We definitely recognize that this is not a sustainable system in its current form. Not only is it not sustainable financially, but it's not developed in the best interest of our clients because it's created a very fragmented type of care. The new system, if it can be done correctly and with all the stakeholders at the table, should make a more cohesive standard of care for clients as well as have good cost containment strategies," says Scott. "We've been very encouraged with the transparency of this process moving forward."

"This is a reality issue, more than a partisan issue and we hope to focus on that as a reality issue as we get into the details and build a system that works for Utah," Liljenquist explains.

Segment 2:

Under SB180, the focus of Medicaid will shift to primary and preventative care.

"I think the main concern that we have and advocates for consumers in the community would be just to make sure we are getting all of those details correct. For example, one thing we are concerned about is to make sure that we have those primary care networks in place to accommodate this change," Scott describes. "The stakeholders are working closely together, to really ensure that these things are in place, that we have a good strong network of primary care providers so that we have access because that's really key."

Liljenquist explains how this reform will save money.

"Diabetes doctors typically don't get paid unless there's an issue," he says. "Our current payment system awards, you only get paid if you cut off a leg or if you go in for open heart surgery. We are not properly incented to keep those people healthy during the continuum of care. Partly because of the way we pay, we write checks for procedures. Going forward we want our providers to take an active role in managing long term illness by educating, by making sure people are taking their medications... that's far, far less expensive than what we're currently doing. We are optimistic that by changing the way we pay, to pay for a continuum of care and to pay for outcome care instead of procedures will make a big difference in cost and we think will make a big difference in quality as well."

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