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EDITORIAL: Better outcomes, actual savings through managed care for nursing homes

Akron Beacon Journal - 5/13/2017

May 13--Will Ohio keep pace with the roughly two dozen states that report progress in the coordination of long-term care and health outcomes for the poor and disabled who qualify for both Medicaid and Medicare? In his two-year state budget plan, Gov. John Kasich proposed taking the next steps. Unfortunately, the House took its cue from the nursing home lobby and sided with delay.

Now it falls to state senators to take a clear look at what has been achieved the past three years under a pilot program and permit the governor to press ahead with coverage of more "dual eligibles."

This is partly old business at the Statehouse. Ohio long has talked about curbing Medicaid spending, the majority of which goes to nursing homes and other facilities that care for the indigent elderly. The state has been slow to deliver results. To his credit, the governor, through the Office of Health Transformation, led by Greg Moody, has elevated the state's commitment, in particular, confronting the political clout of nursing homes.

Worth stressing is the importance of the task -- attempting to slow entitlement spending, which already has taken from other priorities. In that way, there is consensus with a little appreciated component of the Affordable Care Act, launching pilots, experiments and other initiatives to find savings in health care while seeking to deliver improved quality and outcomes.

The Kasich team acknowledges that MyCare Ohio, based on the managed care model, experienced a rocky start. Those problems echo in the House budget plan, nursing homes and the others arguing they already coordinate care. They add that many patients are not better off, as providers cope with slow payments, among other things.

They want a delay in implementation to 2021, allowing for more study and to address shortcomings. They also seek some easing of accountability.

Actually, the state has turned something of a corner as the program approaches the close of its third year. It reports a 4 percent reduction in the use of nursing homes, more recipients in less expensive alternatives such as remaining at home. The state points to a 6.8 percent decrease in per-member fees paid to managed care organizations.

Overall, MyCare Ohio is saving $2.4 million per month.

According to national measures, the pilot also has improved in quality of care, the state in the 90th percentile in nearly half of the standards. It scored better than the national average in completing care plans, documenting goals and follow-up visits. Ninety percent of prior authorizations for procedures are approved, and 90 percent of claims now are paid within 30 days.

Obviously, there is room for much improvement. A report from the Scripps Gerontology Center at Miami University found that Ohio nursing homes scored below the national average in 10 quality measures. The question for state lawmakers is whether to build carefully on the pilot progress or back away, putting off savings and needed structural changes.

In that way, they would do well to examine the achievements in other states, which are way ahead in making the managed care model work, in realizing higher quality and better budget results. That is where Ohio must get and where the Kasich team rightly wants to go.

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(c)2017 the Akron Beacon Journal (Akron, Ohio)

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