New York wants a Wisconsin fix for Medicaid

published by Joe Jarvis on Fri, 01/07/2011 - 09:55

Reports out of Albany (here, here, and here) indicate that newly sworn in Gov. Cuomo has been very impressed by the efforts of Wisconsin to reduce Medicaid costs, led by Jason Helgerson. Mr. Helgerson has been recruited by Gov. Cuomo to lead similar efforts in New York. Excerpts:


Jason Helgerson, who oversaw the state's BadgerCare Plus and Medicaid programs, has been recruited by New York Gov. Andrew Cuomo to oversee that state's Medicaid program, which provides health insurance to almost 5 million people and has an annual budget approaching $60 billion a year.

The BadgerCare Plus and Medicaid programs in Wisconsin have an annual budget of about $6 billion.

Cuomo announced Helgerson's appointment on Wednesday.

Helgerson, who grew up in Appleton, drew the Cuomo administration's attention because of an initiative in Wisconsin that cut an estimated $625 million from the BadgerCare Plus and Medicaid programs over two years.

In a speech, Cuomo said he wanted Helgerson to draw on that experience to rein in Medicaid spending in New York.

"He really wants to pursue radical reform," Helgerson, 39, said. "This is not just trimming around the edges."

New York, which spends more per capita on Medicaid than any state in the country, faces a roughly $10 billion budget deficit.

Helgerson oversaw Wisconsin's health programs for almost four years and had a key role in trimming their costs in the budget crisis that followed the economic downturn.

The initiative, which involved 89 projects, sought ideas from hospitals, doctors, nursing homes and other stakeholders on changes in the programs that would save money.

The changes range from requesting bids from the private companies that oversee the BadgerCare Plus program in southeastern Wisconsin to not paying hospitals for a two-day stay when a patient was admitted to an emergency room late one day and discharged early the next.

Not all the cuts were made by mutual agreement. But Helgerson said the state avoided across-the-board cuts.

"There are cuts in reimbursement, but there were policy reasons for them," he said.

The initiative helped the state avoid having to limit enrollment in the programs at a time when more families were applying for coverage because of the sharp jump in unemployment.

My comment:

There are no line item, across the board, approaches to limiting Medicaid spending that will really work. Mr. Helgerson, apparently, has figured out that reducing Medicaid spending (or any health care spending) requires finding poor quality practices and inefficiency (waste) and eliminating those problems. Every state needs this kind of approach, including Utah. Increasing co-payments and deductibles (or other methods of displacing cost onto Medicaid beneficiaries) will not actually reduce health care costs. Individual patients can not force the changes to health care delivery needed to improve quality and efficiency. When forced to pay more out of pocket, people without means (including the middle class) simply go without needed, effective health care until their condition worsens, meaning they access the health system with a more severe (and expensive) problem.

What Utah needs for Medicaid is a state health leader with a commitment to find quality and inefficiency waste and a governor with the political will to eliminate the waste.

Best,

Dr. Joe Jarvis