Medical Homes, Medicaid,

1
Medical Homes, Medicaid, CHIP

• Gary W. Floyd, MD
• President, Texas Pediatric Society
• Medical Director, Urgent Care Centers
• Cook Childrens Medical Center

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Recipe for Disaster

• Dramatic increase in our uninsured population
• Texas leads the nation with 25 of population
  uninsured
• 31 of ages 19-64 are uninsured with 79 in the
  work force
• 20 of children 0-18 (1.4M) are uninsured, 50
  of these are eligible for Medicaid

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Recipe for Disaster

• Caring for uninsured shifts costs to private
  insurance drives soaring health insurance
  premiums adds 1551/year/family
• Lack of available, affordable health insurance
  options for individuals employers cant find
  medical home
• Patients seek care in more expensive ERs 5.5 M
  in 1992, 8.6M in 2003

4
Recipe for Disaster

• An increasing population that is ballooning at
  both ends of the age spectrum
• A growing number of babies born into Medicaid
  (54 of Texas babies)
• A swell of baby boomers soon to retire
• Will significantly strain our health care
  delivery system

5
Recipe for Disaster

• A shortage of physicians
• Texas has the fewest physicians / capita compared
  to all other states
• Cannot care for needs of our current, much less
  our projected, population
• No need to see underfunded patients
• 67 saw Medicaid patients in 2000, but only 38
  in 2006.

6
Recipe for Disaster

• Shortage of Physicians
• Liability reform in 2003 good public policy -
  led to decreasing liability insurance prices
  increasing physician applicants
• Not catching up fast enough
• Cuts in GME funds dont allow all Texas medical
  students to train in Texas lose
  200,000/student
• 12,000 grads for 6300 positions.

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Recipe for Disaster

• Texas Health Care System has reached a breaking
  point
• Need a system that supports cost-effective, well
  coordinated, high-quality care for patients VS.
• Our present system which is more inefficient and
  expensive
• Need collaboration of government, medicine,
  business, insurance.

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Possible Solutions

• Access to a medical home vs. ER
• Preventive services G D, nutrition,
  immunizations, discipline, safety
• Sick visits follow-up care
• Manage chronic diseases asthma, diabetes, other
  special needs
• Coordinate appropriate lab testing, imaging,
  specialty care
• Proven to be most efficient, cost-effective,
  highest quality care.

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Access to Medical Homes for Underfunded

• 75 of Texas Physicians are in groups of 8 or
  less small businesses
• Must meet rising overhead on decreasing revenues
  decrease 8 over past 3 years
• Medicaid pays 50 of COST no increase since
  1992
• Medicare pays 70 of COST

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Access to Medical Homes for Underfunded

• Administrative hassles for underfunded plans
• Denied claims more paperwork, more overhead
• Lack of patient responsibility - ? services
  covered, no-shows,
• Eligibility dropped in 6 mos. physicians
  labeled as over-users

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Possible Solutions

• Maximize federal matching funds
• 1 Medicaid returns 1.54 to state
• 1 CHIP returns 2.63 to state
• Texas left 800M on table
• For every 1 lost in Medicaid/CHIP
• Local taxes increase 0.51
• HI premiums increase 1.34
• Retail sales decline 1.77
• See report by The Perryman Group

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Possible Solutions

• 12 month continuous coverage in Medicaid/CHIP vs.
  6 months
• Pays to have increased enrollment
• Competitive reimbursement for all physicians at
  least COST
• Restore 2.5 cuts from 2003
• Increase rates by 10/year x 5 yrs.
• Pay for services rendered
• Fix Medicare rates federal

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Possible Solutions

• Recognize the diversity of the Medicaid/CHIP
  population
• Pregnant women children 76 of enrollment,
  but 35 of costs,
• Aged, blind, disabled 24 of enrollment, but
  65 of costs
• Covers 1 in 3 children 2 of 3 nursing home
  patients
• Must address unique needs costs.

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Possible Solutions

• Encourage employer participation ? 3-share
  programs
• Educate/encourage personal responsibility
• Improved scrutiny of where funds go need to go
  to those providing direct patient care services,
  not out of state for corporate profits.