Thursday, September 6, 2012

Arkansas Medicaid plan seen as innnovation

Posted By on Thu, Sep 6, 2012 at 6:53 AM

Ezekeil Emanuel, writing on health policy for the New York Times, has positive words for the Beebe administration plan to reshape Medicaid to save money and, it is hoped, improve results. The "Arkansas Innovation" says the headline.

Mention medical innovation, and you might think of the biotech corridor around Boston, or the profusion of companies developing wireless medical technologies in San Diego. But one of the most important hotbeds of new approaches to medicine is … you didn’t guess it: Arkansas.

The state has a vision for changing the way Arkansans pay for health care. It is moving toward ending “fee-for-service” payments, in which each procedure a patient undergoes for a single medical condition is billed separately. Instead, the costs of all the hospitalizations, office visits, tests and treatments will be rolled into one “episode-based” or “bundled” payment. “In three to five years,” John M. Selig, the head of Arkansas’s Department of Human Services, told me, “we aspire to have 90 to 95 percent of all our medical expenditures off fee-for-service.”

The change will encourage doctors and hospitals to work together to provide patients with the highest quality care, while at the same time lowering costs by eliminating unnecessary tests and treatments. It has been done before, in small-scale experimental pilot programs. But as the Arkansas officials make clear, this change will now be made in every corner of the state, for every hospital, and physicians in almost every specialty: surgeons, anesthesiologists, obstetricians, pediatricians, primary care physicians. For policy makers and the public, the Arkansas experiment is fascinating.

Arkansas on the cutting edge? Taking risks? In the name of better health care for all, particularly those in greatest need? The Arkansas Republican Party, I shouldn't need to remind you, thinks this is a terrible thing. They prefer a simpler solution — every man for himself.

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