As the cost of health care continues to skyrocket, many health insurers are looking for ways to avoid using the health care system by keeping their clients healthy. West Virginia’s Medicaid program joined that proactive group in January, when it launched a pilot incentive program for patients. The preventive care reward program has started in three counties and is part of the state’s ongoing overhaul of its Medicaid system, launched in 2005.
“The Medicaid redesign is a huge change in a 40-year-old program that serves almost 22 percent of our state,” explained Shannon Riley, spokeswoman for the West Virginia Department of Health and Human Services Bureau of Medical Services.
“West Virginia has some of the highest rates of diabetes, heart disease, obesity, and high blood pressure in the country,” Riley said. “We need to change behaviors and attitudes. We are doing this with carrots and not sticks.”
Though eventually the program will be expanded statewide, Riley said state officials don’t yet know how quickly that might take place. She said it depends how long it takes to get fully operational in the pilot program counties. The first phase, Mountain Health Choices, is being implemented this year.
Providing Information
The healthiest Medicaid patients in the three pilot counties were given information about the benefit changes and how they can enroll in the incentive program. To do so, they must sign a pledge to do their best to stay healthy by attending health improvement programs, reading the information their doctors provide, getting regular checkups, and taking medication as directed, among other things.
Those patients can expect to receive additional Medicaid benefits, including free prescription medicine, mental health counseling, house calls, long-term cardiac and diabetes rehabilitation and management assistance, and smoking cessation and weight loss courses.
Those who opt out of the program will receive only the basic Medicaid benefits: four free prescriptions per month, rather than the unlimited amount for those in the incentive plan.
Answering Critics
Critics of the program say it punishes the mentally impaired and those who may not have access to transportation or time for health improvement programs and regular check-ups. Supporters, however, say it is a powerful way to revolutionize a broken system.
“Any type of reform to Medicaid that makes it more like other types of purchases–in that you have consumers making decisions and catering to providers–is a good thing,” said Joseph Coletti, a fiscal policy and health care analyst for the John Locke Foundation, a free-market think tank in North Carolina.
“The idea of providing better benefits to people who are willing to sign the contract is perfectly appropriate,” Coletti continued. “Under the current system, if you have high blood pressure, diabetes, and you smoke, you pay the same price as someone who is perfectly healthy, a newborn child, or anyone else who has the same income as you: nothing.”
That means patients have less incentive to take responsibility for their health, Coletti noted. “It’s always hard for me to agree with people who say you are taking services away from a vulnerable population because the money is coming from someone else,” he said. “Right now, there is no obligation on the part of the [Medicaid] recipient, and that needs to change. The West Virginia program creates patient accountability.”
Changing Habits
The West Virginia Department of Health Human and Services Bureau of Medical Services reports 85 percent of its Medicaid patients have or may develop a chronic condition, and 70 percent of the overall state population is sedentary. Because the state is mostly rural, many Medicare patients seek medical treatment only during emergencies.
“We have cultural barriers we have to overcome,” Riley said. “We want people to participate in health care in an active way instead of passively. Wellness visits are not common within this demographic.”
West Virginians’ reactive approach to health care means the state must create a more fiscally sound system, Riley said.
“People who don’t work in the [Medicaid] business see us making changes and think we have blood on our fangs and cat hair on our shirts,” Riley said. “This is not just a way to save money. We want to pay for health screenings. We want to pay for wellness visits. We want to pay for smoking cessation and weight loss programs, because if we do, it will affect the long-term growth of this program and population.
“If people are living off $600 a month,” Riley noted, “they are not going to pay a $5 co-pay for a wellness visit, so we say, ‘Go get that check-up; we’ll pay for it.'”
Reforming Medicaid
Coletti believes changing the way people use the system is critical to Medicaid reform.
“The problem with traditional Medicare is that you can’t charge co-pays and there are not a lot of disincentives for people to use the care,” Coletti said. “Having rewards and incentives in place will help people be more responsible with their care and realize that there are costs and benefits to the activities they are undertaking.”
The pilot program will provide West Virginia health officials with pertinent information on how effective the benefit package’s educational materials are and what changes, if any, must be made before it becomes available statewide.
Whether the program will expand beyond West Virginia remains to be seen.
“It could work on a national level,” Coletti said. “I think the federal government has to take a step towards reforming Medicaid similar to how it approached welfare a decade ago. It needs to be broken up so you don’t care for long-term patients in the same way as you do mothers and families.
“Medicare is broken everywhere, and West Virginia’s approach is a way to try and make it better,” Coletti noted.
Aricka Flowers ([email protected]) writes from Chicago.
For more information …
West Virginia Health and Human Services Bureau of Medical Services, http://www.wv.gov/Offsite.aspx?u=http://www.wvdhhr.org/bms/
