Texas hospitals are already tackling Medicaid reform

Posted Thursday, Mar. 07, 2013  comments  Print Reprints

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The Medicaid debate in Texas is particularly loud.

Might be because so many people are picking different sides.

On one side are proponents of the federal Affordable Care Act, which would add more than a million adult Texans living near or below the poverty line to Medicaid coverage currently provided for very young children and very poor adults who are elderly, have disabilities or are pregnant.

On another side are expansion opponents who find it fiscally irresponsible to add more people or money into what they see as a broken, unsustainable system.

But there are also voices like state Sen. Tommy Williams, R-The Woodlands, talking about a third option that many in the healthcare industry see as the way forward in Texas.

Williams recommends adopting a flexible solution to Medicaid reform that isn't an all-or-nothing approach.

"A one-size approach doesn't allow Texas to develop ways to encourage healthy habits and program efficiencies," Williams, chairman of the Senate Finance Committee, wrote in a March 3 commentary. (See: "Fix Medicaid's problems before expanding the system.")

Williams' suggestion of expanding Medicaid "managed care" programs to improve and streamline services and reduce costs is exactly what local health providers are doing through a different provision of the Medicaid law called the 1115 Waiver.

Public and private hospitals are partnering with mental health agencies, public health departments, academic institutions and county commissioners' courts to create innovative projects that will lead to better outcomes at a lower cost.

Texas' fiscally conservative approach abounds at the state capital and at the local level, where healthcare decisions should be made. The front doors of our hospitals, community clinics and physicians' offices are where the debate about healthcare goes from philosophical rhetoric to reality. We know our community needs and can balance them with the expectations of the taxpaying public.

Under the Delivery System Reform Incentive Program (DSRIP), Texas Medicaid reform is happening at the local level to train patients to get their routine care at community clinics instead of heading to our already overpopulated emergency rooms that are more costly.

This new system pays based on outcomes rather than the traditional way of paying for a doctor to see a patient, possibly over and over for the same condition. The goal is to reduce readmission rates and manage chronic diseases outside the hospital setting.

Public hospital districts such as JPS Health Network in Tarrant County are footing the bill for designing new ways to provide better care at less cost. And we are willing to put our funds at risk because Medicaid reforms will benefit all Texans by increasing transparency, improving accountability and promoting efficient delivery of care.

Local control of the dollars makes that possible. Some state lawmakers and private hospitals, however, want to siphon tax dollars from the seven large Texas counties to distribute to the other 247. As a representative of the Alliance for Local Control of Healthcare, I suggest this distorts Medicaid reform.

Just as state officials want the federal government to honor its commitments, local healthcare officials want Texas to maintain the course of reform and not backslide on local control. To maximize the benefits of Medicaid reform, local hospital districts are allocating their tax funds to achieve the kind of change Williams recommends. Advocates of putting those funds into the broken, unreformed system of Medicaid -- reducing transparency, decreasing accountability and making care delivery less efficient -- are not the voices the Legislature should listen to.

Robert Earley, a former Texas House member, is president and CEO of JPS Health Network. He serves as the chairman of the Alliance for Local Control of Healthcare.


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