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Medicaid Modernization Plan Announced
Press Release Date:
January 30, 2004
Contact:
Wes Irvin
Jeannie Lausche
Jason Keller
502-564-2611
FRANKFORT, Ky. - Gov. Ernie Fletcher and Health and Family Services Secretary Dr. James W. Holsinger Jr. today announced a Medicaid modernization plan with a goal of providing the highest quality care to our citizens in the most cost efficient manner possible.
The plan will focus on improvements in three areas - care management, benefit management and technology.
"We have a responsibility to ensure that we provide the highest quality of care to our citizens in the most efficient manner possible," said Governor Fletcher.
Secretary Holsinger, whose cabinet includes the Department for Medicaid Services, said "The underlying theme of this program will be that quality care is less expensive than poor care."
The Medicaid program provides health care services to 673,000 Kentuckians and has an annual budget of nearly $4 billion.
Here is an outline of the modernization plan:
CARE MANAGEMENT
Medicaid will start with care management programs aimed at recipients with diabetes and asthma. The program currently spends $610 million annually on patients with diabetes and $376 million a year on patients with asthma. (Once these programs are in place, the department will focus on cancer and congestive heart failure.)
Care management has two components: 1) Providing individuals with education about their condition and what treatment options are available and 2) Making a team of medical professionals available to answer questions from recipients and provide medical advice.
The education component will help recipients identify alternatives to emergency room care.
The concept of self-directed healthcare will be introduced to give recipients an opportunity to be more involved in actual care decisions to improve accountability and quality.
The department will review its utilization review process to make sure it is cost effective and consistent with industry standards.
BENEFIT MANAGEMENT
The department will seek federal waivers to give it flexibility to manage recipient benefits.
A major emphasis will be pharmacy. Kentucky Medicaid recipients average more than twice the national average in the number of prescriptions and about 38,000 recipients currently receive eight or more prescriptions a month. Studies have shown that individuals who take eight or more prescriptions a month are 100 percent at risk for an adverse reaction. The department plans to review its utilization review and prior authorization criteria to bring these averages in line with national averages.
The department will empower the Pharmacy and Therapeutics Committee, which is already in place, to more effectively assist in management of the preferred drug list.
The department will work with the Pharmacy and Therapeutics Committee and its pharmacy benefit manager to seek additional rebates from pharmaceutical makers, resulting in savings for the program.
TECHNOLOGY
The Department for Medicaid Services will assess its computer systems technology, including its claims processing and eligibility management both within the department and through contractors.
A data warehouse will be created to capture utilization information. The accurate and timely data will help managers monitor trends and the progress of new initiatives.
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