Consumers Council of Missouri advocated for the expansion of Medicaid to give more Missourians access to affordable health care -- one of CCM's primary issues -- in testimony before the Missouri House Interim Committee on Citizens and Legislators Working Group on Medicaid Eligibility and Reform. Joan Bray, Interim Director of CCM, spoke before the committee on Wednesday, August 14, at Forest Park Community College.
Bray's two main points were for the state of Missouri to fulfill its obligations to provide healthcare and maximize cost-effectiveness by operating Medicaid as a large business would by self-insuring and to provide each healthcare consumer with a medical home for consistency and continuity. The full text of Bray's comments follow:
Thank you, Mister Chairman and members of the committee. I appreciate the opportunity to appear before you today. My name is Joan Bray. I am the interim director of the Consumers Council of Missouri. Consumers Council is a non-for-profit advocacy organization that represents the interests of individual consumers collectively. We spend most of our efforts in three areas: utility law and regulation; healthcare access; and personal finance.
Today I want to speak to you about our interest in the transformation of Medicaid in Missouri by expanding it and making it more consumer friendly.
We have two recommendations. Missouri should operate Medicaid in the same way most large businesses provide healthcare to their employees. And every consumer of healthcare should have a medical home.
The state of Missouri should look at itself as a large business providing healthcare. A very large business. In the Medicaid program alone, more than 1 million people could be eligible.
Rather than pass along the risk to an insurance company, Missouri should self-insure Medicaid as a group health plan. A self-funded plan, as it is also called, is one in which the employer assumes the financial risk for providing health care benefits to its employees. In practical terms, self-insured employers pay for each out-of-pocket claim as it is incurred instead of paying a fixed premium to an insurance carrier. Typically, a self-insured employer sets up a special trust fund to earmark money (both employer and employee contributions) to pay incurred claims.
Reasons most large businesses self-insure would also apply to the state:
1. The employer can customize the plan to meet the specific health care needs of its workforce, as opposed to purchasing a one-size-fits-all insurance policy.
2. The employer maintains control over the health plan trust fund, enabling maximization of interest income.
3. The employer does not have to pre-pay for coverage, thereby providing for improved cash flow.
4. The employer is free to contract with the providers or provider network best suited to meet the healthcare needs of its employees.
By self-insuring the state enjoys the likelihood of spending less on administering healthcare and more on ensuring better health for its Medicaid population.
But the state should explore putting all its obligations for healthcare –Medicaid, all the state employee pools – including all the departments and universities – and the prison system into the same risk pool and delivery system to come up with the most efficient and effective use of tax dollars for healthcare.
Consumers Council’s second point is to provide each Missourian under its care with a patient-centered medical home. This is a team-based model of care led by a medical professional who personally provides continuous and coordinated care throughout a patient's life to maximize health outcomes. The consumer learns to know and to trust the team.
Costs for such a model can be based on monthly care coordination payments, fee for service based on visits, and performance or outcomes. The model enables not only the highest and best use of public money but also the appropriate deployment of a variety of medical professionals. The most satisfying result is high consumer satisfaction.
In fact, Missouri has invested in the medical home model in pilot programs in small pockets of the state and through federally qualified health centers. It should expand this practice for access to all in its care.
Again, thank you for the opportunity to speak to you.