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Friday’s Medicaid Council meeting featured DSS Commissioner Bremby’s comprehensive, long overdue client services system overhaul. To say the current systems are outdated is a massive understatement – fragmented, ancient, paper-based, and under-resourced. DSS’ plans for the future are as good as the current system is bad. Phone and online systems will be integrated, information for clients will be consistent and easily available, processes will respect how people use systems (not the other way around), clients will be able to pre-screen for eligibility saving everyone a lot of time. Staff are getting training on courtesy, responsiveness and keeping promises. We still need to hear about privacy protections, but this is a wonderful thing.

DSS then described their evolving model to redesign how they pay for the care of possibly 50,000 people eligible for both Medicare and Medicaid. They are proposing to build on the ASO model’s care management services available now to every Medicaid member with data integration and advanced analytics, intensive care management to coordinate between the two programs, and other consultative services such as pharmacy, disease educators and nutritionists, if CMS allows. They are also planning to foster the development of three to five medical neighborhoods, loose affiliations/networks of local providers each serving about 5,000 people offering team-based care individually matched to the patient’s needs. DSS has proposed to split any savings with the feds 50/50. DSS intends to develop strong quality monitoring systems to ensure that needed care is not inappropriately denied. The really big question, how the savings will be shared with providers — primary care and their neighbors, remains to be decided. This could be a quantum shift improving the lives of fragile patients, or a complete disaster. It is unlikely that the first iteration will work perfectly – there will be winners and losers, financially and in quality. It will be up to policymakers to actively monitor those imperfections, and have the will to make unpopular changes that may not benefit large, powerful institutional providers. We’ll see.
Ellen Andrews