Medicaid group releases four-year plan to sustainability

GOV. GINA M. RAIMONDO tasked the group with two objectives: to identify Medicaid cuts and savings for her fiscal 2016 budget and to come up with a long-term plan to improve the overall system. / PBN PHOTO/MICHAEL SALERNO
GOV. GINA M. RAIMONDO tasked the group with two objectives: to identify Medicaid cuts and savings for her fiscal 2016 budget and to come up with a long-term plan to improve the overall system. / PBN PHOTO/MICHAEL SALERNO

PROVIDENCE – A group tasked by the governor to “reinvent” the state’s Medicaid system released the second of two reports on Wednesday, which includes a four-year plan with long-term goals aimed at improving the state’s publicly funded health care system.

The group is Gov. Gina M. Raimondo’s “Working Group to Reinvent Medicaid,” which she created by executive order in February. Its goal: to reduce the state’s per-enrollee costs in a system that the governor has previously called “completely unsustainable.”

The governor tasked the group with two objectives: to identify Medicaid cuts and savings for her fiscal 2016 budget and to come up with a long-term plan to improve the overall system. The group delivered on her first request in May with a slew of cuts and savings to the tune of $91 million, which was whittled down to about $71 million in the fiscal 2016 budget. Wednesday’s report represents the second part the group’s undertaking and includes a four-year implementation strategy to reform the Medicaid system.

“Over the last four months, the Working Group has outlined a progressive version to improve the quality of and coordination of care in a way that is sustainable and affordable for Rhode Island taxpayers and businesses,” said Raimondo in a statement. “This plan sets our state on a path to achieve the predictability all Rhode Islanders deserve.”

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The 33-page nonbinding report comprises 10 goals for Rhode Island’s Medicaid program, all derived from four agreed-upon principles that the system needs to:

  • pay for value, not volume
  • coordinate physical, behavioral and long-term health care
  • re-balance the delivery system away from high-cost settings
  • promote efficiency transparency and flexibility

The goals are meant to act as a guide for policymakers moving forward and include ideas, such as moving away from a fee-for-service model and toward a focus on healthy outcomes; maximizing enrollment in integrated care delivery systems; leveraging health information systems to coordinate care and shift Medicaid expenditures from high-cost institutional settings to community-based settings, among others.

Health and Human Services Secretary Elizabeth H. Roberts championed the governor’s push to restructure the Medicaid system in Rhode Island and she also lauded the workforce’s effort through this process.

“The working group’s recommendations will provide us with a clear path to implement meaningful, sustainable reforms that shift Medicaid – and the entire health system – toward a model that rewards outcomes and quality,” Roberts said in a statement.

In the report, each goal is paired with a measurable objective that the group says can serve as a quantifiable guideline over the next four years. Some of the measureable objectives are more specific than others. For instance: by the end of 2018, the group calls for 80 percent of the state’s Medicaid payments to be tied to quality or value, but calls for year-over-year declines in hospital inpatient admissions over the next three years.

Delivering this report fulfills the second charge of the governor’s executive order, effectively disbanding the group.

Dr. Ira Wilson, professor of health services and policy and practice at Brown University, and Dennis Keefe, president and CEO of Care New England, co-chaired the 29-member committee. Wilson, in a statement, said the state was well-positioned moving forward.

“With an established community of providers and engaged stakeholders from across the state, Rhode Island is well-positioned to reinvent Medicaid and drive a transformation of health care more generally,” Wilson said.

The full report with all of its initiatives can be found HERE.

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