A tale of two health care models

Our View

A tale of two health care models

So, now that Sen. Keith Ingram, D-West Memphis, has criticized Gov. Asa Hutchinson’s plan for the future of Arkansas’ Medicaid expansion program during a recent meeting of the Health Care Reform Legislative Task Force, which we were reminded by Ingram was created by lawmakers not by the governor, we thought it only appropriate to reprint a factual commentary by Erika Gee, an attorney representing clients in government relations, regulatory and compliance matters.

Gee, in her article posted online by Arkansas Business.com, pointed out the task force’s meeting brought some clarity and public focus to the previously quiet discussion on managed care in Arkansas.

She said although there is presently no consensus on what type of reform to adopt, the task force made it clear that there can be some expectation that there will be managed care for Arkansas’ traditional Medicaid population.

In her commentary, Gee said after some unsuccessful wrangling over voting procedures, task force members were asked to support either Option 1, the “full-risk” managed care for the behavioral health (BH) and developmental disabilities (DD) populations, which has been championed by Gov. Hutchinson; or Option 3, the “DiamondCare” plan, a broader “managed feefor- service” (MFFS) model that was supported by Ingram and other legislators, including Rep. Deborah Ferguson, D-West Memphis.

Oh, by the way, we were also reminded by Sen.

Ingram that Ferguson was a prime architect of the “DiamondCare,” and according to Gee the “Diamond Care” plan was first proposed in December by Sen.

Missy Irvin, a Republican from Mountain View, Rep.

Justin Boyd, a Republican from Fort Smith, Rep. Joe Farrer, a Republican from Austin, Rep. Michelle Gray another Republican from Melbourne and Ferguson, the lone Democrat.

These mostly Republicans believe, according to Gee, that the state should balance necessary cost-saving reforms with the promotion of preventative health services.

The “DiamondCare” model would achieve this balance through a MFFS model, including extending the existing provider-payment reforms, such as the Patient Centered Medical Home, to broader sections of the Medicaid population. The model also includes a level of risk by tying administrative compensation to performance. But it does not transfer the financial risk of higher-than-expected cost of care to a third part, as the governor’s plan does.

And, let’s point out, there is a significant difference in the expected savings to be achieved by the two models. The governor’s plan would save a total of $1.439 billion over five years while the “DiamondCare” model would save $1.057 billion over that time frame.

Furthermore, The Stephen Group has recommended the governor’s plan, both because of the estimated savings, as well as the fact that most states are moving away from “managed fee-for-service” toward full-risk managed care.

Based on Ingram’s criticism of the governor’s plan there is some indications that the managed care debate could affect Democratic support for the governor’s other proposals – including his “Arkansas Works” plan.

The April 6 special session of the Legislature will determine whether Ingram and other opposing Democrats will be able to derail the governor’s plan.

BIBLE VERSE

A man's heart deviseth his way: but the Lord directeth his steps. A divine sentence is in the lips of the king: his mouth transgresseth not in judgment. A just weight and balance are the Lord's: all the weights [4] of the bag are his work. It is an abomination to kings to commit wickedness: for the throne is established by righteousness. Righteous lips are the delight of kings; and they love him that speaketh right.

16:9-12

Proverbs