|Posted:||January 11, 2019 04:09 PM|
|From:||Senator Scott Martin|
|To:||All Senate members|
|Subject:||Medicaid Decision System Health Initiative|
|Last session, I introduced Senate Bill 600, which was designed to improve patient health and reduce the per capita cost of health care for Medical Assistance enrollees. The health initiative would be carried out through an RFP and would be required to save more money than it costs to operate in order to minimize the risk and cost to the Commonwealth.
The desired results would be achieved by increasing patient engagement and understanding of their health care options, improving physician access to the latest evidence based medicine, providing decision support and coordinating physical and behavioral health. By reducing hospital re-admissions, emergency room visits and increasing the use of preventative care, the initiative would improve health care outcomes and reduce overall costs.
It is important to note that this would not replace Managed Care Organizations or primary care providers and would not be a reduction in access or care; rather it would be an additional service to enrollees, which has proven to be successful in other states and in the private sector. If the health initiative were implemented statewide, it could save Pennsylvania an estimated $2-$4 billion.
SB 600 received two hearings, one in each chamber. In the spring of 2017 it was included in House Bill 59 as a regional pilot, which was passed by the General Assembly and ultimately vetoed by the Governor.
Since that time, my office has been working on a number of changes to the bill, chief among them are more specific requirements to demonstrate program savings. It also allows for the state to cancel the contract after 6 months if no savings are reported within that time, as well as extend the program an additional 6 months and beyond provided that savings continue to exceed the cost to administer the initiative.
Pennsylvania ranks 4th in the nation for Medicaid spending at over $28 billion a year. Additionally, the federal share to cover the expansion population continues to decrease in 2019 to 93% and in 2020 to 90%, the difference of which the state will have to make up. In November 2018, the Independent Fiscal Office made the following predictions:
I hope you will join me in co-sponsoring this important reform legislation.
Introduced as SB322