This page contains a Flash digital edition of a book.
“There are definitely things that can be done to improve care and save money. But everybody is looking for some magic bullet — an ACO or a medical home — that will fix costs, and it’s not out there.”


ers that physicians deal with. Roughly 20 different HMOs, each with its own metrics, now participate in Medicaid managed care. TMA also believes any alternative care delivery models for Medicaid managed care should include flexibility for practices of varying sizes and means so they aren’t tied to any one model; administrative simplification of time-consuming and sometimes costly Medicaid HMO processes that can take away from patient care; and reasonable payment. “It’s really challenging when you look


four main areas that can both improve quality and hold down costs:


1. Better birth outcomes, 2. Avoidable emergency and hospital visits,


3. Behavioral health services, and 4. Long-term care services.


Future quality measures will build on


those areas, all of which require “a coor- dinated effort between providers, man- aged care organizations, and the state,” to achieve improvement, Ms. Ghahre- mani says.


The state also plans to draw on best


practices gathered from the regional Medicaid 1115 Transformation Waiver projects and the Texas Institute of Health Care Quality and Efficiency. The latter is a state-appointed group charged with rolling out Texas’ own version of health care reform, including innovative pay- ment and delivery systems. Because public health plays a role in


improving care quality, Ms. Ghahremani added that Medicaid plans to partner with state public health agencies, too. Addressing issues like smoking and obe- sity, for example, can help tackle the chronic, and often costly, conditions many Medicaid patients face.


Mary Dale Peterson, MD


Mark Chassay, MD 58 TEXAS MEDICINE December 2013


Getting it right Perhaps one of the biggest challenges, however, is finding the right measures to evaluate quality improvement in Med- icaid, Dr. Peterson says. State surveys of physicians, health plans, and other pro- viders revealed those and other concerns. (See “Gauging Interest,” page 60.) TMA continues to advocate for mean- ingful, evidence-based measures that are consistent across the multiple pay-


across the spectrum to figure out which measures really make a difference and are applicable across multiple popula- tions in the state. There are thousands of measures out there, and it’s too much for any organization — physicians’ of- fices, managed care organizations — to concentrate on,” said Dr. Peterson. And because carriers and various state agen- cies don’t share information, due largely to their reticence to divulge proprietary information, physicians can’t get the his- torical patient data they need on new patients, for example, to figure out what they need to improve.


A partnership between Medicaid and state public health agencies could make a difference, however. If patients get ill from unsafe drinking water, for example, physicians may have no choice but ad- mit them to the hospital. “Are we going to get penalized because public health hasn’t addressed it?” she asked. “Some solutions are not at the physician or managed care level, but at the commu- nity, public heath level.” With Medicaid already such a poor


payer, financially penalizing physicians is not likely to prompt change, Dr. Pe- terson adds.


Nor should doctors be punished for not achieving full medical home or ACO status, for example, says Dallas internist Sue Bornstein, MD, a member of TMA’s Physician Services Organization imple- mentation team. Physicians can take steps that move in that direction and still make a difference in quality, like extend- ing office hours, sending out patient re- minders, and tracking their health using electronic health records. Even those steps take time and money


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68