Business Trends: HEALTH CARE
Randy Ricker of Optima Health Community Care, says the CCC Plus program will give the state some certainty about what it will be spending.
Health-care reform T
New program aims to make medical services more effective by Robert Burke
he people who will benefit most from a new Medicaid initiative in Virginia also are the ones
who need the most help and cost the most to treat. On Aug.1, a program called Com-
monwealth Coordinated Care Plus (CCC Plus) was launched by the Vir- ginia Department of Medical Assistance Services (DMAS). CCC Plus started in Hampton Roads and will be expanded across the rest of the commonwealth by the end of the year. About 216,000 people in Virginia
will be enrolled in the program when it is fully in place. Many are “dual-eligible” enrollees who get benefits from Medic- aid and Medicare. Many are older adults or people with disabilities. They often receive a lot of services and medical care without anyone coordinating their treatment. Sometimes there is unneces- sary care, which doesn’t help the patient or the state’s Medicaid budget. CCC Plus has been in development
Photo by Mark Rhodes
for several years in Virginia, and other versions of the program are already in place in about 30 states. The program is making its debut in Virginia after years of steady criticism of the overall Medicaid system from conservatives who call it wasteful and ineffective. Recent failed efforts by Congress and the White House to end the Affordable Care Act included major funding cuts to Medicaid spending. CCC Plus is designed to make
services for this particular population more effective and less wasteful. The elderly and people with disabilities represent 23 percent of Virginia’s Med- icaid population, yet they consume 68 percent of the state’s $8.41 billion Medicaid budget. These figures are from 2016. “How do you bend the cost curve?”
asks Cindi B. Jones, the director of DMAS. “It’s not an easy thing to do. We feel that by focusing on quality, the savings will come.”
www.VirginiaBusiness.com
Managed-care system The program moves the elderly and
disabled patients from a fee-for-service system to managed care, which gives insurers tighter control over medical spending. These patients are eligible for a lot of services, but they don’t always know the best way to access or use them. “There’s nobody trying to coordinate their care” except for the patients themselves or a support person, usually a family member, Jones says. “I call those ‘fend for yourself ’ programs. Sometimes that process is almost worse than the disease.” Before CCC Plus was launched,
a test program in Virginia limited to about 30,000 people began in 2014. It showed good results, Jones says. Patients liked having care coordinators, and the program cut the costs associ- ated with those patients, she says. Virginia-based Optima Health
has the contract with DMAS to handle services to eligible recipients in the
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