June 2, 2015

John Hood of the John Locke Foundation is a straight shooting analyst with the sharpest pencil in the budgeting game. He understands all the tricks bureaucrats play to make the numbers look good.

Examining the Medicaid savings claims of Community Care of North Carolina , a study co-authored by the Locke Foundation found emergency room visits by North Carolina Medicaid patients actually increased under the CCNC model of healthcare management.

Between 2007-2010, ER visits by the elderly, blind and disabled increased by 5.5%. For all adults, the increase was 10%. However, ER visits by children did decline by 10%.

Under the CCNC program, primary care visits and prescriptions increased. Theoretically, this greater emphasis on prevention at the front end was supposed to reduce expensive ER care. But it didn’t. (Medicaid Cure)

Meanwhile, Kansas has gone to a managed care model. Here is what the Kansas City Business Journal said. “Other ways to find savings are to prevent avoidable hospital readmissions and ER visits. That might mean assigning a home health aide to help a patient with diabetes plan meals and manage her insulin. Or it could mean giving an elderly person a caregiver to make sure he follows doctor’s orders after surgery.

Angela de Rocha, communications director for the Kansas Department for Aging and Disability Services, said that in May, ER visits were down 27 percent in 2013 among those with a physical or developmental disability. The average ER visit costs about $2,000”. (KCBJ)

With Emergency Room visits going up in North Carolina and down in Kansas, Legislators should be taking a hard look at making CCNC compete with managed care companies.

That’s not to say everything is rosy in Kansas. A University of Kansas survey said 45% of Medicaid patients reported a problem with getting services as the state moved to managed care. The same survey also said 64% of Medicaid patients were either satisfied or very satisfied with their program. (Disability & Health Journal)

It seems the benefits for patients outweighed the problems. And Kansas Medicaid expects $1 billion in savings.

The defenders of the North Carolina status quo of ever bigger Medicaid spending may want us to stick our heads in the sand like ostriches. But ostriches belong in the Australian Outback, not in the Legislature.