Person-centric Medicaid: Gingrich, Mehrotra account for factors to help coordinate Medicaid care

June 1, 2007

Medicaid has to evolve into a delivery model that takes into account the uniqueness of each individual-both their specific health status, and issues outside of the traditional healthcare system, such as transportation, living conditions and substance abuse problems, according to insight from Newt Gingrich, founder of the Center for Health Transformation (CHT) and Rishabh Mehrotra, president and CEO of SHPS, a provider of health advocacy and health benefits solutions.

"In order to drive value in the Medicaid system, we need to create a person-centric approach to healthcare. This means we need to understand health risk factors and coordinate care across all services supporting individual well-being," says Mehrotra. "Large employers are adopting person-centric healthcare strategies, including creating coalitions, integrating health advocacy with incentives and adopting innovative plan designs. As a result, they're seeing improved employee health and cost savings of 20%. There's no reason Medicaid can't put the same approaches in place."

Former House Speaker Gingrich tells MANAGED HEALTHCARE EXECUTIVE that the bias in healthcare for the 20th century was profession-centered rather than individual-centered and was primarily focused on acute care.

"In addition, we have adopted a wage and price control system, whereby businesses have been encouraged to pick up the cost of healthcare," Gingrich continues. "We created a system where people have had no personal investment in the cost of healthcare. As a result of that, there's no natural center of people asking about value and choice."

In Making Medicaid Work: A Practical Guide for Transforming Medicaid, co-authored by CHT and SHPS, Mehrotra and Gingrich propose a series of principles for understanding how Medicaid must look in the future if it is to be a higher quality, fiscally sustainable program. They propose four key recommendations:

Q A viable electronic health record (EHR) system is still years away-how can we create a better system when health IT is still just emerging?

Gingrich: It is true that universal adoption of EHRs may still be years away, but information technology has advanced far enough that states and other entities can begin reaping benefits of an EHR system today.

Mehrotra: Some of the more advanced care management vendors now have the IT infrastructure to compile a 360-degree view of a member including their complete claims history, their care plan, healthcare providers and health status in one location. This holistic snapshot of the individual provides significant value and utility for the provider, who could access it with the patient's permission. By providing a comprehensive view of a member's health claims, clinical risks and care plan, we're making rapid and immediate improvement from where the industry has been to date.