Monday, January 9, 2012

More About Health Insurance and Mental Health Care

On Friday I discussed the article in The Dayton Daily News to close Greene Memorial Hospital's psychiatric facilities.  Today there is another health care related article in the DDN, this time about a nonprofit organization from San Fransisco's efforts to push value-based health-care reform for the state's Medicaid program.

The Dayton Daily News isn't exactly a bastion of stellar journalism, so it took me a little bit of interpreting to figure out exactly what this means.  As near as I can tell, "value-based health-care reform" means shifting the bulk of the state's Medicaid contract payments to managed care providers who can prove that they're effectively treating their patients.  So, rather than blindly handing out money, providers will have to be able to prove that they are "adding value" -- i.e., they actually are providing services that are making their patients healthier.

Could it be that this is actually a good idea?  It kind of sounds like it, at least to me.  This article from 2009 in the New England Journal of Medicine  discusses value-based health care system as an effective strategy for health care reform, and makes a pretty good case as to why it's the best way to look at reforming the system.  The author says, and this makes perfect sense, that true financial savings in health care reform are really only achieved in health care reform if it's savings through good outcomes of services -- not through cost-shifting and restricting services.  So if Ohio is truly committed to reform through value-based health care, there really are a lot of potential places to save money and improve the current Medicaid system.

What troubles me about the article is that while the program won't "cost the state money" (the author seems to stress this point a little too vigorously), state officials don't "have quality and savings goals in place to measure success."  Any time I see a governmental goal discussed that doesn't have some sort of assessment method, I get a little worried.  And as to the question of mental health care reform, in my experience, mental health care is so trial-and-error, it may be very hard to quantify mental health treatment as a "value added" treatment--unlike, say, treatments for diabetes or heart disease. 

But, hey, maybe it's still a step in the right direction.  Gotta start somewhere.

Anyhow, I got way off topic. No more boring discussion of health care or health care reform for the rest of the week, I promise.

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