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Saturday, July 26, 2014

HealthNet reshapes state program

Tuesday, July 3, 2007

(Photo)
Missouir Gov. Matt Blunt gives Grace Blanton, 5, a copy of signed legislation.
SIKESTON -- Monday marked a new beginning for Missouri's 40-year-old Medicaid program.

That's what Gov. Matt Blunt said when he signed legislation to enact Mo HealthNet and reshape the system. Ferguson Medical Group in Sikeston was one of Blunt's five stops on the statewide tour.

"I think this is something Missourians can be proud of," Blunt said of the system.

Kelley Rushing, CEO of Ferguson Medical Group, said the location for the signing was fitting. "We're one of the largest rural health clinics in the country," he said. "And we do have a very high concentration of Medicaid patients."

Mo HealthNet will restore coverage to some of the thousands who lost it because of budget cuts two years ago, and rid some abuses of the old system. It was a priority for Blunt and the Republican-led legislature, which passed SB 577 it in the final hour of its 2007 session.

Legislation like this is quite historic.

"These big changes in health care delivery don't happen every day," said Gordon Jones, who practices family medicine at Ferguson.

"The governor's plan puts huge emphasis on prevention and individual responsibility for health and well-being," said Ellen Brandom, Missouri District 160 state representative.

She served on the medical facilities committee. "We didn't realize we were going to be the Mo HealthNet committee, but we evolved into that," Brandom said.

When campaigning for the seat last year, Brandom said she quickly learned health care was a No. 1 concern in this area.

"Local ideas are really important and I realized they were really saying the same thing as all the doctors that testified," Brandom said.

She said she undertook a large amount of work as a freshman legislator, but added that it was a good learning experience and she is proud to have worked on the bill. "Every minute was worth it," she said.

One of the best points of the new system from a physician's standpoint is the health care home, which gives one group or doctor the responsibility to coordinate care, Jones said. Blunt called it the "building blocks" to health care.

"Now, it's scattered and you can just go anywhere," Jones said. "Because of that disjointed care, you set up problems for the quality of care the doctors can deliver and concerns of patient safety."

For instance, two doctors may order CT scans within weeks of each other, or prescribe conflicting medications, Jones said.

Another goal is to limit emergency room visits.

"The rules are yet to be laid out," said Rushing. "But it will be limited to true emergency situations and not to be used for primary care."

Another change will streamline all medical records into one database within minutes after the appointment. Currently, that information is entered after bills are submitted, which can take a full month.

"It's just one more check and balance that helps you deliver the care better," Jones said.

It's also good for the patients. "I think the patients will like it, knowing that they've got someone to coordinate their care," he said.

Access to specialists should be increased, too.

"(Before) If you had something that was non-emergency, it might take six months to get someone in," Jones said of referring patients to specialists. That was one of his biggest frustrations.

The long waiting time is partially due to low reimbursements, he said.

So, the plan calls for a gradual increase in reimbursements over the next four years, until it reaches the same level as Medicare.

Rushing said those involved have "done the state a great service as compared to other states."

He compared it to Tennessee's Tenn Care, passed about 10 years ago. "When they started that program, it was almost a disaster," he said, adding they had not done the same research.

Missouri officials involved realized the face of health care is always evolving. That's why an oversight committee with members from all affected fields, will be put into place for an ongoing reform.

"We'll be meeting several times a year so we can continue to make progress," Brandom said.

Rushing applauded the efforts of those involved. "I think they've put the homework into it, and they've laid the groundwork to continue it," he said.

There are objections, however. House Minority Leader Jeff Harris said the bill amounts to little more than a new name for a program that still will not help as many Missourians as it should.

"At first glance it may look nice, but close examination exposes it for the false reform it is," he said in a written statement.

The Associated Press contributed to this report.