By JULIE MINDA
To build support for Medicaid expansion and for the Affordable Care Act in general, ministry health systems are continuing outreach efforts to educate community members about the benefits of increasing eligibility limits for Medicaid enrollment.
Among those that have been undertaking high-profile, multipronged campaigns are Catholic Health Initiatives of Englewood, Colo.; Mercy of Chesterfield, Mo.; Providence Health & Services of Renton, Wash.; and Ascension Health of St. Louis.
Mercy of Chesterfield, Mo., has been encouraging employees systemwide to participate in rallies supporting Medicaid expansion, including this spring gathering at the Arkansas state capitol in Little Rock. Here Scott Street, who is in a special projects role for Mercy, addresses the crowd.
CHI is continuing its "Protect Our Patients" campaign to shore up support for the Affordable Care Act by educating on how health care reform can help people in need. This includes efforts by CHI leaders to meet with state and federal legislators. Mercy organized staff from throughout its network to take part in rallies at state capitols in support of Medicaid expansion. Providence Health & Services employees have been talking with business leaders about the potential negative impact of declining reimbursement levels without the expansion of insurance coverage — they've explained that with more uncompensated care, more costs are shifted to private insurers, and costs go up for businesses. Ascension Health representatives also are talking with business leaders in their communities through a campaign launched in January to educate on the positive impact that Medicaid expansion has on communities.
Michael Rodgers, CHA senior vice president of advocacy and public policy, said the Catholic health ministry has long called for health care coverage for all, and while the Affordable Care Act provides a big step in that direction, that achievement is now partially dependent on states' decisions to expand their Medicaid programs. "If states choose not to expand their Medicaid programs, then many low-income individuals in our communities will remain uninsured," according to Rodgers.
The secondary result of those decisions is less healthy communities and continued large uncompensated care costs for hospitals, Rodgers added.
Mercy's Executive Director of State Government and Regulatory Relations Brooke Timmons explained how this conundrum is playing out on a practical level state by state: "Medicaid disproportionate share hospital (DSH) payment reductions were included in the ACA on the assumption that the law's coverage expansions would result in a reduction of hospitals' uncompensated-care costs. However, the failure of some states in our service area to expand Medicaid changes the equation of financing.
"Facilities that are receiving DSH payments are currently preparing for the imminent reduction of these payments," said Timmons.
She added that the Affordable Care Act built a 10-year reduction in Medicare and Medicaid DSH reimbursement as a partial offset to the anticipated increase in revenues that providers would receive from Medicaid and private insurance coverage expansions, thereby reducing hospital uncompensated care costs.
"The major impact to be felt in states that do not expand Medicaid will be the reduction in Medicare and Medicaid DSH payments," Timmons explained.
CHA and ministry providers have been urging legislators at the federal level to delay these DSH reimbursement cuts; but, as Catholic Health World went to press, Congress had not acted on the legislation. The ministry also has been advocating that states expand Medicaid eligibility — to households below 138 percent of the federal poverty level — as the Affordable Care Act had intended. So far, 23 states and the District of Columbia have decided to expand Medicaid coverage, 21 states have decided not to expand eligibility; and six have not yet made a decision, according to the Kaiser Family Foundation.
Ministry executives said that even as they are advocating for the expansion of state Medicaid programs and a delay in federal DSH cuts, they are continuing the macro-level, long-range strategies they orchestrated in the early days of health reform, to prepare for the changes in the care delivery and payment systems.
Mary Ella Payne, senior vice president of policy and system legislative leadership for Ascension Health, said that a large part of the system's approach is to focus more on primary care and prevention, in part by helping to ensure patients have a primary care medical home. More care delivered early can mean decreased need for costly emergency care later, thus improving patients' health and reducing costs.
CHI's strategy to prepare for the Affordable Care Act's full implementation is in large part to shift to a population health model, in which delivery of care is well orchestrated among providers along the full continuum of care. Colleen Scanlon, CHI senior vice president of advocacy, said this allows for more effective care delivery and the potential to reduce costs.
According to Janice Burnett, chief financial officer of Bon Secours Health System of Marriottsvile, Md., that system has been reducing operational costs and also shifting to a more proactive population health model that tries to address health problems at a primary care level before they escalate into costly, chronic health issues.
Timmons said Mercy's proactive approach to cost containment includes better integrating all of its facilities across the care continuum into a single network; using telemedicine to more efficiently deliver care to rural populations; and participating in quality and cost reduction programs from the Centers for Medicare and Medicaid Services.
Joel Gilbertson, senior vice president of government and public affairs for Providence Health & Services, explained that a concern that providers are facing as they absorb the impact of the Affordable Care Act implementation is that the nation's payment system is lagging behind the transformation of the care delivery system.
"As we move from a fee-for-service model to a model based on competencies in population health, risk bearing and providing the full continuum of care É we need payment models that reflect that we are taking on that risk," Gilbertson said. Currently, traditional reimbursement formulas are not providing the resources needed to make this shift, he said.
Gilbertson went on to say while putting in place the long-term strategies that will transition providers to the new delivery system under the Affordable Care Act, the ministry must continue to push for the payment system to keep pace with these changes.
"Coverage expansion is intractably intertwined with the question of cuts — it's part of the calculus" of successfully transforming the health care delivery system, he said. "It is incumbent upon the ministry to ensure (Medicaid) expansion takes place" so the broader efforts of reform are sufficiently financed, he said.