State really is listening on TennCare
Across America, health care costs have been increasing at an unsustainable rate for decades, in part because the incentives that exist in the system point in the wrong direction. Patients don’t have insight into the actual cost of medical care, because typically their insurance companies are footing the bill.
On the other side of the care equation, doctors and other health care providers traditionally are paid based on how many patients they see and how many procedures they perform. Outcomes from treatment or efficiency of care are not considered in payment, even though data often show wide variation in costs for similar procedures.
Health care is complex and fragmented, and managing health care costs is increasingly difficult. However, it is arguably even more difficult in Medicaid, the program that provides health insurance coverage to low-income populations and is jointly administered by states and the federal government. Federal requirements constrain our ability to make changes in TennCare, Tennessee’s version of Medicaid, and in tight budget years we have historically been left with only crude mechanisms for saving money, such as reducing benefits or across the board reductions to what providers are paid.
Fortunately, Tennessee leaders have been working on an innovative solution to realign incentives and control health care spending. Five years ago, TennCare joined with commercial insurers and health care provider associations to change the way health care is paid for – moving toward paying for value instead of paying for volume. This initiative provides information to doctors on how they compare to their peers and creates financial incentives for efficiency and high quality patient care.
I was disheartened by an April 5 oped in the News Sentinel authored by Dr. Matthew Mancini, incoming president of the Tennessee Medical Association (TMA). He seemed to suggest that the state hasn’t listened to TMA on the design of its program. As a physician and TMA member myself, I have made engaging primary care doctors, specialists, hospitals, and other relevant provider groups a hallmark of our valuebased payment initiative. Every “episode” of care that is designed is done so with recommendations from groups of expert clinicians from around the state. Once an episode is designed, it is rolled out over a multi-year period to create the greatest chance of success.
In the past five years, the state has had more than a thousand meetings with stakeholders to solicit input on our value-based payment efforts. We have made numerous changes – from major program adjustments to technical changes – based on the continuous feedback we have received from TMA.
TennCare has a challenging dual mission: We have a responsibility to ensure our enrollees have access to high quality health care while also being effective stewards of taxpayer money. As a nearly $12 billion program, our ability to manage costs has implications for the entire state budget. It is critical that we continue to move forward with initiatives that help us control costs while maintaining quality of care, and we are committed to building on our partnerships with providers to continuously improve these efforts and ensure we are successful together.
Dr. Wendy Long is the deputy commissioner and director of the Division of TennCare.