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House Committee Hears Testimony on Patient Care in Medicaid

On October 15, the House Energy and Commerce Subcommittee on Health held a hearing on the coordination of patient care in the Medicaid program.

Many witnesses discussed the benefits of providing disease management services to Medicaid beneficiaries with chronic diseases, including arthritis, asthma, cancer, cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, depression, diabetes, HIV/AIDS, and autoimmune diseases.

Chris Selecky of the Disease Management Association of America (DMAA) explained that disease managers are typically nurses, dieticians, health educators, and social workers who work with patients to manage their illnesses between physician visits. Because chronic disease patients are monitored more closely, they can avoid unnecessary and expensive hospitalizations, surgeries, and emergency room visits. Ms. Selecky argued, “…if health care payers can efficiently deliver interventions that result in improved management of their chronic condition to those beneficiaries, quality improvement and cost savings will result.” She also noted that chronic diseases disproportionately affect minorities and pointed out that “focusing on managing people with [chronic] diseases helps to minimize the impact of racial and ethnic disparities experienced in health care.”

Testifying on behalf of Keystone Mercy Health Plan of Pennsylvania, Dr. Dan Hilferty explained how Medicaid managed care plans place a strong emphasis on preventative health care services. Many plans routinely provide prenatal care, hearing tests for newborn infants, and osteoporosis screening. They also routinely contact enrollees with reminders about child immunizations, cervical cancer screening, and mammograms.

Dr. Hilferty cited as an example the Health Ministry Program for Women in Pennsylvania, which provides women with health assessments to determine if they are at high risk of developing certain diseases. The program also teaches women preventative health measures, focusing on nutrition, exercise, and stress management techniques. Another program in Florida and Illinois is aimed at improving patient care for pregnant Medicaid beneficiaries. It identifies those women who are at risk of developing complications during their pregnancies and assigns to them obstetrical case managers who coordinate the care they receive from their primary care physicians.

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