Medicaid must be a priority for health leaders

On the heels of the 10th anniversary of Congress' successful effort to reform the nation's welfare system, it is time to draw attention to the urgent need to reform America's Medicaid program. However, real change will not come without the active involvement of the talented men and women who lead America's healthcare companies.

When it comes to recognizing the critical need to strengthen our country's healthcare system, managers of these innovative and dynamic entities are in a special position to understand the pitfalls of adhering to the status quo and the enormous potential and promise that can come with reinvigorating an outdated model.

Medicaid today does not adequately meet the healthcare needs of the individuals who comprise the incredibly diverse population served by the program. To help those who need it the most, we must systematically examine the fundamental challenges faced by Medicaid and take concrete steps to address the resulting growing human and financial toll.

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Every day, new discoveries in drugs, devices and medical procedures give Americans better, more personalized medical care. Many Americans do not have access to lifesaving treatments and technologies because they cannot afford them. Congress must take creative and comprehensive action, as it did in reforming welfare, to strengthen Medicaid's ability to meet individualized needs, to empower individuals receiving benefits through the program, to improve the program's core structures, and to reach out to the uninsured.

Members of the four groups comprising the Medicaid population - pregnant women, children, the disabled and the elderly - generally have starkly different needs. To serve them, state and federal governments must be allowed to focus on the populations they know best. We must realign responsibility for the Medicaid program so the federal government assumes a greater role in planning for, delivering and paying for services for the elderly - especially long-term care services - and states take on greater responsibility for caring for those under 65.

Further, we must ensure that the Medicaid program is nimble enough to enable states to address the needs of different populations differently. Taking advantage of this agility, states should create options for families and target chronic and serious needs.

States should offer Medicaid families more options for meeting their healthcare needs, including helping them obtain commercial insurance by providing subsidies to cover the cost of participating in employer-based programs. States also should provide more coordinated, comprehensive and targeted care for individuals with chronic needs and other serious illnesses, through care management programs and other creative options.

Medicaid does not efficiently encourage individuals to play an active role in their healthcare. First, Medicaid must empower individuals to take more control of their healthcare. To achieve this, we must methodically identify and examine barriers to empowerment and engagement in the healthcare process; improve the infrastructure of the Medicaid program to ensure that each individual has a healthcare home and receives care in a less fragmented manner; and recognize the value of and appropriately reimburse health literacy and other programs that promote prevention and wellness.

Medicaid payment structures and technologies are outdated. States must be encouraged to recognize and reward high-quality care and improved outcomes. Steps must be taken to facilitate the implementation of new technologies, such as health information technology and electronic medical records, to achieve efficiency and improve quality across the Medicaid care continuum.

Medicaid is not doing its share to address the problem of the uninsured. States must be encouraged to expand Medicaid coverage to lessen the strain on our healthcare safety net. Medicaid must do a better job of supporting state and local efforts to develop creative options for covering the uninsured, through public-private partnerships and otherwise.

If we can enable the Medicaid program to meet diverse needs more adequately, empower individuals to play a more active role in their care, update core structures and play a greater role in addressing the problem of the uninsured, we will have taken great strides toward reform and building a better healthcare system.

However, enacting real change requires the passion and initiative of dedicated individuals. Healthcare leaders must begin to push for substantive changes to our nation's Medicaid program.

Tommy Thompson is the former Secretary of the Department of Health and Human Services.