State Medicaid a model for reform - The Explorer: Editorials

State Medicaid a model for reform

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Posted: Tuesday, October 27, 2009 11:00 pm | Updated: 1:24 pm, Mon Apr 18, 2011.

As a physician legislator, I have the opportunity to scrutinize almost every program that Arizona funds.

One of the largest is our state Medicaid program, AHCCCS. In the hospital, I treat many AHCCCS patients, but the more I learn about AHCCCS in the Legislature, the more impressed I am with the program. Arizona might be sitting on the solution to our national health reform debate.

The Arizona Health Care Cost Containment System was created in the 1980s to serve as our state Medicaid program. The last state to establish such a program, Arizona utilized a new model that had not been previously attempted – managed care instead of fee-for-service. This setup relies upon a partnership between the state and private health plans. The health plans have a profit cap and voluntarily bid for contracts. The winning bidder receives a large guaranteed pool of patients.

AHCCCS eligible patients get to choose an available health plan in their region and a primary care provider. More than 80 percent of the primary care doctors in Arizona are contracted. Prescription drug coverage is broad and low-cost. AHCCCS members can go to just about any hospital when needed. About 1.3 million Arizonans, 20 percent of our population, rely upon AHCCCS for their health coverage.

Unfortunately, some people assume care provided through AHCCCS is of low quality. That assumption is absolutely wrong. AHCCCS covers Arizonans with a remarkable degree of quality and efficiency. In fact, the benefit package for AHCCCS members is as good as or better than most private plans.

Furthermore, AHCCCS requires contracted health plans to focus on prevention, including weight management, immunizations, cancer screenings, blood pressure, cholesterol and diabetes checks. This keeps patients out of the hospital, saving money in the long run.

The Kaiser Foundation recently ranked AHCCCS as the least expensive to operate of all 50 state Medicaid programs, citing the low cost per member per month. Combined with the impressive set of benefits AHCCCS provides, Arizona taxpayers receive the most bang for their buck. Overhead costs are among the lowest in the nation at only 3.3 percent and provider reimbursement rates are surprisingly competitive.

We have in AHCCCS an efficient government program that provides excellent coverage to qualified families through a public-private partnership within a health insurance exchange that has won national recognition for its success. AHCCCS has been working well for the people of Arizona for more than two decades. This model for health care delivery works. Health reform proponents would be well served to closely examine AHCCCS and learn from its accomplishments.

One of my patients recently shared his thoughts about health reform from his hospital bed saying, "It's time for the human family to come together and take care of itself." I appreciated the compassion and civility in his words as he assessed our ongoing efforts. If we truly are committed to resolving the problems facing our health system in a meaningful way, we will keep the focus on patients and people and we will come to a solution. I suggest that we look to AHCCCS as a proven, efficient model for national health reform.

Rep. Matt Heinz represents District 29 in the Arizona House. He is a Democrat and physician. E-mail Matt Heinz at mheinz@azleg.gov

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