Executive office update: The fork in the Medicaid road

Tuesday, January 01, 2013 12:07 AM

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

Medicaid as we know it could soon go the way of the dinosaur. The federal package is on the table and is now politically viable after the November elections. Over the course of the next six months our state legislators and the executive branch have the opportunity to build what hasn’t been politically possible since the program’s inception decades ago.

Many physicians are understandably cautious about the growth of Medicaid, given the sheer enormity of the task of transforming the program into a high-performing delivery system. This enormous undertaking, already well underway in the Hickenlooper Administration and heading in the right direction, will soon be considered by a state legislature that is philosophically predisposed to expansion and reform. The process won’t be short of spirited dissents and competing proposals. With more than 35 freshmen and 22 sophomores, a plurality of the legislature will be participating in first-time policy debates on a subject of immense complexity. The consensus medical view reflected in statewide polls, listening sessions at September’s Annual Meeting and in other physician forums is for CMS to be there, on the ground, in the Capitol, and fully engaged.

We will press for the operational reforms that are critical to assuring that an expansion will be sustainable. After lengthy discussions, our public policy committees took the point of view that our perspectives will have more credibility if we are at the table, not holding our cards until later in the debate. Our approach will be less political and more practical in nature. For our ideas and knowledge to have consequences at this tipping point in health care delivery, there is no more waiting for things to gel. The pot is boiling.

There has been extensive preparation for this once-in-a-career opportunity by both CMS and an impressive array of health policy advocates, experts and thought leaders. In September 2005 the House of Delegates first directed CMS to develop strategies to bridge the gap between Colorado’s insured and uninsured, putting us on the field pressing the case for what became Senate Bill 208, which was enacted and signed into law by then Governor Bill Owens. This work evolved into the bipartisan, broad spectrum 208 Blue Ribbon Commission. Their remarkable, voluminous piece of work preceded by several years the federal reforms embodied in the Affordable Care Act. Its wisdom and recommendations should be of considerable value to legislators and advocates with regard to what works, what might, what won’t and most importantly, the interdependence of the moving parts.

We have been doing our homework. As Congress fiercely debated the role of government and commercial markets in care delivery, we pulled together our own Physicians’ Congress for Health System Reform and methodically built a matrix of system components to be measured against the congressional models. We have helped build coalitions to champion patient safety, managed care operational innovations, and care coordination initiatives of national prominence, just to mention a few of our more prominent efforts.

There will inevitably be some tough choices and trade-offs in the coming months. Cost containment won’t be missing from the state package. There will be the usual poison pills to reject, and well-intentioned ideas that we know from experience have a half-life of a few years. But as Yogi says, “When the road forks, take it.”