Senate Aging Committee Focuses on Medicaid Managed Care

September 15, 2006
Philadelphia, PA - On September 13, the Senate Special Committee on Aging held a roundtable discussion focusing on opportunities for expanding Medicaid managed care to serve high-need, high-cost populations including dual eligibles, the disabled, and persons with multiple chronic conditions.

Sen. Gordon Smith (R-OR), chairman of the committee, indicated that this was the first in a series of roundtable discussions that will focus on developing solutions for strengthening the Medicaid program. While Smith is not planning to pursue legislation this year, he urged the panelists and other interested parties to work with his staff in the coming months to develop a legislative proposal that will encourage states to expand managed care for vulnerable populations, while also ensuring that necessary safeguards are in place.

Daniel Hilferty, President and CEO of AmeriHealth Mercy and Keystone Mercy Health Plans, was one of the panelists in the September 13 forum. Hilferty's testimony emphasized that AmeriHealth Mercy has been serving the Medicaid population for 23 years and has improved quality of care, access to care, and efficiency through innovative approaches to care management, collaborative provider arrangements, community outreach, and enhanced technology.

Hilferty discussed his company's PerforMED initiative, which uses predictive modeling to determine which Medicaid beneficiaries will be high utilizers of health care services and intervenes pro-actively to reduce preventable acute care episodes for these individuals. Another AmeriHealth Mercy initiative, Healthy Hoops, helps asthmatic children and their families manage their condition through appropriate medication usage, proper nutrition, monitored exercise, and recreational activities. In 2004, this initiative reduce emergency room admissions by 63 percent and sleep disturbances by 70 percent.

While reviewing the positive impact of these and other Medicaid managed care initiatives, Hilferty pointed to a study by The Lewin Group, which concluded that Pennsylvania has received $2.7 billion in cost savings over five years through the innovative practices of Medicaid managed care plans. He noted that another Lewin study projects that expanding managed care capitation to Medicaid on a nationwide basis would yield savings of $83 billion over ten years.

Other participants in the roundtable discussion included representatives of the Arizona Health Care Cost Containment System, Families USA, the Health Policy Institute of Georgetown University, the National Association of Community Health Centers, and CareOregon.