Medicaid Agencies Should try to Avoid Spinning Too Many Plates | Deloitte US has been saved
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By Jim Hardy, specialist executive, State Health Transformation Services, Deloitte Consulting LLP
I might be dating myself here, but I can remember watching the Ed Sullivan show as a kid on Sunday nights. Aside from musical acts like the Doors and the Beatles, one of my favorite performers was a plate-spinner named Erich Brenn. It was mesmerizing to watch him frenetically race around the stage…using physics and timing to stay a step ahead of gravity. Brenn’s skill at keeping multiple bowls and dinner plates spinning on top of poles and on tables became synonymous with multi-tasking. He probably would have been an exceptional Medicaid director.
Consider all of the plates that Medicaid directors are spinning today: Value-based purchasing, chronic-disease management, dual-eligible integration, patient-centered medical homes, cost-containment programs for prescription drugs, social determinants of health, and community engagement initiatives. While some of these new initiatives might improve patient outcomes and member experience, they also can pull resources and focus from existing programs. But deciding not to take on a new project might be tougher than starting one—particularly if there is pressure from stakeholders, the legislature, or the governor’s office.
When I was Medicaid director in Pennsylvania, I limited the number of strategic initiatives we took on to no more than three at any given time. I can remember having a challenging budget year and we were under tremendous pressure to cut costs. We stopped working on small projects and chose three large initiatives that would have the biggest impact. We focused our resources on implementing our preferred drug list, launched an enhanced primary care management program, and instituted a hospital quality program. Resisting the temptation to take on other projects was sometimes difficult, but staying narrowly focused helped us achieve our goals. I recommend taking this approach to all health care leaders who are constantly spinning plates or juggling investment decisions.
Four recommendations Medicaid leaders should consider
Most state Medicaid agencies are perpetually trying to come up with strategies to make their programs run more effectively. At the same time, they are typically dealing with constant budget pressure, and a desire to create more value for beneficiaries and taxpayers. But managing multiple programs, and regularly evaluating them, can be daunting, particularly if new initiatives are coming on line. Consider these four strategies:
Taking on additional initiatives is nothing new in Medicaid, but it seems like many Medicaid directors have more plates spinning than ever. For any health care stakeholder, too many plates can create a backlog and a strain on the agency as staff members run from one initiative to the next to make sure nothing drops. Before picking up the next plate to spin, Medicaid directors should consider taking a breath and a step back to assess existing programs.
Jim is Deloitte Consulting LLP’s Medicaid Advisory Services lead. Previously Pennsylvania’s Medicaid director, he has more than 20 years of Medicaid, health policy, reimbursement and rate development experience. Recently, Jim assisted in developing a state Medicaid care management strategy and long-term care reform strategy; assisted states with coverage initiatives; and led a hospital payment reform initiative for quality incentives and to reduce payment for avoidable re-admissions.