Stop costing so much!!
Posted on May 25, 2012 by Kirsten Dunham
It sometimes sounds like people with disabilities and seniors who have chronic conditions or complex health situations are getting the blame for costing our health care system so much. You hear it at presentations - “people with disabilities and seniors make up 20% of the Medicaid enrollment but use 80% of the Medicaid dollars” (roughly speaking). There are several new models of care delivery and payment systems, many targeted at the “high cost” health care consumers. When you consider the reality of population growth and constantly rising health care costs, clearly there is a need to address this issue to reduce the pressure of health care costs on our economy and our family budgets. What can make one nervous is how the problem is addressed. Many responses so far have not given much hope to people who need to use a lot of health care, particularly people using public health care like Medicaid. We read about proposal like mandatory managed care for Medicaid participants and limits on hours of personal attendant services.
So if we have a shared interest in controlling health care costs, where does the responsibility lie? Is up to the individual to make behavioral changes to improve one’s health? It is extremely challenging to find a gym that has an accessible facility AND accessible equipment. That is one reason there is a waiting list for Paraquad’s gym. Do family members need to provide even more free care to aging family members instead of getting assistance? Giving up income to stay home is not realistic for most families. And while driving a neighbor to church is a reasonable expectation, it is another matter entirely to assist with a toileting routine. Is it a matter of doctors and other health professionals communicating better so medications don’t interact? Will free preventive services help? Certainly those changes can prevent hospitalizations and serious health conditions. But there are factors beyond individuals’ and doctors’ control – genetics, environmental hazards, side effects and long-term consequences of life-saving treatments and medications, accidents just to name a few.
I’m not saying all this to be a stick-in-the-mud who thinks nothing will work. There is a lot that needs to happen to remove barriers to quality health care for people with disabilities and seniors. What I’m worried about is if things change without people with disabilities, people who need a lot of health care, and family members being a part of the conversation. A lot of change has to happen at the national, state and community levels, and we need the voices and the experience of people who are frequently navigating the health care system. People with personal stories have lots of examples about how time and money can be saved, the process can be streamlined, care can be improved, they can be more in control of their care and what supports they need to be more healthy. Including and considering the experiences of people with chronic conditions or complex health needs can help analyze proposals and avoid harmful consequences of policy decisions.
There is a shared responsibility to achieve affordable, quality health care coverage and to create healthy communities. Missouri has implemented a “health home” program which will provide care coordination through a primary care provider or a community mental health center. A team will work with the participant and encourage him or her to be active in his or her care. There is an opportunity for savings to the state, but the focus must always be on the quality of care and improving health. Paraquad submitted comments, including strong recommendations for consumer direction of care and meaningful consumer input in the evaluation and improvement of the program. Help us make sure our politicians don’t try to reduce the solution to a simple command “Stop costing so much!”. Share your stories and ideas to improve care coordination and health outcomes without sacrificing necessary medical care.