How can New York save money on Medicaid coverage of mental health while safeguarding care for those who need it?
If Governor Cuomo wants New Yorks mental health Medicaid programs to be more efficient and effective, hiring a penny-pinching manager from Wisconsin isnt the cure hes looking for.
A better approach: if New Yorks costs are too high -- and they are -- then look beyond changes in management to do what only elected officials can do: change policy. New York should reconsider its entire service model, since many cost challenges have a great deal to do with New York being New York, and very little to do with Wisconsin being Wisconsin.
Many New York health programs are still old school, with a heavy focus on provider-based financing and expensive institutional care. The states mental health needs are also concentrated in one of the most costly real estate and salary markets in the world, so New Yorks service model spends a disproportionate share of funding on bricks, mortar and institutional management. A thoughtful plan to move more care out into the community can save millions -- and actually improve care for many patients.
As candidate Cuomo, the governor agreed that financial decisions in Medicaid were often micromanaged by politicians. But micromanagement by one bureaucrat new to New Yorks system could be just as cumbersome as micromanagement from the Legislature.
Im a psychiatrist, so I know “patient choice” isnt a sensible approach for many mental health patients. But it can work for some. Patient-centered funding models can improve care and cut costs for many others.
For example, in 2010, New Yorks Corporation on Supportive Housing argued that mental health patients who are persistently homeless cost the system a great deal as patients seek access to services in a sort of “institutional circuit.” The corporations argument: developing programs to target community-based services at individual patients (as opposed to funding the institutions they arrive at) can be more cost-effective. Theyre right.
The only thing stopping New York from taking this approach more often is Albanys persistent habit of micromanaging programs based on political -- or departmental -- priorities, instead of building care supports efficiently around patients, services and outcomes.
Original Source: http://www.nytimes.com/roomfordebate/2011/01/09/medicaid-and-mental-health-how-can-fraud-be-contained/help-medicaid-patients-not-politicians