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Redesigning Medicaid is the Only Way to Improve Health Care in America

by Vanessa Jones on April 1, 2015 at 4:37 PM
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Redesigning Medicaid is the Only Way to Improve Health Care in America

Medicaid, first created in 1965, provides healthcare coverage for 68 million Americans. This program is meant for lower income Americans and it is the largest source of health coverage in the United States. A great deal of growth in health coverage under Obamacare is due to expansion of Medicaid in many states.

Yet the Medicaid program has not seen any changes after it originated in 1965. Patients still receive basic primary care along with some acute care services when they are sick - usually due to problems which could have been sorted out at the initial stage if there were enough caregivers. Due to poor access to care, a condition which could have been contained is now exaggerated and will need more attention. There is little that aims to protect and preserve the health of patients and is designed to meet their special needs of the population that receives Medicaid.


Redesigning the Medicaid program may embody the prospects of improving healthcare in the United States, which represents the single greatest opportunity to improve health care in the country. Over the past year, CareMore and Amerigroup, which are two subsidiaries of Anthem, have collaborated to launch a new model in Memphis, Tennessee, that began providing care for 14,400 Medicaid members last January 1. In addition to providing traditional health care coverage, they have built a number of innovations to meet the specific needs of Medicaid beneficiaries.

The primary care in America lacks programs which can deal with chronic ailments of their patients, Comprehensive care centers with integrated primary care. Medicaid is a program where care is usually given through sporadic visits. Off-site, telephonic, disease-management programs have rarely been successful because they are detached from patients' primary care physicians and nurses.

In Tennessee, to help people in the Medicaid program, there are now 3 comprehensive care centers. Here patients are assigned to primary care nurse practitioners, who have access to a number of 'on the site' disease management programs. They help patients manage their individual medical conditions with the help of specialized medical assistants and nurses.

Once eligible people enroll in the Medicaid program they participate in a 90 minute rally called "Healthy Start" which implies an assessment at a care center where the patient's physical, behavioral and cognitive health is assessed along with routine lab tests and bio-metrics. These tests help to identify patients who face health risks and steps are taken to reduce them at initial stages. Patients are quizzed about their health habits and past medical conditions. The Healthy Start approach helps patients to use services at the Care Center, to better manage their health. Sometimes undiagnosed illnesses found can be treated before they reach a state of emergency.

Caremore has built an integrated approach to manage both chronic diseases along with depression and anxiety. Medicaid patients are known to use emergency rooms because of poor access to primary care services - these hospital visits can be very costly. Caremore and Amerigroup have strategically placed comprehensive care centers across Memphis. People can access care over here from 7a.m to 7 p.m.

Remaking American health care will require a lot of reprogramming with health insurance programs and integrating them as health care delivery platforms. Memphis may play the role model for other states to help patients in the Medicaid program.

Source: Sachin H Jain and Leeba Lessin

Source: Medindia

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