A Crisis is a Terrible Thing to Waste

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May 13, 2009 No Comments ›› admin

May 13, 2009

The news was grim. New numbers showed tax collections in April were down more than a third over the previous year. The Legislature’s Joint Finance committee postponed further action on the state budget. The Governor held a press conference.

Budget cuts and layoffs were announced. State employees would give back salaries by taking mandatory unpaid leave; programs would be eliminated or postponed. Agency budgets would be revised. More cuts would be made to schools and local government.

Wisconsin is not alone. Across the nation state leaders are cutting employees, programs and services. The National Conference of State Legislatures estimates states will have to take another $62 billion out of their budgets to make them balance – after states already cut $40 billion.

And tax payers don’t want new taxes.

People interrupted Mother’s Day activities to call me. “I don’t want to pay a new gas tax.” “We already pay enough in property tax.” “I want to see government run more efficiently!” 

I agree.

Let’s start with health care. How about finding a way to save money in Medicaid – the medical program for low-income people?

Health care delivery is provided in a fragmented, ineffective manner. Too often patients enter the health system through the Emergency Department; too often new mothers experience pregnancy complications; too often babies end up in intensive care. Too often care for chronic diseases are uncoordinated, duplicated or too expensive.

Let’s focus on primary care, wellness and prevention. How about assigning a primary care provider to every Medicaid and BadgerCare patient? And making sure they see the provider at least once a year?

We should think about how to take care of primary care problems in a primary care setting.  How about creating a toll free 24-7, nurse staffed hotline to help make decisions on when and if patients go to the Emergency Department.  According to the Hospital Association lowering Emergency Department use by just 25% in five disease areas (asthma, diabetes, chronic obstructive pulmonary disease and hypertension) could lower Medicaid costs by almost $2 million.

While we are thinking about Mother’s Day – let’s make sure those new moms are healthy. The most common reason Family Medicaid patients are hospitalized is birthing. Low birth weight infants, premature deliveries and birthing complications contribute to high Medicaid costs. We know prenatal care saves money and lives.  How about ensuring every pregnant woman has access to prenatal care?

By my rough math, Wisconsin could save $7 million if we could drop the C-Section rate from almost a quarter of all Medicaid births to 17%. Iowa was able to drop Medicaid C-Section rates to 12% in some HMOs. And cost savings doesn’t end there. Almost one quarter of all Family Medicaid hospital costs are related to pregnancy, birth and neonate care. Let’s have fewer infants in intensive care and fewer moms with pregnancy complications.

As we focus on prevention and wellness, what about treatment for those with substance abuse and mental illness?  Alcohol and drug dependency is a frequent reason for hospital admissions.

If half of all acute care alcohol and drug abuse admissions without rehabilitation were reduced through early detection and treatment, Medicaid could save almost $3 million.

Let’s expand the Screening, Brief Intervention, Referral to Treatment or similar alcohol and drug screening and intervention program to all Medicaid patients. Research shows early screening, brief intervention and follow-up can reduce alcohol and drug dependency. 

According to the WI Initiative to Promote Healthy Lifestyles, for every patient receiving screening and brief intervention services, the state saves nearly $1,000 in health care and criminal justice costs. Currently only ten to twenty percent of Wisconsin residents receive help for alcohol problems. We can do better than this.

Then when we finish reforming the Medicaid program, let’s start on the rest of the health care system. After all – a crisis is a terrible thing to waste.


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