Friday, March 27, 2009

Medicaid Agencies ARE Public Health Agencies

We all remember the Golden Rule from our childhood days, "do unto others as you would want them to do unto you." But all too often in health care, regretfully, it seems a different Golden Rule prevails, "He or she with the gold, rules."

What got me thinking about this was some recent debate in the state of Florida about merging the Agency that oversees Medicaid and the Agency that oversees Public Health (as reported by Florida Health News). Apparently, leaders in the Florida Legislature think that the missions of these two agencies are mutually exclusive. To me, that just does not make sense and is further evidence that the current Medicaid program is not a model we want to expand as part of any major reform effort.

Government speeches are not typically the kind of thing to get excited about and in my five years at CMS, I can remember only one that fits this bill. In a speech given by Dr. Mark McClellan back in 2004, he stated that CMS was a public health agency, "seeking to use its influence, reimbursement systems, regulatory authority and leadership to seek widespread transformation of the United States healthcare system in order to meet the six [IOM] goals." [see CMS Quality Roadmap]

It may seem self-evident now but at the time, this was a pretty radical concept and the culture change at CMS is a work in progress but as they say "acknowledging you have a problem is the first step to recovery." Fact is, STATE MEDICAID PROGRAMS AND CMS ARE PUBLIC HEALTH AGENCIES by virtue (or vice) of the other Golden Rule, "he or she with the gold, rules."

Even though some states are ahead of this curve in that they have a "strategic plan" including public health objectives and various strategies and tactics (including Medicaid) to achieve those objectives, most do not. It is time for all states to transform their Medicaid programs from "claims payment shops" to purchasers of high value care so that increasingly limited resources can stretch farther and provide for the health of the Public. ~BAA