In 2013, Ohio approved Medicaid expansion. Since then, Cleveland Clinic, like some other hospitals in the state, has experienced an increase in its Medicaid patient population, growing to 12% of the overall patient population. These patients receive the same level of care as patients insured by commercial payers, says Gregory Rosencrance, MD, FACP, Chairman of the Cleveland Clinic’s Medicine Institute.
Rosencrance is among the 35% of respondents to the most recent NEJM Catalyst New Marketplace survey of Insights Council members who say their organization always provides equal care to Medicaid patients.
But the larger volume is not without impact. Rosencrance says, “The shift to government payers drives the organization to find more efficiencies across the board.”
How Medicaid Helps Care
Rosencrance is among the 34% of survey respondents who say that Medicaid patients are establishing regular sources of preventative care and are better able to access and comply with prescribed therapies, though he says there is still a long way to go.
“I think more Medicaid recipients identified a personal physician, skipped medication less often because of cost, and have more health maintenance screenings done,” he says. “These are very positive aspects of Medicaid expansion.”
As Medicaid expansion matures, he is optimistic that patients will learn how to utilize the system appropriately, including shifting away from emergency room visits and hospitalizations to primary care and outpatient visits.
But Rosencrance says the burden is shared between providers and payers to educate patients on their benefits. “Medicaid is a long-term play and will take years to change behaviors,” he says.
Lack of Clarity on Coverage
Lynda Young, MD, Ambulatory Physician Leader in Pediatrics at UMass Memorial Health Care and Clinical Professor of Pediatrics at UMass Medical School in Worcester, Massachusetts, works with a younger Medicaid population. The overall patient population at UMass Memorial Health Care includes 45% Medicaid subscribers, says Young (who is past President of the Massachusetts Medical Society, which owns NEJM Group, the publisher of NEJM Catalyst).
“For pediatrics, it’s easier if patients are on Medicaid,” she says, explaining that there is not much cost to the patient versus self-pay or some employer-negotiated contracts. Therefore, families are more likely to follow through on her treatment plans for the patient. “Some of the managed Medicaid contracts have narrow networks, so I have to be careful where I refer patients,” she says. For instance, the mental health provider embedded in her clinic can only see patients on certain Medicaid plans.
Young says that while the UMass health system always provides the same level of care to Medicaid patients as to others, patients don’t always understand the care they can get. “Our patients know they have a Medicaid card and can get care; they just don’t know the nuances,” she says. For instance, parents know they can get their child necessary vaccines but sometimes aren’t aware that they are covered for preventative primary care.
Although the NEJM Catalyst report on Medicaid concludes that the program suffers major shortcomings, Medicaid is essential in U.S. health care, says Young, pointing out that “40% of our children in America are covered by Medicaid programs!”