Community Partners to Assist Medicaid Beneficiaries

Preventive health services ensure people are seeking care before their conditions are critical or urgent in nature. As healthcare services for Medicaid and Medicare beneficiaries expand under the Affordable Care Act, so will the need for professionals who can administer certain preventive measures.

In Philadelphia, PA, a recent federal decision will permit trained professionals—who may not be healthcare providers—to become members of a healthcare team and provide preventive services to Medicaid and Children’s Health Insurance Program (CHIP) participants with asthma. A doctor or nurse practitioner would recommend patients to a trained individual who would then be reimbursed for their services. These new partnerships intend to reduce costs, and improve the effectiveness of healthcare teams, as they reduce the strain of increased patient loads on doctors.

“Many doctors don't have time to spend instructing each patient/family in how to take care of chronic disease. By being able to recommend and work with trained professionals, providers will have partners who can help families better understand the condition, identify and remove triggers, and ensure correct use of medicines and equipment,” said Dr Floyd Malveaux, executive director of the Merck Childhood Asthma Network and a member of the Childhood Asthma Leadership Coalition. “Since half of Medicaid recipients are children, those with poorly controlled asthma will also have better access to community- and home-based services.”

Stephen Cha, MD, MHS, chief medical officer for the Center on Medicaid and CHIP Services, adds how other states are focusing on this effort. Oregon is already utilizing community health workers to lessen strain on doctors of administering preventive health services, and Massachusetts is also emphasizing asthma prevention as a targeted area of healthcare administration.

“Prevention is critical to improving care and lowering costs in our country’s health care system," Dr Cha wrote in recent article examining CMS’s efforts of expanding Medicare preventive measures. “CMS is working hard with states and providers to increase access to comprehensive preventive care for all Medicaid beneficiaries.”

Around the Web

Change Could Aid Kids with Asthma [Philly.com]

Preventive Care For All Medicaid Enrollees [Health Affairs]