Blunt plan would emphasize prevention, rename Medicaid

JEFFERSON CITY, Mo. -- Missouri's health-care program for the poor would gain a new emphasis on personal responsibility, a new focus on preventing health problems and even a new name, under a plan being developed by Gov. Matt Blunt's administration.

The proposed successor to the present Medicaid program is tentatively dubbed Missouri Healthnet. Blunt's staff is to release its recommendations in December, and the governor is to present it for legislative consideration in 2007.

The state is under pressure to develop something soon because the Missouri Medicaid program, as it now exists, is to end by July 1, 2008. Medicaid had 828,802 enrollees as of September -- down 175,000 from its March 2005 peak before the Republican governor and legislature cut eligibility and benefits as a way to save money.

Blunt and his staff have given general previews of the still-evolving plan to select health-care interests and legislative leaders over the past couple months. One thing apparently not in Blunt's plan are additional cuts in Medicaid eligibility, though patients may have to change the way they get their health care.

At the core is the philosophy of a patient as a participant in -- as opposed to a mere recipient of -- health care in a program "that manages health and not just manages emergencies," Blunt spokeswoman Jessica Robinson said Friday.

"It's going to be a new and better program, so it's appropriate it have a new name," she said.

Although the governor's office has given nine private presentations about the plan to small groups and individuals, none has been exactly the same because the plan keeps changing.

"I think what the governor's office was interested in was a reaction to the broad concepts -- things like Medicaid reform, disease management and transparency in quality information and cost information," said Dwight Fine, senior vice president for governmental relations for the Missouri Hospital Association, who was briefed on the plan along with some hospital executives.

"I didn't see anything that sounded like cuts in benefits or eligibility, but looking at better ways to manage the cost of the population," Fine added.

Tom Holloway, a lobbyist for the Missouri State Medical Association, said Blunt told him that higher payments to medical providers would be part of the package, as would an emphasis on electronic medical records and better coordination of care. One way to accomplish that could be to require participants to have a primary care physician -- as already is the case in many private insurance plans.

Many of the concepts in Blunt's plan are similar to the recommendations included last year in a 76-page report by the legislature's special Medicaid Reform Commission.

"But there weren't a lot of details" during Blunt's presentation, Holloway said.

Blunt's staff members showed the St. Louis Post-Dispatch a set of slides outlining the draft Thursday in response to a Sunshine Law request by the newspaper. But the governor's office would not release an electronic or paper copy of the slides, contending the proposal is not a public document.

The slides envision a program in which participants would apply over the Internet, use a state rating system to pick a doctor, receive benefits tailored to their health situation and be rewarded for good habits. Patients who followed their plan of care could receive enhanced benefits, such as vision or dental care.

They also could be asked to fill out questionnaires assessing their health risks. If they try to reduce those risks, like by losing weight or quitting smoking, they could be rewarded -- perhaps with a debit card that could be used to buy such things as medical equipment. State employees already have a similar incentive on their health-care plan.

The slide presentation also envisions the creation of a "five-star program" to rate medical providers who produce the "best outcome."