October 13, 2011 - CNBC
By The Associated Press
CHARLESTON, W.Va. - With chronically ill West Virginians accounting for at least three-fourths of health spending in the state, coordinating their care can do much to ease the rise in such costs, an Emory University professor told a House-Senate committee studying the issue Tuesday.
Kenneth Thorpe, chair of Emory's Rollins School of Public Health, also recommended expanding a diet, exercise and lifestyle program that he said has prevented adult-onset diabetes and can provide similar results against other chronic illnesses.
"Both of these things are important capacity-building investments that I think at the end of the day are going to prove to have very substantial dividends," Thorpe told the Joint Committee on Health.
The Legislature and the governor's office hired Thorpe to review health care spending in West Virginia. Around 17 percent of residents are covered by Medicaid, the state-federal health care program for the poor and disabled. Only 11 states have a higher percentage of residents on Medicaid, according to the latest federal figures.
With medical inflation increasing faster than other forms of inflation, rising Medicaid costs are a key reason behind state budget growth. But at least half of the people who rely on Medicaid receive no help managing their care, Thorpe said. That leads to unnecessary visits to emergency rooms, otherwise preventable stays or return trips to the hospital, and similarly needless drains on the health care system, he said.
Thorpe offered a dour picture of the typical chronically ill West Virginian: an overweight adult with diabetes, hypertension, bad cholesterol, asthma, back problems, pulmonary disease and depression.
"They're probably seeing a couple of physicians, a couple of specialists and are on 10 to 15 medications," Thorpe said.
Some of the state's community clinics already have teams of doctors, nurses, pharmacists and other professionals who help these people manage their prescriptions and stay out of the hospital. Studies show that this approach works, he said.
"What we've seen from the data is that quality improves and costs go down," he told lawmakers. "We'll actually save money in the program by doing this."
West Virginia can apply to amend its Medicaid plan to expand such teams statewide, and the federal government would cover 90 percent of the resulting costs, Thorpe said. These teams also create jobs by requiring more health care-related positions, while increasing need for training programs at the state's technical and community colleges, he said.
Thorpe said West Virginia's share of obese adults and children has more than doubled since the mid-1980s, contributing greatly to the prevalence of chronic illness. The resulting rise in adult-onset or Type 2 diabetes alone accounts for 10 percent of the growth in health care spending, Thorpe said.
Thorpe noted that state health officials recently landed a $1.8 million federal grant to promote the diabetes prevention plan. While more funding is needed, this plan greatly cuts a person's likelihood of ending up with diabetes even with modest weight loss, he said.
West Virginia should embrace both recommendations before the federal health care overhaul adds an estimated 170,000 people to its Medicaid rolls, Thorpe said. He added that these proposals can also benefit Medicare, which offers no coordinated care, as well as the private insurers.
Thorpe said lawmakers otherwise face cutting Medicaid services or payments to providers to address the rising costs.
"If you continue to cut payment rates to hospitals, that puts pressure on the cost of private health insurance," Thorpe said. "Hospitals are going to look for ways to offset those cuts to the Medicaid program by increasing prices to privately insured patients. So I think that this investment is critical, and to have it done as thoughtfully and expeditiously as possible and engage as many individuals in the Medicaid program as we can."