MANAGED HEALTH CARE: Wise or Foolish?

The Omnibus Health and Human Services Bill of 1997 allow counties the option "…to act as the manager of health care for persons on Medical Assistance and General Assistance Medical Care and who are enrolled in Prepaid Medical Assistance Program…." If done, Ramsey County would assume responsibility for the provisions of health care services for approximately 60,000 individuals and a budget of roughly Four Hundred Million dollars ($400,000,000). Fifty percent of the dollars are county levy dollars.

The Health Care Planning Team of Ramsey County has been developing an all inclusive Managed Care Service Delivery Model. The components of the model are—"ensuring access to services, good financial management systems, information and quality assurance systems, and distribution of risk…." So is this wise or foolish? Early on Janice said:

"Should we be getting into the health care provider business or is this something that should remain in the private sector? Almost daily you can read an article in the newspaper about rising health cost; and how they are totally uncontrollable by HMOs and other health providers. Before we take on this new responsibility, I want some assurances that funding dollars from the state and federal grants continue, and that the obligation to continue providing services do not pass without funding. If it happens without funding, the county will be having to raise taxes to cover the short fall."

At the Board meeting of August 12th, Janice expressed her concerns:

"1) Why does the State want to pass on managed care to the counties? Did they have difficulties controlling cost? and 2) Are we being led down a ‘slippery slope’ that will get us into a ‘business’ where we ought not to be? At this time I am going to vote no. I realize that you have enough support to go forward with the application process and I remain open to more study of the issue… Folks, let’s make sure that we stay focused on our ‘Human Services’ responsibilities…."

The vote was for Ramsey County to make a preliminary application to become the County Based Purchasing Authority. The Health Care Planning Team argues they can provide a better health care delivery system that is more cost effective and that will produce revenue for the county; (i.e., reduce tax levy dollars or purchase more services.) At the October 28th County Board meeting adopted the "Multi-tract Delivery Model." which is to: 1) take advantage of the strengths of the current health care provider networks, 2) share risk with the private sector, and 3) create opportunities to establish new, more cost effective means of delivering medical and social services to high needs/high cost citizens…." There are many pros and cons. What do YOU think? Let us know.

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