Call it what you want, but it's costly and it's risky to taxpayers—county based purchasing. With all that is happening throughout the nation (doctors wanting to unionize, HMOs dropping costly services, Patients Bill of Rights, Hospitals specializing in more profit procedures, and prescription drug costs skyrocketing), why would a county want to enter the medical services provider business? Reasons given are usually 1) better service and 2) cost savings.

Janice has argued continually (see RRR, June/July/Aug 1998) that Community Human Services staff already has the capability to coordinate health and human services and deliver better services.

As to cost saving and revenue generating, the application for waivers to do county based purchasing hit a major bump (some Commissioners believe a minor bump) when Health Care Finance Administration (HCFA) noted their reluctance to speed up the decision making process at the money end. Mary Mahoney, Director, Office for Integrated Care Management, reported on a conference call with HCFA. Four questions were raised: 1) whether the plan falls under the federal requirements for competitive procurement; 2) whether or not the model being proposed interferes with consumer choice; 3) the impact on the administrative system; and 4) general comments about whether a state-wide waiver would be granted for the state to do this type of model anywhere, or if they would prefer site-specific project waivers. Mahoney said, "Her observations from the conference call are that the federal government considers this proposal to fall under the competitive procurement requirements... Detailed justification will be needed about why this model is preferable to competitive bidding at the state..." In addition, HCFA indicated dollars saved would remain their dollars.

Janice believes that the hand writing on the wall tells the county there is little to no chance that this will produce revenue (the HMOs didn't); that there will be risk to county tax dollars because of county's need to act as the safety net; and, a duplication of administration dollars is guaranteed. According to Mahoney's estimate, administrative, set-up costs, and the application process will cost $1.7 million through the year 2000. Commissioner Guerin moved, seconded by Janice that Ramsey County discontinues pursuing Integrated Health Care. The motion failed 2-5.

"The final document (resolution) should have opt-outs for the county," Janice said.

Call it Managed Health Care, County Based Purchasing, or Integrated Health Care, it quacks the same. Without a waiver to by-pass competitive bidding, it's just treading water... More updates to come.

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