From The Patriot News -

Health care reform in Pennsylvania must include access to quality care while containing costs, especially for the most vulnerable among us.

Many of the patients we serve at Hamilton Health Center in Harrisburg are on medical assistance. When our primary care physicians need to coordinate care for our patients, they contact the Medicaid managed care case manager, who is responsible for ensuring that all health care needs of their members are met, including prescription drugs.

If the Legislature approves a drug benefit "carve-out," as proposed by the governor, the state Department of Welfare will be responsible for prescription drug coverage. Physicians will then have to contact DPW in addition to the managed care case manager to address patient health care needs, creating greater challenges and roadblocks to successfully coordinating care.

Carve-outs aren't new to managed care; currently there is a behavioral carve-out with mental health and substance abuse services managed by an organization other than primary health care services. Two bureaucracies have been developed to manage one person's problem. IF THE pharmacy carve-out is approved, we'll have three bureaucracies -- one for physical health, one for behavioral health and one for prescriptions.

The justification for the carve-out is to save taxpayer money by claiming a rebate from the federal government. One has to wonder how much money will really be saved once state staff is hired to manage prescription drug coverage and what impact this change will have on the quality of care provided.

Why is it that, rather than creating systems of care that address individual needs, we create bureaucracies that force our most vulnerable citizens to navigate multiple systems? Clearly, we all need to be concerned about maximizing cost effectiveness but I urge the Legislature and the governor to challenge the existing system to find ways to reduce the cost of care rather than developing additional government processes that will eventually cost the taxpayers more money.

My 30-plus years of health care experience has shown that when insurers, providers and government work together, the commonwealth can save money while improving the quality of care. Let's find the solution that best serves our citizens.

JEANNINE PETERSON is CEO of Hamilton Health Center Inc.