What happens in Harrisburg doesn’t necessarily stay in Harrisburg. In fact, decisions our legislators make carry enormous consequences for us at home. As budget debates continue, Delaware County residents should be especially concerned about state plans to change the health-care delivery system for the neediest Pennsylvanians.

One proposal would transfer pharmacy services for Medicaid patients from managed-care organizations (MCOs) to the state Department of Public Welfare.

The state claims the plan will save money and help to close a budget hole. In reality, the plan will erode health-care and lead to higher medical costs.

Managed-care organizations provide health care to more than 300,000 people in southeastern Pennsylvania, including 52,000 residents in Delaware County. Separating drug coverage from health-care services disrupts the ability of MCOs to use medicines as a way to manage disease and reduce overall health-care costs. Similar plans have been defeated by the General Assembly for three straight years, with bipartisan support. Legislators would be wise to reject the plan again this year, too.

Another proposal would strip “pay-for-performance” provisions from the state budget. This is contrary to good health-care policy.

Managed-care organizations use the “pay-for-performance” funding to reimburse providers for extended office hours to increase access to care, or to implement electronic medical records.

The programs focus on increasing preventive, lower-cost care that not only improves consumers’ health status, but also ultimately leads to reduced use of more expensive emergency room and hospital services.

Eliminating the provisions limits managed-care organizations’ ability to invest in programs that improve medical outcomes and reduce the overall cost of health care.

Taxpayers lose and patient-care suffers.

Dr. JAY FELDSTEIN
Corporate Chief Medical Officer
Keystone Mercy Health Plan

From the Daily Times