S.C. Medicaid reform aims for healthier future

The current national dialogue concerning access to health care is a welcome development. But one question that rarely gets asked is whether those who do have health insurance are using the system of health care wisely. For physicians who treat a large number of Medicaid patients, the answer to that question is often as resounding “no.”

Of the some 35,000 children in my Darlington and Florence practice, a little less than half are enrolled in the Medicaid program, which provides health insurance to the state’s poor. Many of the families of Medicaid eligible children we treat seek only sporadic care at best. It is not entirely their fault. The Medicaid program has not served as a coordinating influence that helps people navigate the health care system. Under the traditional “fee-for service” Medicaid, patients can seek care from multiple doctors and specialists without any referral from, or even the knowledge of, their primary care physician.

Far too many parents automatically take their children to hospital emergency rooms for common illnesses such as ear infections and cold, despite the fact that many practices like ours have expanded hours to accommodate patients. This often leads to a large number of unnecessary — not to mention very expensive — medical tests being performed in emergency rooms.

This pattern of disjointed treatment puts both the physician and the patient at a disadvantage. How can a physician provide effective care to patients who can’t recall what medications they may be taking, or what other doctors they may have visited? In these cases, access alone is not translating into good health outcomes. My practice, like many others across South Carolina, is seeing an alarming number of instances of childhood obesity, diabetes, depression and conduct disorders. The ramifications of these problems span well beyond individual families since all taxpayers shoulder the burden of poor health outcomes.

This is why I am encouraged that the South Carolina Department of Health and Human Services has launched a new program to align Medicaid recipients with a stable medical home. The program, called Healthy Connections Choices, gives recipients the opportunity to join one of several Managed Care Organizations or Medical Homes Networks. The goal is to increase coordination through a primary care physician who serves as a gatekeeper for appropriate care. Those enrolled with Healthy Connections Choices also have access to special benefits and incentives that encourage routine health maintenance.

Here’s one example where an organized managed care network can help: during the past several years we have seen a decrease in childhood immunization rates in our state. This alarming trend can be reversed only if more parents seek consistent treatment for their children through primary care physicians they know and trust.

I do not believe in a proverbial silver bullet that can solve all the state’s health care woes. The problems are too complex and deep-seated to go away any time soon.

But enhancing care coordination and routine health maintenance for the state’s low-income Medicaid population is surely a step in the right direction and worthy of support.

— Dr. C. Morrison Farish is a pediatrician with Eastern Carolina Pediatrics in Florence and Darlington. He is the former chairman of the state’s Medicaid Care Advisory Committee.