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 Response Page - Jesson  Interview -      
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These comments are responses to the statements listed below,
which were generated in regard to the 
Lucinda Jesson  Interview of
02-01-13.
 

OVERVIEW

Department of Human Services (DHS) Commissioner Lucinda Jesson believes that without reform, the demographic changes resulting in the aging of the state's population will make her agency's programs, as structured today, unsustainable in the long run. Reform and redesign offer the best path to sustainability, she says. The department's reform efforts started two years ago with the overhauling of its managed care contracts, the area where the biggest dollars are involved. Other redesign efforts include: (1) being the first state to contract with Medicaid providers to change the financial incentive from quantity (doing more tests and procedures) to quality (efficiently keeping a population healthy); (2) working to streamline the department's multiple public health care programs into one unified public program that changes incentives for enrollees and providers; (3) intervening earlier to help keep people in their homes; (4) giving people more control in choosing the services and providers they wish to have.

For the complete interview summary see: http://bit.ly/YDZPrT

Response Summary: Readers have been asked to rate, on a scale of (0) most disagreement, to (5) neutral, to (10) most agreement, the following points discussed by Commissioner Jesson. Average response ratings shown below are simply the mean of all readers’ zero-to-ten responses to the ideas proposed and should not be considered an accurate reflection of a scientifically structured poll.

1. Continue higher standards. (7.9 average response) Minnesota should continue its commitment to serve seniors and the disabled better than most other states.

2. Target costs, share savings. (7.3 average response) Contracting with health care providers to provide care for a given population for a target maximum cost, and sharing any savings realized below that target cost, is a good method for controlling public health care costs.

3. Strategic intervention lowers costs. (8.5 average response) Intervening before problems become chronic or acute and offering a broader array of services to help people stay employed and in their homes longer are important strategies for containing Medicaid costs.

4. Let beneficiary direct dollars. (7.1 average response) Allowing people to direct the dollars available to them for personal care assistance, choosing their own service providers and levels of care, will result in cost savings and more satisfied enrollees compared with a "one-size-fits-all" approach.

5. Let counties pilot new programs. (7.9 average response) Counties should be encouraged to do more pilot programs at the local level, testing different ways of delivering health and human services for better outcomes.

6. Reduce dependence on state. (6.8 average response) The state can no longer afford to invest the same kind of money in health and human services as it has in the past; citizens will just have to be more responsible for their own and their families’ care.

Response Distribution:

Strongly disagree

Moderately disagree

Neutral

Moderately agree

Strongly agree

Total Responses

1. Continue higher standards.

6%

6%

6%

29%

53%

17

2. Target costs, share savings.

6%

12%

0%

53%

29%

17

3. Strategic intervention lowers costs.

6%

6%

0%

35%

53%

17

4. Let beneficiary direct dollars.

0%

6%

24%

59%

12%

17

5. Let counties pilot new programs.

0%

6%

18%

41%

35%

17

6. Reduce dependence on state.

12%

12%

0%

53%

24%

17

Individual Responses:

Dave Broden (10) (7.5) (10) (10) (7.5) (2.5)

1. Continue higher standards. Minnesota tradition of commitment to care for its citizens should continue to be a focus of programs in Minnesota. This includes all ages and all demographics and economic levels. This, however, does require innovation and attention to the value of the activity at all levels.

2. Target costs, share savings. Targeting costs is always a good value; however, often when the primary metric is cost and does not also include consideration of the level and quality of service there is a missing element. Contracting with solid metrics is needed [and] not … driven by cost only.

3. Strategic intervention lowers costs. Attention to health care and the individual’s life style and ability to work must be [a] factor … considered to manage and reduce costs.

4. Let beneficiary direct dollars. Choice must be a key factor; as choice is used, however, there must be some form of monitoring that ensures the funds are used effectively. In many cases a floor criteria may be preferred.

5. Let counties pilot new programs. Pilot programs will also have great value. Pilots may be done at the county level, at the local government level or whatever level is appropriate for both the type of care/service and the demographic/population and access to the services, etc.

6. Reduce dependence on state. The health and human services investment relates to the Minnesota quality of life that we wish to maintain as a state. Some adjustments will have to be made, and should be, but the basic commitment of care, concern and desire to help our citizens must remain.

Robert Freeman (7.5) (10) (10) (5) (10) (7.5)

1. Continue higher standards. There should still be safeguards to ensure good stewardship of public dollars. The PCA example, where this program was subject to fraud and abuse for years before the OLA examined it, shows where it is easy to put a program on autopilot and bad actors can take advantage.

2. Target costs, share savings. With the understanding that this is a brave new world and providers should be able to have some flexibility to innovate without being at too much risk.

4. Let beneficiary direct dollars. The PCA program has traditionally been subject to much fraud and abuse, and it is important to have some independent oversight.

Rosemary Schultz (10) (10) (10) (7.5) (10) (7.5)

3. Strategic intervention lowers costs. Prevention is the key to sustaining DHS. Prevention of chronic disease is important to bring about any savings to DHS.

5. Let counties pilot new programs. I feel our present public health and human service workers know their clients and the family situations. They are better prepared to deliver services at the local level.

6. Reduce dependence on state. I feel the counties that are forming ACO's to care for Medicare, Medicaid and clients with mental health issues can be successful in caring for this population through managing contracts with the medical caregivers. The county's HHS departments know their clients and will do the preventative care to allow savings for treating these patients.

Scott Halstead (7.5) (7.5) (10) (5) (7.5) (0)

1. Continue higher standards. The state of Minnesota, all local governments and employers need to provide employees with incentives for healthy living in their health care policies and extend to senior health care. Provide communities with additional grants for Communities For a Lifetime program that reduces the risk of chronic diseases, dementia, etc. to reduce the cost [of] health care and Medicaid. We need to look at our tax system to encourage our seniors [to maintain] their Minnesota residency and their active involvement instead of having them leave and return in their latter years when they need a high level of services.

2. Target costs, share savings. It sounds great, but will the individuals really receive quality care?

3. Strategic intervention lowers costs. We also need a much better long-term care financing system. The current long-term care insurance and tax system provide wonderful benefits to the wealthy that don't need long term care insurance, provide a lousy unreliable system for the middle class and results in lower income people using Medicaid.

6. Reduce dependence on state. The State of Minnesota always works with the medical and health providers on the various programs. Perhaps input should be sought and utilized from citizens and citizen groups. It is time to reform medical school, the medical device, pharmaceutical industry, health insurance and medical service industry.

Don Anderson (10) (7.5) (10) (7.5) (5) (0)

Anonymous (10) (10) (10) (5) (10) (7.5)

Chuck Lutz (10) (9) (9) (9) (8) (3)

Tom Spitznagle (10) (6) (8) (6) (9) (6)

Government health care programs have the leverage to negotiate lower reimbursement rates from providers, but I’m concerned that providers will then be compelled to try to meet their profitability goals by raising rates for private insurance plans. This would be counterproductive. Is this a consideration of public policy makers? If so, then how can this situation be prevented from occurring?

Al Quie (1) (10) (10) (10) (10) (8)

David Detert (10) (2) (4) (4) (4) (10)

Mina Harrigan (10) (10) (10) (8) (10) (10)

Paul and Ruth Hauge (7) (7) (8) (7) (8) (8)

Carolyn Ring (5) (6) (8) (8) (5) (8)

Wayne Jennings (10) (8) (10) (9) (10) (9)

Roger A. Wacek (0) (0) (0) (5) (5) (10)

William Kuisle (7) (4) (8) (7) (7) (10)

Larry Schluter (9) (9) (9) (7) (8) (8)

This was a very interesting and important discussion that affects so many people and such a large part of our state budget. I hope many of these projects work. I think it would be very important to bring back Ms. Jesson in the future on how all this is working.

 

    

The Civic Caucus   is a non-partisan, tax-exempt educational organization.   The Core participants include persons of varying political persuasions,
reflecting years of leadership in politics and business. Click here  to see a short personal background of each.

   David Broden,  Janis Clay,  Bill Frenzel,  Paul Gilje,   Jan Hively,  Dan Loritz (Chair),  Marina Lyon,  Joe Mansky, 
Tim McDonald,  John Mooty,  Jim Olson,  Wayne Popham  and Bob White


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