When the cancer diagnosis hit, Mary (not her real name) had just moved back to Arkansas after years of living elsewhere. She didn’t know anyone locally, and even her kids had grown up and moved out of the area. Depression added to her burden, as she batted around a single thought over and over in her mind:
“How in the world am I going to make it with no help?”
Help came along in the form of Arkansas’ IndependentChoices program, which gives people back control over their health care decisions. Through IC (a later version of which is known as Self Directed with Service Budget, or SDSB), Mary learned how to hire and manage a caregiver of her choosing, paid for through Medicaid. Moreover, Mary got the emotional and psychological boost of staying in her own home and avoiding institutional care at the hands of strangers. Looking back, she’s thankful “to God and the program” for being available in her time of need.
Mary and thousands of other Arkansans just like her are living testimonials to the value of self-direction programs. The roots of publicly funded self-direction programs go back decades. In fact, Arkansas was a pioneer in self-direction, as one of just a handful of states to pilot programs back in the 1990s. Since, self-direction programs have mushroomed all over the United States. Why? Because any way you slice it — clinical outcome, fiscal responsibility or social benefit — self-direction presents a better, more cost-effective option than institutional care.
Brought in to assess the state’s Medicaid picture, the Stephens Group left no doubt earlier this year as to the dire circumstances the state is facing without “modernizing” its delivery systems. Among its recommendations?
Widening the reach of, and removing the barriers to, self-direction programs, noting such plans not only cost less than institutions (annually, about $22,000 versus $64,000, respectively), but when measured by patient satisfaction and medical outcomes, deliver greater value as well. These are the facts.
Self-direction plans even boast an economic development factor, creating on average 1.5 caregiver jobs per participant in small towns and rural areas where such opportunity is limited, thus returning a portion of public funds via tax rolls. And, statistics show that properly managed self-direction programs are at least as effective, and often more so, at curtailing fraud and abuse as other delivery options.
Ironically, surrounding states have used Arkansas as the model for their own, more robust self-direction programs, even as we continue to be largely stuck in first gear. The latest adopter, Texas, just announced its implementation of a Medicaid reform initiative that shifts thousands into eligibility for self-direction. So great is the potential cost savings — as much as 75 percent, based on 2012 spending — it even drowned out the Obamacare straw man argument advanced by the nursing home lobby, in arguably the most conservative state in the nation.
Arkansas has a rare opportunity to once again set the pace delivering the most crucial of services while at the same time living up to its fiduciary responsibilities to the taxpayer. Self-direction is that modernizing delivery mechanism, as logical as it is moral, to provide for the needs of that segment of the population which needs it most.
Better outcomes at significantly lower cost. We have an opportunity to provide a greatly needed service to our citizens, so I hope we remove the politics and influence of certain groups and embrace self-direction as a viable tool in our health care system.