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The Journal Gazette

Monday, May 01, 2017 2:00 am

A HIP example

Indiana presents model for health care fixes

Nationally, health care policy is in turmoil. But in Indiana, HIP 2.0 continues to grow. Some 430,000 Hoosiers are enrolled in the program, and there are thousands more who likely would be eligible to join.

Many involved in the struggle to retool or replace Obamacare believe HIP 2.0, the state's alternative to Medicaid expansion, offers a model for the rest of the nation. Among them is an executive of one of the four managed-care firms that help administer HIP 2.0, who spoke with us Friday.

“What we've found is that those that are in the program are much more engaged in their health care, they're much more likely to receive preventative services, they're much less likely to visit the ER, much more likely to remain adherent on their medications,” said Steve Smitherman, executive director of the Indiana division of CareSource, which was selected as a managed-care provider for HIP 2.0 last year.

Three other contractors – Anthem Blue Cross and Blue Shield, MDwise Inc. and Managed Health Services – also offer managed care for HIP 2.0 enrollees. Each company provides and oversees the same base services, such as setting up a health-savings account for each enrollee called a Personal Wellness and Responsibility (POWER) account. But each company also offers a set of incentives and special programs. Enrollees may compare their offerings and sign up with any of the four companies.

CareSource, a Dayton-based nonprofit, has only been a HIP 2.0 managed-care provider since January. But long before it joined the Indiana effort, Smitherman said, the company shared the get-the-enrollees-involved philosophy that underpins the state's program.

The accounts encourage enrollees to “take ownership of how their health care dollars are spent,” Smitherman said. “When they go to the doctor, they're going to get a statement that shows them how much money is in the POWER account, how much that doctor's office visit costs, how much they have remaining. We're hopefully educating them on how their health care benefits are being spent.”

As part of HIP 2.0, the state offers a program called Gateway to Work that helps health enrollees get job training and connects them to job opportunities. 

“There are so many social determinants that are keeping people from focusing on their health care,” Smitherman said. “Not having a job, not having child care, not having education, not having a place to stay, food insecurity. ...”

A pilot program involving Medicaid recipients in two Ohio counties showed that most people who were helped to get jobs kept those jobs and eventually were able to switch to employer-based health coverage, according to Smitherman.

“It's a win-win-win for everybody,” he said. “You get them off of Medicaid, it saves taxpayer dollars, it pumps money into the economy because they now have an income to spend.”

The solutions programs such as HIP 2.0 offer need to be kept in mind by conservatives and liberals as they battle over health care policy in Washington.