February 27, 2004

TennCare reform to impact Vanderbilt

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TennCare reform to impact Vanderbilt

Gov. Phil Bredesen told the Tennessee state legislature he plans to adjust TennCare benefits and establish limited co-pays for services and pharmaceuticals in a concentrated effort to keep the program — which serves 1.3 million Tennesseans — afloat.

Bredesen’s proposal maintains current eligibility standards, preserves full benefits for children, the disabled and pregnant women, adjusts benefits for adults in line with private insurance and imposes strict pharmacy controls.

Since the inception of TennCare, Vanderbilt Hospital and Regional Medical Center in Memphis have been two of the largest TennCare providers in the state. Vanderbilt expects to have 8,750 TennCare admissions and more than 100,000 TennCare outpatient visits during fiscal 2004.

Bredesen laid out his strategy to trim costs up to $2.5 billion in a joint session of the state senators and representatives Feb. 17.

“The Governor has shown real leadership in his proposal to reform TennCare. He has taken a complex problem, one that could potentially have disastrous consequences for the financial health of the state, and he has made the trade-offs clear and intelligible,” said Dr. Harry R. Jacobson, vice chancellor for Health Affairs. “He has described a solid vision for the program. He has outlined a series of common-sense measures and sacrifices that must be made to keep the program alive. And he has left ample opportunity for input.”

Bredesen asked TennCare enrollees, advocates and health care providers to maintain a productive dialogue as changes begin going into effect later this year.

He also sought help from Vanderbilt to help streamline medical records and provide the most up-to-date medical care.

“Imagine a system where our best doctors establish standards of practice, and we have the technology so that each person has a single medical record, which they can take from place to place. Imagine a system where we have the technology so that when a practitioner does something that is learned in medical school and it is no longer the preferred way, it is flagged and he is referred to the research.

“While we are at work saving TennCare, I’d also like to start building some of the foundations to turn it into a model for other states. This might be an impossible dream except that we already have right here in Tennessee the national leader in the field of medical informatics — Vanderbilt University Medical School,” Bredesen said during the joint session.

“I’d propose to start with one of our large providers — the Med in Memphis — and working with Vanderbilt and our own medical schools pioneer a real 21st century approach there. When it is successful, we can begin expanding it to other providers.”

According to Tennessee Department of Finance Commissioner Dave Goetz, who met with provider groups Feb. 18, the first change to be phased in is the pharmacy benefit restrictions — possibly in July. Disease management and evidence-based medicine will take years to implement, said Goetz.

Goetz told the group that $30 million to $50 million will be set aside for regional safety net providers which could include hospitals and clinics. This would require TennCare enrollees who could not or would not pay a co-payment to travel to one of these facilities for non-emergent care.

Warren Beck, director of Finance for Vanderbilt Hospital, is optimistic that Bredesen’s plan will work, but said it’s too soon to know how the changes will affect the operations of the hospital until more details are given.

“[Vanderbilt] has been the backbone of the TennCare system,” Beck said. “The governor said all the right things and we have some opportunities, but it comes with some worries so we hope to get more details soon.”

Added Jacobson, “Gov. Bredesen’s proposed program guidelines remain to be fully described, but his commitment to maintain current eligibility, to provide a benefit-rich program to children, the disabled and pregnant women and to enforce a stricter formulary for drug prescriptions make very good sense from both the perspective of health and fiscal policy.”