Pro's and Con's of accepting Medicaid...

I pretty much agree with Duct, and I think his heart is in the right
place. But, IMO Medicaid dollars would be better spent by bolstering
behavioral health boots on the ground rather than referrals to a
traditional IPM pain management clinic. This cohort of patients
won't benefit from injections or opioids.

Having seen lots, and lots of Medicaid patients these past
two years has lead me to believe that the attached graph is right.
But with the caveat that, within the CNP medicaid population,
the social and environmental factors and individual behaviors
contributions are much, much larger than depicted, while health
literacy is much lower than in commercial and Medicare insurance.

I think the ACA - I'm in a rural blue state - has created a 'new' cohort of
'patients' heretofore unstudied in the US because they were never
before insured. Treating the social/environmental + individual behaviors
in a traditional medical model is too costly and doesn't address the root cause
of the distress. The big insurer in OR found this out the hard way and
has had to scale back operations due to losses sustained due to an
underestimation of the cost of caring for these newly insured as well as
the Feds risk corridor recalculations.

If you really want to treat this cohort it can't be through the traditional
PA for narcs > IPM doc for injections model. That model makes money
for the IPM doc but it's costly and not beneficial to these patients. The
CCO's know this and the hospital systems are becoming aware. In my
area a hospital system shut this model down, closed the pain clinic, because
the primary care docs and hospital admin realized that pills and shots
wasn't working, the patients never got better and stayed on opioids. Now
the same hospital system is trying to come up with something that
will work, and find someone willing to staff it.

This is pain management as a money saver, not money maker. That's
an entirely different culture than what IPM fellowships inculcate.

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Pro's and Con's of accepting Medicaid...