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Some cuts OK, but not to program for Alaska's elderly, mentally ill

Op-Ed

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Anyone who has been responsible for providing care for a loved one knows how important it is to have options. Every patient has different circumstances to deal with, and there are no one-size-fits-all solutions. In my mother's case, she valued being close to family and friends and surrounded by things familiar to her and where the mainstay of her life's memories had been created -- at home.

Alaskans didn't always have many options for long-term care, particularly when it came to mental illness. Until 1960, "long-term care" meant Morningside Hospital in Portland, Oregon. In 1961, the State of Alaska established Harborview Nursing Home in Valdez, but unfortunately the only real option for long-term care was institutionalization.

That changed in the late 1980s, when there was a legislative push to make Alaska one of the first states to adopt an "institution free" model of care for long-term physical and mental health patients. This process was completed in 1997 with the closure of Harborview Medical.

This approach depends on giving families and health care providers as many options as possible, especially where those options save the state money and produce better results. More options make caring for loved ones easier and more effective. The state has supported this effort with programs like Mediset.

What is Mediset? It's the simple solution to the complex logistical and potentially costly problem of keeping an elderly or mentally-ill patient on their medication schedule. It's a clinical pharmacy service that packages, delivers, and monitors medications, prepared weekly, in an easy-to-understand and medically-compliant way.

It's easy to see how such an approach would decrease the risk of improper dosing while saving time and money for anyone running a group home. Patients can access the Mediset when their doctors request it.

If you're like me, you'll be glad to hear that the state Department of Health and Social Services already provides this for many of Alaska's Medicaid patients through the Mediset program. If you're like me, you won't be glad to hear that they are about to stop.

Under new regulations proposed by the state, reimbursement for Mediset pharmacies would be reduced to the level that a regular pharmacy receives. As a result, Mediset clinical pharmacies would no longer be able to afford to provide their specialty services. The move would save a modest amount of money in the short term, but in the long-term the costs to the state would be much higher as more patients wind up being hospitalized after taking their medication incorrectly or when they forget to take the right dosage.

I support cutting agency budgets that are too large -- and the Health and Social Services budget is the state's largest. But we can and should be smarter about how we do it. Value-based budgeting will be a more effective approach in this case. This process involves focusing on the results we want and identifying cost-effective strategies to get those results.

If the Mediset program is allowed to vanish, it will mean fewer options for the 2,000 elderly, disabled, and vulnerable Alaskans served by this program. As long-term care homes and independent living communities devote more staff time to the challenges of prescription management, the quality of care will decrease while the costs of that care increase. This would be damaging to small businesses, consumers, patients -- and our wallets.

The National Consumers League estimates that $290 billion in avoidable health care expenses are caused by medication non-compliance. For Alaskan Medicaid patients, the state pays these costs -- costs which the Mediset program helps to reduce. It doesn't make fiscal sense to save money on prescription dispensation and compliance services if the result is paying much more on increased hospitalization and managed care costs.

It may be tempting to scour the budget for small, little-known programs to cut and hope no one misses them. But that small program may be a critical element in a broader strategy to achieve the results we want as efficiently as possible. Mediset is that sort of program. Losing it would be short-sighted, providing small savings in the short run, and incurring large costs in the long run. Let's make sure the longer view wins the day on this one.

This coming session I intend on working with the state on finding a way to encourage out-of-box solutions to our rising medical costs by appropriately funding programs which deliver specialized services that save us money in the long run. Mediset is one of them.


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