PFCD Offers Ways to Lower Medicaid Health Costs

PFCD Releases Thoughtful New Policy Paper

06.26.13 | By

The Partnership to Fight Chronic Disease (PFCD) has released a thoughtful new policy paper outlining the most effective ways to lower Medicaid health care costs without compromising quality of care or patient health outcomes.

These recommendations are being made at a time when fiscal pressures and additional administrative responsibilities caused by Medicaid expansion have compelled states to turn increasingly to private health plans to administer Medicaid benefits.

Here are some of the PFCD’s suggestions:

  • Strategically target programs that emphasize improving delivery of care for a small group of high-cost patients.  (Five percent of Medicaid enrollees account for 54 percent of Medicaid spending). 
  • Avoid the traditional cost-cutting options, such as reducing provider payments and limiting the number of prescriptions covered and caps on services, which “do little to reduce spending because they reduce patient access.  . . . Limiting access to medicines, services and providers means an increase in expensive . . . emergency department visits [and] hospitalizations.”
  • Coordinate care among health care providers and care settings since many Medicaid patients have multiple chronic diseases and several different doctors, clinics and hospitals.
  • Identify hospitals with low readmission rates since one in four Medicaid adults hospitalized for non-maternal stays are readmitted within a month.

Teach patients to manage their conditions and adhere to treatment regimens. Failing to take medicines as prescribed alone adds $300 billion a year to the nation’s health care bill.

The PFCD, a coalition of hundreds of patient, provider, community, business and labor organizations, recommends that Medicaid partner with local care management programs that teach patients how to help manage diseases and adhere to prescriptions.  For example, the Connecticut Pharmacists Association provided a medication management program to Connecticut Medicaid that saved $1,600 per patient.

The PFCD’s membership includes AARP, the American Academy of Family Physicians, American College of Preventive Medicine, the Service Employees International Union, Sheet Metal Workers International Association, International Association of Firefighters, Healthcare Leadership Council, National Association of Public Hospitals and Health Systems, National Association of School Nurses, U.S. Chamber of Commerce and PhRMA.  

To learn more about PFCD’s policy recommendations that help us fight the human and financial cost of chronic diseases, go to   

More On PhRMA — powered by PhRMApedia


Cost in Context