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Efforts in Sharing Risk

Philip Betbeze, for HealthLeaders Media, April 15, 2013
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This article appears in the April 2013 issue of HealthLeaders magazine.

Editor's note: This piece is adapted from Philip Betbeze's February 22 online column, "CMS Waiver Answers Safety Net's $64M Question ." To read his weekly Leadership Corner columns, visit
www.healthleadersmedia.com/Leadership.

Last year, Cleveland's MetroHealth, the local safety-net system, provided $130 million in care for the uninsured, says John Corlett, vice president of government relations and community affairs. The 731-bed MetroHealth Medical Center, which also has 17 clinic locations in the local area, last year got a $36 million subsidy from the local government, and about $28 million from disproportionate share hospital funding from the Centers for Medicare & Medicaid Services.

The balance, some $66 million, came from the health system's margin. That's not exactly a drop in the bucket for a system that takes in nearly $800 million in revenue each year.

"So that's how life was before the waiver," says Corlett. "Going forward, we'll enroll up to 30,000 uninsured adults and get paid through this Medicaid waiver."

Fortunately, through work with CMS and local government officials, life will be different, because the portion of the care burden borne by MetroHealth's margin will be greatly reduced in 2013.

That's because CMS recently approved the launch of MetroHealth Care Plus, essentially a Medicaid waiver demonstration project. It will provide a medical home and health coverage to up to 30,000 uninsured residents of Cuyahoga County, where MetroHealth is located. That designation allows MetroHealth to access $64 million of annual federal Medicaid matching funds that will fill that $66 million hole in the budget quite nicely, according to Corlett. Meanwhile, the anticipated drop in DSH funding over time will be cushioned as well.

Unfortunately, the scheme is unlikely to survive past the end of December. That's because Ohio has decided to budget for the Medicaid expansion called for in the Patient Protection and Affordable Care Act, which would supplant the waiver program. But for hospitals and health systems similar to Metr Health in the states that have decided to let the federal government set up their exchange, such a waiver, if granted, might have a much longer shelf life.

Nevertheless, Corlett says the program is worth doing not only because it provides new funding for the uninsured but because it allows MetroHealth to expand many working relationships with outside health providers that it will need as shared risk ramps up in coming years.