National Press Club

Johns Hopkins CEO: Surge of Medicaid Patients Offers Problems, Rewards

June 21, 2010

captions in here

The expansion of Medicaid, which will bring health coverage to 16 million disadvantaged Americans by 2019, “could be the most important and problematic” aspect of the new health insurance law, Dr. Edward Miller, dean the medical faculty at Johns Hopkins University medical school and CEO of Johns Hopkins Medicine, warned at a Club luncheon June 21.

Yet, he said, the experience at Johns Hopkins shows that the surge in Medicaid patients – a majority of the 32 million Americans overall who will gain coverage -- could be “the most rewarding aspect of the entire law.”

Miller, leader of the giant Baltimore medical facility since 1997, described how Hopkins this year is making a small profit from its Priority Partners organization, a managed-care program it launched 15 years ago that now serves 175,000 Medicaid patients. But the program’s early difficulties, he said, offer “a cautionary tale for every policymaker in the room.”

When the program was launched, he said, “a flood of new patients came to us seeking health services. Many had never seen a doctor on more than a sporadic basis. Some had multiple and costly conditions. And almost all came from poor or disadvantaged background.”

That’s the population, he said, that is “poised to enter the health-care system in 2014.”

Hopkins -- one of the few academic medical centers to run a managed-care program – lost $57 million in nine years in caring for these patients, Miller said. But the facility turned the losses into a profit by developing what he termed a “population health model.”

Under the model, Miller said, Hopkins assigns each month assigns every patient a risk score that factors in age, gender, frailty and a host of other factors to determine “who needs what kind of help.” It then stratifies the patients, from low to high scorers, to determine levels of treatment, which emphasizes a team approach.

The Priority Partners program, Miller said, “is a system of care that can be duplicated around the nation.”

In answer to a question on the one thing he would change in the health-insurance law, Miller replied that he would like to have seen greater emphasis on moving away from the current fee-for-service structure.

“It just will not work in the future,” he said. “The fact that you can use as many services as you like as often as you like and not have any measure of quality does not make any sense.”

Among other priorities, he said, are opening up a greater number of slots in hospitals and boosting pay for residents training to be primary-care physicians; developing an action plan for reducing diabetes and obesity in children; and addressing “end-of-life issues in a proactive way.”

-- Bill Miller,