Professor Part of Global Health Care Funding Reform Event
| Oct. 20, 2016 | UAMS professor William Golden, M.D., recently spoke about the future of health care funding at a NEJM Catalyst event that was live-streamed online to facilitate discussion among health care leaders across the globe.
A project of the New England Journal of Medicine, NEJM Catalyst offers articles, events, podcasts and case studies on the changing landscape of health care delivery.
Golden is a professor of medicine and public health and served as director of the Division of General Internal Medicine at UAMS for nearly 20 years. Since 2009, he has been the medical director of Arkansas Medicaid, where he is the clinical lead for its payment reform initiative, one of the first six such efforts funded by the Centers for Medicare and Medicaid Services.
During the NEJM Catalyst event, Golden discussed lessons learned from the Arkansas Medicaid reform and from his collaborations with leaders in other states as part of the Medicaid Medical Directors Learning Network.
“It’s an opportunity to get people really thinking about redesigning primary care into a much more chronic-disease oriented, preventive service approach, because currently what we do is we incentivize short-term visits that really aren’t in the best interest of the health care system,” Golden said. “We think we’re going to be part of the solution for changing peoples’ attitudes about how we deliver care to make ourselves a sustainable health care system.”
The event, titled “New Marketplace: New Risk, New Business Models,” was hosted by NEJM Catalyst on Oct. 6 in Boston, Massachusetts. A recording is available at catalyst.nejm.org.
Golden appeared alongside speakers, including a Harvard Business School professor, business CEOs, the former Medicaid director for Rhode Island, CEO of Vanderbilt University Medical Center, senior vice president of New York-Presbyterian Hospital and others. They offered personal perspectives about the changing health care marketplace, describing firsthand experiences with reforming Medicaid, launching new ventures, designing innovative care delivery models and testing new payment methodologies.
Golden was a member of a three-speaker session specifically on Medicaid reform.
Golden said that when they set about reforming Arkansas Medicaid, it was clear that they couldn’t keep raising patient costs or taxes. Instead, cost-effective care needed to be the focus, and that change had to happen at all levels – with providers, payers, patients and policymakers.
“Everybody has to reorient to greater stewardship, which would mean how do you change what you pay for and how do you get outcomes out of that system,” Golden said. “So you have to create new incentives, new financial rewards to shape the health care delivery system.”
As part of the reform, they created the Episodes of Care model in 2012 in which providers are accountable for the total cost of treating a condition, such as heart bypass surgery, rather than paid for each doctor’s visit, X-ray and any other procedures during treatment. If expenses go above the acceptable level of cost for that particular condition, the provider absorbs the loss. If expenses are below the acceptable cost, the provider shares in the savings. They started with a handful of conditions and have expanded to include more in the years since.
Much of that achievement was made possible by using data to target inefficiencies and trends and change policies accordingly, Golden said. Data-sharing and information-sharing with other states as part of the Medicaid Medical Directors Learning Network has enabled further progress. Other states are now replicating the Arkansas Episodes of Care model and the Centers for Medicare and Medicaid Services has borrowed portions of it for their efforts.
“It got people thinking for the first time beyond just their service and they actually started talking about how you coordinate care,” Golden said.
Prior to Golden’s current position, he served for 16 years as vice president for clinical quality improvement of the Arkansas Foundation for Medical Care, for which he has designed numerous statewide quality improvement and health technology projects, and for Medicare and Medicaid. He is currently on the Guiding Committee of the Centers for Medicare and Medicaid Services Health Care Payment Learning Action Network and co-chairs its new workgroup on primary care.
He has written and lectured extensively on performance measurement and health system improvement and has served on or chaired numerous national committees designing quality metrics.
Golden graduated from Brown University with an undergraduate degree in health care delivery. He received his M.D. from Baylor College of Medicine and his internal medicine training at Rush-Presbyterian-St. Luke’s Medical Center in Chicago, where he was also chief resident. He was a Robert Wood Johnson Clinical Scholar at the University of Pennsylvania.