Many states and localities are trying to change the model for delivering health care, to improve quality of care while keeping costs in check. But the boldest of those efforts taking place is in New York state, which earlier this year unveiled an $8 billion plan to rebuild its Medicaid system around outpatient care and community-based services. It’s an audacious plan, but one reason for optimism is the strong leadership of the state’s Medicaid director, Jason Helgerson.
Helgerson has now headed up Medicaid programs in two states, New York and Wisconsin. But early on in his career, he never imagined working on health-care policy. Back in 2005, Helgerson was at the Wisconsin Department of Revenue when Gov. Jim Doyle recruited him to work on his Medicaid reform agenda. Helgerson tried to turn him down, but Doyle insisted. “I knew his ability to see the big picture,” Doyle says. “He kept saying he didn’t want to take the job, and eventually I had to order him to do it.”
Helgerson ended up becoming the state’s Medicaid director in 2007, and for four years he helped Doyle expand the state program prior to passage of the Affordable Care Act. His success garnered attention and job offers from other places, including the White House. But ultimately it was New York that needed him most.
New York’s Medicaid program was in dire straits. At $50 billion a year, the state’s spending on Medicaid in 2011 was the highest in the nation. Expenditures were rising 13 percent a year. Gov. Andrew Cuomo wanted a redesign, and he wanted Helgerson to lead it. Helgerson instituted a global cap on spending, and he worked to get patients into models of care led by teams of doctors accountable for whole groups. The state also began focusing more intently on social determinants of health, such as supportive housing. Since 2009, spending per patient has fallen steadily, to 2003 levels, and overall spending has actually declined.
Those results are remarkable on their own. But now Helgerson is taking on the even bigger challenge of completely remaking the state system in what is arguably the largest Medicaid overhaul ever, in any state. “Major restructuring was necessary in order to close the budget deficit,” he says. “Nothing was off the table, except taking insurance away from people.”
In crafting the reform plan, Helgerson deftly brought together various stakeholders. “His ability to garner support is gifted,” says Kenneth Raske, president of the Greater New York Hospital Association. “I think the reason for that comes from his core values. At the end of the day, his main objective is to be as responsive as possible to the Medicaid recipient.”
It will be years, or even decades, before the New York effort can claim success. But at a time when out-of-control health-care costs demand bold ideas and new thinking, Helgerson is leading the way.
-- By Mattie Quinn
Read about the rest of the 2015 Public Officials of the Year and watch his acceptance speech below: