Medicaid Health Plans Urge Adoption of Mandatory Managed Care to
Improve Patient Care; Eliminate Unnecessary Spending
SPRINGFIELD, Ill., May 5 /PRNewswire/ -- Citing lack of access and continuity
of care with the current "broken" Medicaid system, Bryan Baier, Executive
Director of the Illinois Association for Medicaid Health Plans, today urged a
legislative commission to act on recommendations for Medicaid reform which were
presented to members of the General Assembly earlier this week.
These recommendations were part of an independent report commissioned by the
Illinois Commission on Government Forecasting and Accountability. The report
provides a blueprint for how the Illinois Medicaid program could eliminate $1.5
billion in unnecessary spending over the next five years while improving health
care access and quality for low-income citizens by implementing mandatory
managed care.
Illinois' Medicaid system currently costs the State approximately $7 billion
per year -- which is more than 25 percent of the General Revenue Fund for the
current fiscal year -- leaving less funding for other state priorities such as
education.
"The Illinois Medicaid system is broken. It does not work for taxpayers nor
does it work as well as it should for those it is intended to serve. It is
designed to pay claims, not coordinate care," said Baier in his testimony. "In
the absence of a dramatic overhaul -- specifically, mandatory managed care --
it will continue to impose huge, unsustainable burdens on the state treasury." Illinois lags far behind most states in its use of managed care to control
Medicaid costs and improve health care for the 1.8 million residents in the
program. With only about 10 percent of Medicaid participants enrolled in the
state's voluntary program -- compared to the nationwide average of 60 percent
-- Illinois ranks 47th among the 50 states in its use of managed care as a
means of controlling costs and improving health care for Medicaid
beneficiaries.
The only states ranking below Illinois are Alaska, Mississippi and Wyoming.
Dr. Art Jones, who is the CEO of Lawndale Christian Health Center in Chicago,
and a Medicaid managed care provider, has seen the benefits of the managed care
system firsthand and supports the implementation of mandatory managed care
throughout the state.
"Medicaid patients in managed care plans receive a significantly superior level
of care, service, and access to care than do the majority of Medicaid
recipients who are left on their own to navigate the complex and often
unfriendly Medicaid system," Dr. Jones said. "Managed care patients have a
'medical home;' many others are essentially left 'homeless.' "Until the State mandates managed care, the majority of Medicaid recipients
will remain lost and underserved," Dr. Jones said.
As an example of the way the current system fails to serve Illinois' Medicaid
recipients, Baier shared the story of Gwendolyn Williams. Unable to find an
obstetrician willing to accept her Medicaid card, Williams went through her
entire pregnancy with inadequate prenatal care and delivered her baby in an
emergency room, with a doctor who had no access to her medical records. Now,
without a pediatrician nearby who will accept her Medicaid card, she again
relies on the emergency room to deliver routine care -- such as immunizations
-- to her son.
"It's clear the current system not only is too costly -- it fails to provide
adequate care for our most vulnerable citizens. If the system is too
expensive, unwieldy and lacks accountability -- and fails the people it is
intended to serve -- the people of Illinois have every right to demand change,"
Baier said.
In his testimony, Baier also addressed the concerns raised by the Illinois
Hospital Association (IHA), which is opposed to mandatory managed care because
it would affect funding schemes utilized in the current system that generate
revenues to its hospitals.
"The Illinois Association of Medicaid Health Plans wholeheartedly shares the
belief that protecting hospitals that serve as a safety net is critical. But it
is grossly misleading to suggest that an appropriately designed managed care
model will put these financing mechanisms in harm's way," said Baier. "Frankly,
the federal government's increased scrutiny of these mechanisms poses more of a
threat to the funding schemes than does managed care." The report, drafted by the Lewin Group, an independent national health care
consulting firm, recommends a phased-in approach to address these concerns and
provides a guideline for implementing managed care while preserving health care
safety nets. Significant evidence around the country demonstrates how
mandatory managed care and such funding mechanisms can co-exist: 25 states are
successfully using both systems.
Summary of Lewin Report Recommendations The Lewin Report found that "a well-designed expansion" of Medicaid managed
care should improve the state's ability to both deliver and monitor these
services to Medicaid-eligible children. It also found that Medicaid health
plans would have a positive impact on access and continuity of care by
providing a "medical home" for Medicaid recipients -- a medical professional to
provide diagnoses, referrals for specialty care and generally guide patients
through the medical system.
The Report recommends that this expansion be accomplished as follows: -- Immediate implementation of a mandatory health plan model for Medicaid
recipients in eight counties in the extended Metro East region and
Southern Illinois (Franklin, Jackson, Madison, Monroe, Perry,
Randolph, St. Clair and Williamson) and eleven counties in the
northern part of the state (Boone, DeKalb, DuPage, Grundy, Kane,
Kankakee, Kendall, Lake, McHenry, Will and Winnebago).
-- Immediate implementation of a mandatory health plan model in selected
Cook County zip codes, with future implementation throughout the
County. The State currently uses a complicated system of
"intergovernmental transfers" to support Cook County Bureau of Health
Services Hospitals (John H. Stroger, Jr. Hospital of Cook County, Oak
Forest Hospital of Cook County and Provident Hospital of Cook County)
and the University of Illinois Hospital and help the State leverage
additional federal matching dollars. The report recommends that the
State work to develop solutions to this issue, which is already being
challenged at the federal level, to pave the way for future
implementation of the mandatory managed care model throughout Cook
County.
-- Implementation of a "Primary Care Case Management Model" (PCCM) in
counties without mandatory health plans. In a PCCM, each Medicaid
recipient is guaranteed a "medical home" through the designation of a
primary care provider. The state still reimburses all providers on a
fee-for-service arrangement, so that savings are not as great as with
a health plan.. About the IAMHP
The Illinois Association of Medicaid Health Plans was created in January 2005
by the managed care companies serving Illinois' Medicaid beneficiaries: Harmony
Health Plan, Amerigroup, United Healthcare, Family Health Network and Humana
Health Plan. The organization serves as a resource to medical providers,
legislators, state regulators, health plans and others to enhance the delivery
of health care services to Illinois' Medicaid recipients. DATASOURCE: Illinois Association of Medicaid Health Plans CONTACT: Emily Hulburt, +1-312-573-5483, or Angela Wells, +1-312-735-7008, both of Jasculca/Terman and Associates, for the Illinois Association of Medicaid Health Plans
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