Fw: Arc and Tribune Editorial Docs and Hospitals Get on Board

[Guest guest]

Arc and Tribune Editorial Docs and Hospitals Get on BoardLet us hope that

Managed Care has the kind of outcomes that the Tribune is talking about...

Any more stories out there?

Ellen

Ellen Garber Bronfeld

egskb@...

Arc and Tribune Editorial Docs and Hospitals Get on Board

The Arc of Illinois issues of the day from the desk of Tony

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The Arc of Illinois

The Arc of Illinois is a state chapter of The Arc

of the United States. The Arc of Illinois is committed to empowering persons

with disabilities to achieve full participation in community life through

informed choices.

Leaders in The Arc:

I was glad to see this editorial from the Chicago

Tribune telling the deadbeat teaching hospitals to get on board with the

Integrated Care Pilot. Many of these hospitals have left our people out in the

cold without their specialized health care needs and are using them as pawns!

Tony auski

The Arc of Illinois

815-464-1832

www.chicagotribune.com/news/opinion/editorials/ct-edit-medicaid-20110831,0,19213\

51.story

Docs and hospitals, get on board

Everyone wins if Medicaid care is improved

August 31, 2011In January, we applauded Illinois

lawmakers for finally passing a serious Medicaid reform bill. The state's

ambitious goal: Move half of Illinois' 2.6 million Medicaid patients — that's

1 of every 5 Illinoisans — into managed care by 2015. The overarching strategy

is to improve health care for millions of Medicaid patients and save the state

tens of millions of dollars.

We're now seeing the first phase of how that

works. Managed care generally means patients are assigned a " medical home " — a

doctor (it could be an HMO-style clinic) who oversees their care. Doctor and

hospital fees are geared to delivering better health care, not just more of it.

Providers stand to receive bonuses if they meet quality benchmarks — reducing

readmissions to hospitals, for example.

At the time the bill passed, we noted that

reforming Medicaid wouldn't be easy. We figured Department of Healthcare and

Family Services Director Hamos could expect plenty of blowback from

hospitals, health care providers, patient advocate and unions that defend the

status quo. A major flashpoint: asking doctors and hospitals to accept

restructured, possibly lower, reimbursements.

Unfortunately, our prediction about Illinois'

evolution to managed care is coming true.

As the Tribune's Judith Graham reported Friday,

the state is pushing to enroll people with serious physical and mental

disabilities in two private, HMO-style plans — Aetna Better Health and

IlliniCare Health Plan.

But many doctors and hospitals have refused to

join the new managed care program. The hospitals listed by Graham include

Northwestern Memorial Hospital, Rush University Medical Center, the University

of Chicago Medical Center, Children's Memorial Hospital and Loyola University

Health System. We've heard that many of these elite hospitals and physician

groups are still negotiating terms and rates so all of this could — should —

change.

For the moment, however, those hospital and doctor

refusals are forcing hundreds if not thousands of poor, chronically ill patients

who had been relying on them to find new doctors and make new health care

arrangements.

What a shame. Many of these hospitals and doctors

have long and admirable records of serving the kinds of patients included in the

state's pilot managed care program. These providers already treat many Medicaid

patients and they work with HMOs in the commercial sector. Why are they

resisting the state's managed care initiative?

We've heard several reasons: Hospitals and doctors

don't like the bureaucratic red tape of working with the new plans. They're

fearful of relentless cost-cutting measures often associated with managed care.

They're not looking to expand their Medicaid treatment base because they already

lose money on those patients.

We're not in the business of telling hospitals how

to function. We know that many hospitals in the state operate on thin margins; 1

in 3 Illinois hospitals is losing money, according to the Illinois Hospital

Association.

But we hope these hospitals and doctors realize

there's a larger point here: The state's shift to Medicaid managed care is vital

and long overdue.

All hospitals, doctors and patients can embrace

the ultimate goal: Coordinated, and better, health care for Medicaid patients.

One example: Effective managed care — treating health problems before they get

more serious — should keep patients out of emergency rooms, saving hospitals

plenty in unreimbursed expenses.

There are other incentives for providers to

participate. The private insurers running the managed care programs have pledged

to pay providers faster — in 30 days at most. That's a huge sweetener in a

state where Medicaid bills can pile up in state offices for six months or more.

In some cases, Aetna Better Health CEO

Mendonsa told us, hospitals and doctors stand to be paid higher than normal

Medicaid reimbursement rates, based on quality-performance benchmarks. Bottom

line: Everyone wins if Medicaid care is improved and its costs controlled.

Other states have already done this. Illinois can

too. No, it must. We hope those doctors and hospitals negotiate contracts that

will work for them and … get on board.

Copyright © 2011, Chicago Tribune

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