Guest guest Posted August 1, 2011 Report Share Posted August 1, 2011 Arc and Medicaid Managed Care to ExpandFYI Ellen Ellen Garber Bronfeld egskb@... Arc and Medicaid Managed Care to Expand The Arc of Illinois issues of the day from the desk of Tony auski Is this email not displaying correctly? View it in your browser. Friend on Facebook Follow on Twitter Forward to a Friend 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: As I have been telling you for quite some time now, managed care is moving to other parts of the state. See story below from the Peoria Journal Star. We are in the process of setting up a webinar on the Integrated Care Pilot for families on Wednesday, August 24, 2011. The time is 6:30 pm - 8:30 pm. More information on the webinar and registration to come soon. Tony auski The Arc of Illinois 815-464-1832 http://www.pjstar.com/news/x1510863427/Medicaid-program-to-expand Medicaid program to expand 'Coordinated care' networks aim to improve care, but not all patients are happy. DEAN OLSEN GateHouse News Service Posted Jul 30, 2011 @ 10:50 PM SPRINGFIELD — After kicking off a pilot project this spring in the Chicago area that has resulted in hundreds of people losing their longtime doctors, the state will set in motion plans to expand " coordinated care " networks for Medicaid patients in downstate Illinois. Officials, health care providers and advocates for the poor say they are excited about expanded use of coordinated care, also known as managed care. " The goal is to try to structure something that would hopefully improve the quality of care for Medicaid patients, " said Dr. Mikell, chief physician executive for Hospital Sisters Health System, which operates Springfield's St. 's Hospital. The state's recently enacted Medicaid reform law requires at least 50 percent of Illinois' 2.9 million Medicaid recipients to be enrolled by 2015 in managed-care networks. The new law and the need to prepare for 700,000 to 800,000 more Illinoisans who will join the Medicaid rolls in 2014, as a result of federal health care reform, add a sense of urgency to the project. " We are transforming the health care delivery system, " said Hamos, director of the Illinois Department of Healthcare and Family Services. " That is not an easy thing to do. " The department later this year plans to request proposals for more pilot projects. Medicaid makeover Hospital Sisters is starting to talk with officials from Springfield's Capitol Community Health Center, Southern Illinois Healthcare Foundation and other health care providers in central and southern Illinois on whether to propose a downstate pilot project, Mikell said. Sangamon County has 38,500 Medicaid patients, and Macoupin and Montgomery counties have 9,700 and 6,500, respectively. " It will be challenging, " Mikell said, " but we're very encouraged by what Director Hamos is trying to do with this. " Hamos said HFS is changing Medicaid from a program that simply pays health care bills to one that provides efficient health care and improves the health of recipients. Advocates say increased use of managed care in Medicaid could save money while reducing unnecessary emergency room visits and hospital expenses. At the same time, a well-designed system could help remind patients to take medicines, make sure they show up at doctor's visits and connect them with counseling, housing and other essential services, advocates say. Doctor access lost? The five-year " integrated care " pilot project in Chicago, begun this spring, will require all 40,000 disabled adults on Medicaid to be enrolled by fall in coordinated-care networks operated by two vendors - Aetna and Centene-IlliniCare - as part of state contracts totaling $450 million a year. Most of the money goes to pay medical providers. The project focuses on the disabled, a small chunk of the total Medicaid population, because disabled adults are among the costliest patients to serve. The contracts, which pay doctors fixed amounts of money per patient each month regardless of how many times the patient is served, are expected to save the state at least $200 million in five years. Hamos said she is concerned, however, by reports that some disabled patients have lost access to doctors and hospitals they have used for years. " Even when they've been serving their disabled patients for a long time, they refuse to sign up for this, " Hamos said. " We don't understand what's going on exactly. " A total of 27,685 Chicago-area residents on Medicaid have been enrolled in the pilot project so far, said Jim , HFS' deputy administrator of medical programs. All disabled adults on Medicaid must be enrolled in one of the networks by fall if they live in suburban Cook County or the counties of Lake, Kane, DuPage, Will or Kankakee. Officials from Aetna and IlliniCare said fewer than half of all hospitals in those areas have signed up for the network, but more hospitals, and the doctors affiliated with those hospitals, continue to join. Kinne, president and chief executive officer of IlliniCare, said some hospitals have unjustified fears that they will face unnecessary bureaucracy or lose money if they join. " We're not paying them less, " he said. " If anything, we're paying more, and we're paying fast. " Kinne said IlliniCare has persuaded up to 70 percent of the doctors regularly used by IlliniCare's members to join its network. " It's a slow education process, " he said. " We're not where we want to be, but we're not where we were a few months ago. " Patients skeptical The situation left Jeanette Kujawa in tears. The 66-year-old Melrose Park resident, who has dementia, diabetes, arthritis and chronic obstructive pulmonary disease, has lost her longtime family physician, Dr. Philip Palutsis, who is part of Rush University Medical Center's physician group. When Kujawa learned Palutsis and her other doctors weren't available, she said: " I just flipped. I cried. I just want to keep what I have because I have all of these sicknesses. " Palutsis didn't return a phone call. Rush spokesman Pontarelli said " numerous factors, " including rates, billing procedures and utilization review processes, were part of Rush's decision to stay out of the networks. However, Rush may restart negotiations with IlliniCare and Aetna in the future, he said. Webb, 63, of Oak Park, who was severely burned in a house fire in the 1970s, said she has lost access to her primary care doctor, a lung specialist and other doctors - physicians she has seen for more than a decade - because they are associated with Chicago's Northwestern Memorial Hospital, which hasn't joined the new networks. Webb said she doubts the state's assurances that Medicaid patients will receive better care. " I don't feel secure, " she said. " It just doesn't make sense. " Jansa, program director of the Progress Center for Independent Living in Forest Park, said access to a broad base of health care providers is a fundamental issue in the success of the project. " Right now, we're not seeing it being addressed the way we'd like it to be, " he said. Dean Olsen can be reached at (217) 788-1543. Average annual growth in Medicaid spending Illinois Nationwide 1990-2001 11.1 percent 10.9 percent 2001-2004 8.7 percent 9.4 percent 2004-2007 7.6 percent 3.6 percent 2007-2009 1.9 percent 7.1 percent Source: Kaiser Family Foundation's statehealthfacts.org Copyright 2011 pjstar.com. Some rights reserved follow on Twitter | friend on Facebook | forward to a friend Copyright © 2011 The Arc of Illinois, All rights reserved. You are receiving this email because you are a member of The Arc of Illinois. Our mailing address is: The Arc of Illinois 20901 S.LaGrange Rd. Suite 209 fort, IL 60423 Add us to your address book unsubscribe from this list | update subscription preferences Quote Link to comment Share on other sites More sharing options...
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