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Arc and Medicaid Managed Care to ExpandFYI

Ellen

Ellen Garber Bronfeld

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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?

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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:

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

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