Legislators say slow down on managed care

By Rachel Wells


A proposed pilot program that would affect about 40,000 elderly and disabled Illinoisans could save the state $200 million over five years, but that’s not reason enough to rush into things, legislators said today.

The program in question is Gov. Pat Quinn’s Integrated Care Pilot Program, which outlines changes to some Medicaid fee-for-service plans for residents in DuPage, Kane, Kankakee, Lake and Will counties and suburban Cook County starting as early as October 2010. The program – focused on wellness and prevention – would offer incentives to medical providers based on patient health outcomes.

HB 5086, sponsored by Aurora Democrat Rep. Linda Chapa LaVia, would halt the program before it begins and create a task force to analyze its merits.

“The bill supports an inclusive and transparent planning process,” Chapa LaVia said. She said those affected by the pilot program were not asked for input early enough in the development process. “It could be a great program. Just allow us to sit at the table so we can help, so we can [share] our concerns, why we have concerns with what the [proposal] shows.”

Administrators at the Department of Healthcare and Family Services said affected citizens and advocacy groups have been a part of the process all along, but to address their concerns, the state must now choose the health maintenance organizations (HMOs) that would run the program.

“We have been aggressively pursuing input from groups since September, and in more recent months we’ve been [asking] them, ‘What are the outcomes you want to see?’” said Theresa Eagleson, Healthcare and Family Services administrator.

Eagleson said programs that seem to worry stakeholders the most – like long-term care – won’t start right away; advocacy groups and others will continue working with the selected HMOs as the Integrated Care Program gets under way.

But advocacy groups for the disabled say the managed care program would result in less consumer choice and a prioritization of cost savings instead of individuals’ health and well-being.

“The managed care system that the administration has proposed goes against our vision for Illinois. In fact, it takes us backward,” said Barbara Pritchard with Campaign for Real Choice in Illinois. “The managed care system is a medical model. Rather than seeing people with disabilities as individuals who have unique needs, managed care seeks to provide the least expensive services.”

Eagleson and fellow administrator Jim Parker said overall cost savings would be the result of best medical practices.

“The HMO is on the hook for the cost … so if people need a specialist, they’re going to get it because they don’t want to pay the cost of an exacerbation,” Parker said. “If you apply all the economic incentives in the right way, the system will behave in the way that’s best for the patient.”

Medical providers would receive incentives for fewer hospital readmissions, but that end is best met by sending the patient to a scheduled follow-up visit with his or her primary care physician who can intervene before an emergency arises, Parker explained.

The system would work better for patients, Parker and Eagleson said, because it can now include networking technologies that keep a patient’s multiple providers up-to-date on what each has done or encountered with a specific patient.

While fears also include fewer choices for patients, Parker said choice is already limited in the Medicaid system now covering the affected patients.

“We firmly believe that in some circumstances being in this integrated care network will give them better access to some services, not less,” Parker said.