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Rauner wants fewer managed care companies to serve lots more Medicaid clients

Monday, Feb 27, 2017

* AP

Gov. Bruce Rauner’s administration is seeking to offer more Medicaid services through managed-care programs.

Rauner and two cabinet members announced the plan in Chicago Monday. It involves choosing a vendor that’ll provide managed-care services to 80 percent of Medicaid clients.

That’s up from 65 percent now. It’ll also be expanded to all Illinois counties and children in the care of the Department of Children and Family Services.

* But there will be fewer managed care providers

Rauner inherited managed care from Democratic Gov. Pat Quinn, who backed a law aggressively placing 50 percent of Medicaid enrollees into a health plan that would keep close tabs on their medical care. Now about 65 percent of the state’s 3.1 million Medicaid recipients are in managed care.

While Rauner wants to expand managed care services statewide and add another 15 percent of all Medicaid enrollees to the program, he explained why he plans to cap the number of insurers that can participate to between four and seven.

There are simply too many insurers now participating, he said. While the number has shrunk from roughly 30 to 12 insurers now, the vast system is an administrative headache for doctors, hospitals and patients, he argued. In Central Illinois, for example, enrollees have little access to managed care.

Illinois has been gleaning lessons from other states, including Arizona, which requires all Medicaid recipients to be in managed care. The idea of managed care is to surround patients with teams of nurses, social workers and doctors to coordinate treatment and therefore lower medical costs. […]

Rauner said he couldn’t speculate about how much money the new contracts could save Medicaid, but he said “there’s clearly significant savings to be had” by increasing quality and focusing on prevention.

Rauner wants to take that number of managed care organizations down to as few as four and no more than seven, according to the state’s RFP. Needless to say, some managed care companies are starting to freak out.

And all of this is happening while DC tries to figure out what it’s going to do with Medicaid and the ACA.

- Posted by Rich Miller        

28 Comments
  1. - Precinct Captain - Monday, Feb 27, 17 @ 3:33 pm:

    He doesn’t know how much they could save? Not a basic estimate? Must be more of a fantasy than his pension proposals.


  2. - Free Set of Steak Knives - Monday, Feb 27, 17 @ 3:33 pm:

    Wait, I thought Republicans were in favor of folks being able to choose their own doctor?


  3. - Anonymous - Monday, Feb 27, 17 @ 3:37 pm:

    Not to mention that providers are concerned that current MCOs that do not “win” through the RFP will not follow through on financial obligations to in-network providers and could not be as diligent for the remaining 6 months of their contracts.


  4. - Not It - Monday, Feb 27, 17 @ 3:37 pm:

    The issue is that managed care companies save the State money by providing health care providers (doctors) to jump through a lot of hoops to provide care. The more expensive the treatment the more hoops. However, when you have 20 different companies all using different procedures, forms, and computer programs, it becomes an administrative nightmare for the doctors and their staffs.


  5. - Living it daily - Monday, Feb 27, 17 @ 3:38 pm:

    who has money in the vendor, when they are all wanting out, someone from California, the K brothers?


  6. - Thoughts Matter - Monday, Feb 27, 17 @ 3:38 pm:

    Another reason why he should have been meeting with the other governors today.

    So less choices automatically increases quality?


  7. - Cable Line Beer Gardener - Monday, Feb 27, 17 @ 3:39 pm:

    Maybe he should have stayed in DC to discuss this too along with the ACA, the violence in Chicago, matching governmental funds for necessary programs-you know-governor stuff.


  8. - VanillaMan - Monday, Feb 27, 17 @ 3:40 pm:

    This governor believe that some citizens don’t contribute enough to Illinois for any rights to choose how they are cared for.

    Rauner’s supporters don’t care either.

    What needs to be done is to show how competition in a marketplace is good for all. It seems that Rauner doesn’t believe that.

    Who does he know that wants a bigger cut of this contract?


  9. - Earnest - Monday, Feb 27, 17 @ 3:47 pm:

    >Rauner wants to take that number of managed care organizations down to as few as four and no more than seven,

    This is his vision for the state: fewer providers and more large multi-state corporations, in many areas. I dislike it, but it is the way things have gone around the country for the last few decades.


  10. - JAH - Monday, Feb 27, 17 @ 3:55 pm:

    What happens if and when President Trump changes how Medicaid is handled?


  11. - wordslinger - Monday, Feb 27, 17 @ 4:06 pm:

    So….

    What’s the conservative-GOP-harrumph-harrumph rationale for arbitrarily reducing the number of insurers who can participate?

    I take it “competition” and “market forces” are not among the reasons?


  12. - Swift - Monday, Feb 27, 17 @ 4:07 pm:

    Is this actually a move for efficiency or a move to address the lack of state payments to the managed care providers?

    It’s my understanding the managed care providers can’t pay the hospitals because of the bill backlog. As a result hospitals aren’t taking the patients of the providers, unless emergency care is required.

    Fewer providers makes sense only when the goal is to ensure the providers have the financial ability to endure late payments from the state.


  13. - Rich Miller - Monday, Feb 27, 17 @ 4:15 pm:

    ===because of the bill backlog===

    Medicaid backlog is nothing like the state health insurance backlog.


  14. - Johnnie F. - Monday, Feb 27, 17 @ 4:19 pm:

    I will gladly pay you Tuesday for a health care plan today. Note to Insurers: Check out the Quality Care plan for state employees. Can you afford to always be floating the state a loan, and never known when you will receive your premium payment?


  15. - logic not emotion - Monday, Feb 27, 17 @ 4:21 pm:

    You could standardize it by requiring the same forms, coverage, payment rates, etc. so providers don’t have to wade through a bunch of individual hoops.

    Then you impose some guidelines regarding enrolling providers (i.e. have to enroll all providers in certain categories unless they are barred due to disciplinary actions, etc.) to ensure adequate number of providers.

    Finally, you provide a recourse for providers. Basically, a place where providers could contact with payment and other concerns. If the MCO doesn’t pay fully, timely, etc., this contact would serve as the arbitrar of sorts without forcing either into going to court.


  16. - Annonin' - Monday, Feb 27, 17 @ 4:30 pm:

    Does this make it easier for Vendor Assistance bankers to dole out cash. Never have figured out why managed care cheaper other than rationin’


  17. - A guy - Monday, Feb 27, 17 @ 4:51 pm:

    ==I take it “competition” and “market forces” are not among the reasons?==

    If there will be 4-7 competing, I’d say market forces will be unleashed as never before.


  18. - wordslinger - Monday, Feb 27, 17 @ 5:02 pm:

    –If there will be 4-7 competing, I’d say market forces will be unleashed as never before.–

    Read harder, because you make no sense.

    4-7 is the proposed cap.

    There are 12 competing now, and as many as 30 in the recent past.

    What’s your best Adam Smith as to how an artificial, governmentally dictated lower cap on competitors leads to “market forces.. unleashed as never before.”-


  19. - Anon - Monday, Feb 27, 17 @ 5:07 pm:

    Logic not emotion got it right. With little management, oversight, or leadership from HFS over the mcos, the confusion that providers have experienced has led to lack of payment. The real problem here is the defensiveness of those democrats who were architects and supporters of transitioning Medicaid to managed care. The defensiveness of this broken system has really opened my eyes to their ability to admit the errors of the past and how to correct it going forward. These democrats have lost the hard earned faith that they had developed with health care providers throughout the state.


  20. - @MisterJayEm - Monday, Feb 27, 17 @ 5:20 pm:

    “Rauner said he couldn’t speculate about how much money the new contracts could save Medicaid”

    Quite the business mind, this guy…

    – MrJM


  21. - chitown gal - Monday, Feb 27, 17 @ 6:03 pm:

    He does not know how much they have saved over the last year or so???Why NOT? Okay so there is currently no oversight on MCOs by the state. State has no way to measure how much they save so they have to believe the MCOs…who are exploiting the numbers….


  22. - LTSW - Monday, Feb 27, 17 @ 6:10 pm:

    The current managed care companies were not selected competively. Because of the statutory requirements to get 50% enrolled within a year, selections were based on companies ability to cover population areas. Because illinois’ provider rates are so low there is very little room for savings without case managers controlling services.


  23. - wordslinger - Monday, Feb 27, 17 @ 6:42 pm:

    –”Rauner said he couldn’t speculate about how much money the new contracts could save Medicaid”–

    So what’s the point of cappin’ the number of providers?

    Suddenly, there’s a faint aroma of fryin’ bacon, a brief vision of stacked shoeboxes in a closet, and a whispered, whiskey-ravaged Little Egypt accent squealin’ “I can smell the meat-a-cookin.”


  24. - Arthur Andersen - Monday, Feb 27, 17 @ 6:46 pm:

    Annonin’ I don’t think so. Wrong pot o’ gold. Tell me if I have it backwards.


  25. - Rabid - Monday, Feb 27, 17 @ 7:15 pm:

    You have to be competitive to be compassionate


  26. - Property of IDOC - Monday, Feb 27, 17 @ 8:52 pm:

    Vman is correct, it’s only about the money, clearly a possible conflict of interest.


  27. - Rolodex2017 - Monday, Feb 27, 17 @ 9:15 pm:

    for-profit health insurance companies…argh. Let’s just just bite the bullet, raise taxes and go to a single payer heal CARE system.


  28. - illini - Monday, Feb 27, 17 @ 10:43 pm:

    @Wordslinger - Much as I respect your thoughtful and pointed comments I fail to see the relation between this post and the unfortunate history of Paul Powell. Maybe I am missing something.


Sorry, comments for this post are now closed.


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