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State automatically enrolling people in lowest rated Medicaid managed care program

Thursday, Oct 10, 2019

* In case anyone is still wondering why some of us were so upset about the state’s rush to shove thousands of foster kids into Medicaid managed care, here’s Stephanie Goldberg at Crain’s

Illinois is funneling more people into the Medicaid managed care plan with the highest turnover and lowest scores on state quality measures.

The Illinois Department of Healthcare & Family Services sends 35 percent of new Medicaid enrollees who didn’t request a particular plan to NextLevel Health. That ties CountyCare for the highest percentage assigned to any of the state’s Medicaid managed care providers.

NextLevel gets all those new customers despite poor quality grades and high rates of defection among its current members. The plan finished last in the state’s latest quality survey, which rated NextLevel “low” or “lowest” in five of six performance metrics. Meanwhile, NextLevel lost customers at twice the rate that patients left the program overall.

Go read the rest.

* Meanwhile

A new study found waste accounts for roughly one-quarter of all U.S. healthcare spending, an estimate that’s in the same ballpark as its predecessors.

The cost of waste in the U.S. healthcare system ranges from $760 billion to $935 billion annually, according to a JAMA review of 54 peer-reviewed studies, government reports and other information, released Monday. The study found one-quarter of that could be cut using interventions found to reduce waste. […]

The current study divided waste into six previously identified categories. Administrative complexity accounted for the most waste, at $265.6 billion annually. Below that was waste due to pricing failure, which costs $230.7 billion to $240.5 billion annually. Failure of care delivery accounts for $102.4 billion to $165.7 billion annually. Overtreatment or low-value care results in $75.7 billion to $101.2 billion in waste annually. Waste related to fraud and abuse costs between $58.5 billion and $83.9 billion annually. Finally, failure of care coordination generates $27.2 billion to $78.2 billion in waste annually.

The study also estimated potential annual savings from measures shown to cut waste. In aggregate, those interventions could save $191 billion to $282 billion annually, or about 25% of the total cost of waste.

- Posted by Rich Miller        

24 Comments »
  1. - don the legend - Thursday, Oct 10, 19 @ 9:52 am:

    ==The cost of waste in the U.S. healthcare system ranges from $760 billion to $935 billion annually==

    With this staggering estimate confronting our Congress it’s nice to know they can instantly confront the scourge of vaping but find no ability to set partisanship aside and address this elephant in the room.


  2. - Demoralized - Thursday, Oct 10, 19 @ 9:55 am:

    ==no ability to set partisanship aside and address this elephant in the room==

    That’s because one side wants to go to providing those wihout insurance access to a national healthcare system while the other side thinks you can fix the problem though changes to the way the marketplace works. Not much middle ground there. But I agree with the sentiment of your comment.


  3. - Demoralized - Thursday, Oct 10, 19 @ 9:56 am:

    The purpose of the switch to managed care is to save money and the way they will save money is to ensure that these people can’t access healthcare. They are relying on this managed care company to deny services so why not pick a subpar company to take care of ensuring none of these people have access to care.


  4. - Ok - Thursday, Oct 10, 19 @ 10:03 am:

    Finally found that “Waste, Fraud, and Abuse” line item.

    Surprise! It is on the private side.

    And no surprise that most of it comes from Administrative Complexity!


  5. - Donnie Elgin - Thursday, Oct 10, 19 @ 10:04 am:

    Lost in the article is the fact that this only applies to those folks who do not bother looking out for there own self interest. “Medicaid beneficiaries in Illinois have 30 days to choose a plan. Those who don’t—about half—are automatically assigned to an insurer.


  6. - DuPage - Thursday, Oct 10, 19 @ 10:04 am:

    (The logic of whatever administrator decided on this.)

    1. They are the cheapest.

    2. I saved the state money.

    3. Hey look at me the great money-saver! I deserve a promotion and raise!!

    4. Poor quality and bad outcomes? I don’t see anything about that in the bid documents.


  7. - Donnie Elgin - Thursday, Oct 10, 19 @ 10:08 am:

    sorry meant “their own self interest


  8. - morningstar - Thursday, Oct 10, 19 @ 10:17 am:

    @Donnie - there are many reasons why eligible persons do not select a plan within the 30-day window, and not all of them have to do with the person’s lack of response/initiative. Other reasons could be lack of or poor communication from the State.


  9. - Ron Burgundy - Thursday, Oct 10, 19 @ 10:21 am:

    I would venture that many of the folks not picking a provider don’t understand that they have to. They probably think of Medicaid as a single thing, not as being serviced by multiple private providers. Once they sign up for “Medicaid” they think they are done.


  10. - Soccermom - Thursday, Oct 10, 19 @ 11:19 am:

    Picking a plan was overwhelming for my college-educated employed daughter. Imagine what it’s like if you have no idea what all these things mean.


  11. - Perrid - Thursday, Oct 10, 19 @ 11:39 am:

    Donnie, what exactly is your point? We shouldn’t care about this because the people affected didn’t make an active choice? The state can treat people badly as long as those people don’t stop the state from doing so?


  12. - Rudiforte - Thursday, Oct 10, 19 @ 12:06 pm:

    Automatic enrollment in an insurance program is in no way treating someone bad. And what about personal responsibility? A lot of things are difficult in life, we can’t expect the government to do everything for us. Picking government provided insurance seems like something individuals can do.


  13. - Donnie Elgin - Thursday, Oct 10, 19 @ 12:09 pm:

    Donnie, what exactly is your point?

    NextLevel Health gets 35% of new Medicaid enrollees. The article mentions there are only six providers available statewide and only two that are Cook County only. So if the default plan was randomly assigning folks into the plans they would have a either a 16.6% or 50% chance of being in NextLevel. The article also mentions that they use an algo to select the default plan. Nextlevel must have characteristics that are more aligned with the specifications than the others. Most importantly you only get the default if you don’t select a plan yourself. Folks need to be accountable for things that impact them personally


  14. - Perrid - Thursday, Oct 10, 19 @ 12:24 pm:

    Donnie, no, people would have a 0% chance (if they lived outside of Cook county, as most do, as NL is not active outside of Cook) or they would have a 16% plan (all 6 plans are active in Cook County) of getting enrolled in NL, with an “even” split.

    So an even split would have them at less than 16%, probably around 8%. And the article specifically says the algorithm was tweaked in July to give NL a boost.

    The article also says many other states use quality to help determine the weights of auto enrollment, to help improve overall quality of care, which IL does not seem to do.


  15. - JS Mill - Thursday, Oct 10, 19 @ 12:53 pm:

    = Folks need to be accountable for things that impact them personally=

    Too bad you don’t feel the same way about large energy corporations of banks.


  16. - Demoralized - Thursday, Oct 10, 19 @ 1:09 pm:

    ==Folks need to be accountable==

    And there’s that classic argument. The ever so cavalier “it’s not my problem” argument. How nice of you.

    You obviously have no clue about this clientele or you wouldn’t be making the argument you are attempting to make which is to blame the victim.


  17. - Anonymous - Thursday, Oct 10, 19 @ 1:15 pm:

    Hey Miller…Persona with waivers are forced into these MCO’s…I’m one of them…Molina changed my PCP to a Decatur Physician who does not choose to participate…leaving me in the lurch after my Physician of thirty years retired…good job Illinois.

    I received a card from Molina a few days ago with DMH Dr. David Baumberger’s name printed on it…indicating he was my new Doc…called the office number…and was told the Doc does not choose to participate…and that they (The State) should not have issued a card with his name as my Primary Care Provider.

    Contacted Sharon Green @DMH who hooked me up with another Physician…Round and round we go…again.

    Someone did the goofy…again.


  18. - NoGifts - Thursday, Oct 10, 19 @ 2:25 pm:

    My question is why the state is offering a bad medicaid plan? Don’t they have performance requirements and penalties for non performance? Who is evaluating the medicaid providers?


  19. - illinifan - Thursday, Oct 10, 19 @ 2:35 pm:

    You can solve some of this by having the person select a plan at the time they apply for Medicaid. Once application is processed the person is enrolled in the plan they selected. Kentucky does this and it saves a lot of time and money.


  20. - Froganon - Thursday, Oct 10, 19 @ 2:59 pm:

    There is no excuse for the poor service described for NL. “Tweak” that algo so the referral rate is at a level they can serve properly. If they improve their current level of service, they get more referrals, if not, referrals go to zero. Accountability runs both ways. The State and ultimately voters are accountable for contracting with competent providers and overseeing delivery. Demanding accountability from struggling people when you’ve assigned them to a deficient provider is mean. Let’s focus on giving them a hand up not kick in the teeth.


  21. - NoGifts - Thursday, Oct 10, 19 @ 3:54 pm:

    ^^^Froganon^^^ yes to all of this.


  22. - Chairman - Thursday, Oct 10, 19 @ 5:04 pm:

    The State’s medicaid managed care program is a disaster. Not even close to the coordination of care program we were promised. This was supposed to improve healthcare, I thought.


  23. - Rudiforte - Thursday, Oct 10, 19 @ 7:08 pm:

    As with most things in Illinois, it seems the state is not capable of doing it’s job.


  24. - JSI - Thursday, Oct 10, 19 @ 11:15 pm:

    It’s worth noting that NextLevel Health is only available to Cook County Medicaid recipients.


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