State shift in patient-care programs leaves Chicagoans without coverage | Healthcare | Crain's Chicago Business
By: Anthe Mitrakos May 16, 2011
(Crain's) — The Quinn administration next month is ending a statewide program touted for its savings for Medicaid patients with chronic diseases. It will be replaced with a larger, more expensive pilot program that covers the Chicago suburbs but excludes thousands of residents in the city and the rest of the state.
Just a year ago, Julie Hamos, director of the state Department of Health and Family Services, was praising Your Health Care Plus, which has saved the state $569 million over four years, at a combined cost of about $126 million, according to state officials.
Launched by former Gov. Rod Blagojevich, the disease-management program helped patients with disabilities and complex illnesses get regular primary medical care, keeping them out of emergency rooms and hospitals where the costs of treatment are much higher. Health Care Plus is being phased out in favor of the Integrated Care Program, a managed care organization. The new program directly treats Medicaid patients with disabilities and diseases such as diabetes and asthma, unlike the prior program, which helped arrange for treatment.
Though it covers about 40,000 patients in DuPage, Kane, Kankakee, Lake, Will and suburban Cook counties, Chicago residents are ineligible for enrollment in Integrated Care. As a result, thousands of Medicaid patients, among the most expensive to treat, will lose a key service that the state has lauded for keeping costs down.
"Our systems of care are very fragmented, and what's likely to happen is some people will get lost in the system," said Dr. Karen Batia, executive director of Heartland Health Outreach and vice-president at the Chicago-based Heartland Alliance, a non-profit that focuses on human rights. "Some of those people . . . will probably end up requiring some more expensive services than they might have otherwise."
The shift to Integrated Care is part of a nationwide trend to cut costs by moving Medicaid patients into some form of managed care, which typically puts some financial risk on health care providers.
"We feel it is time to advance to a more sophisticated model in which disease management is incorporated more closely into a greater care integration system," a Health and Family Services Department spokeswoman said in an email.
State officials say the new program is expected to save the state about $40 million a year, but some observers are skeptical of those claims.
"From a fiscal standpoint, I'm just concerned that the savings are not what they claimed to be. . . .It's very hard for folks to claim these savings are real," said Ralph Martire, executive director of the non-profit Center for Tax and Budget Accountability in Chicago.
Health Care Plus, which was voluntary, handled about 40,000 patients a year statewide. The number of Chicago patients could not be determined, but state officials say about 58,000 Chicago Medicaid recipients were eligible for the program.
The city was excluded from the new state program because it would have driven up the state's Medicaid budget, among other reasons, the Health and Family Services spokeswoman said.
Health Care Plus, run by San Francisco-based health care management firm McKesson Corp., was praised by Ms. Hamos just a year ago.
"Your Healthcare Plus is leading the way to better care, better health outcomes and more cost savings for our state," she said, according to a May 2010 press release.
After it ramped up, the program saved the state about $142 million annually, on average.
About $126 million was paid to McKesson the first four years of Health Care Plus, according to documents filed with the state comptroller.
McKesson's contract is scheduled to end June 30. "The program is ending simply because the contract is ending," a company spokesman said in an email.
In September, Health and Family Services picked two firms to run the new program: Aetna Inc., a Hartford, Conn.-based health insurer, and Centene-IlliniCare, a subsidiary of St. Louis, Mich.-based Centene Corp., which runs Medicaid programs.
The new program, launched May 1, is expected to cost $2.25 billion over five years because the firms will be directly overseeing patient care.
The combined fees for medial and disease management paid to Aetna and Centene of $36 million a year are slightly less than the amount McKesson was being paid annually to run the old program, the Health and Family Services spokeswoman said.
But Integrated Care's annual savings of $40 million a year would be less than a third of the annual savings of Health Care Plus.
Integrated Care's annual savings estimate doesn't include the money the state was already saving under the old program because that would have created a "false impression," the department spokeswoman noted.
The remainder of the approximately 250,000 Health Care Plus members not eligible for Integrated Care will have to navigate other programs, such as Illinois Health Connect, which connects patients with primary care sites but is not geared specifically for those with disabilities and chronic diseases.
Read more: http://www.chicagobusiness.com/article/20110516/NEWS03/110519915/state-shift-in-patient-care-programs-leaves-chicagoans-without-coverage#ixzz1MWNJw0k1
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