Chicago Tribune Editorial
August 31, 2011
Docs and hospitals, get on board
Everyone wins if Medicaid care is improved
In January, we applauded Illinois lawmakers for finally passing a serious Medicaid reform bill. The state's ambitious goal: Move half of Illinois' 2.6 million Medicaid patients — that's 1 of every 5 Illinoisans — into managed care by 2015. The overarching strategy is to improve health care for millions of Medicaid patients and save the state tens of millions of dollars.
We're now seeing the first phase of how that works. Managed care generally means patients are assigned a "medical home" — a doctor (it could be an HMO-style clinic) who oversees their care. Doctor and hospital fees are geared to delivering better health care, not just more of it. Providers stand to receive bonuses if they meet quality benchmarks — reducing readmissions to hospitals, for example.
At the time the bill passed, we noted that reforming Medicaid wouldn't be easy. We figured Department of Healthcare and Family Services Director Julie Hamos could expect plenty of blowback from hospitals, health care providers, patient advocate and unions that defend the status quo. A major flashpoint: asking doctors and hospitals to accept restructured, possibly lower, reimbursements.
Unfortunately, our prediction about Illinois' evolution to managed care is coming true.
As the Tribune's Judith Graham reported Friday, the state is pushing to enroll people with serious physical and mental disabilities in two private, HMO-style plans — Aetna Better Health and IlliniCare Health Plan.
But many doctors and hospitals have refused to join the new managed care program. The hospitals listed by Graham include Northwestern Memorial Hospital, Rush University Medical Center, the University of Chicago Medical Center, Children's Memorial Hospital and Loyola University Health System. We've heard that many of these elite hospitals and physician groups are still negotiating terms and rates so all of this could — should — change.
For the moment, however, those hospital and doctor refusals are forcing hundreds if not thousands of poor, chronically ill patients who had been relying on them to find new doctors and make new health care arrangements.
What a shame. Many of these hospitals and doctors have long and admirable records of serving the kinds of patients included in the state's pilot managed care program. These providers already treat many Medicaid patients and they work with HMOs in the commercial sector. Why are they resisting the state's managed care initiative?
We've heard several reasons: Hospitals and doctors don't like the bureaucratic red tape of working with the new plans. They're fearful of relentless cost-cutting measures often associated with managed care. They're not looking to expand their Medicaid treatment base because they already lose money on those patients.
We're not in the business of telling hospitals how to function. We know that many hospitals in the state operate on thin margins; 1 in 3 Illinois hospitals is losing money, according to the Illinois Hospital Association.
But we hope these hospitals and doctors realize there's a larger point here: The state's shift to Medicaid managed care is vital and long overdue.
All hospitals, doctors and patients can embrace the ultimate goal: Coordinated, and better, health care for Medicaid patients. One example: Effective managed care — treating health problems before they get more serious — should keep patients out of emergency rooms, saving hospitals plenty in unreimbursed expenses.
There are other incentives for providers to participate. The private insurers running the managed care programs have pledged to pay providers faster — in 30 days at most. That's a huge sweetener in a state where Medicaid bills can pile up in state offices for six months or more.
In some cases, Aetna Better Health CEO Robert Mendonsa told us, hospitals and doctors stand to be paid higher than normal Medicaid reimbursement rates, based on quality-performance benchmarks. Bottom line: Everyone wins if Medicaid care is improved and its costs controlled.
Other states have already done this. Illinois can too. No, it must. We hope those doctors and hospitals negotiate contracts that will work for them and … get on board.
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Ability Chicago does not support the Medicaid reform as in effect, way to
many concerns. The history of the State of Illinois in medical care, and treatment for its citizens is not favorable...
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