CountyCare wins contract in Rauner’s Medicaid revamp – Health Care News

on Aug5

4 August 2017 | 8:57 pm

CountyCare, a health plan run by one of the largest public health systems in the nation, has won a new contract in Gov. Bruce Rauner’s move to overhaul a major Medicaid initiative.

CountyCare is among the winners of Rauner’s revamp of the Medicaid managed care program to squeeze out more savings by largely shifting the management of enrollees’ care to private insurers, a source confirmed. A spokeswoman for the Cook County Health & Hospitals System, which launched CountyCare in 2012, declined to comment. The health plan oversaw more than 140,000 Medicaid recipients as of June, state records show.

Meanwhile, NextLevel Health, a health plan that Obama friend Dr. Cheryl Whitaker started in 2014, is out of the running and plans to appeal to the Illinois Department of Healthcare and Family Services, which oversees Medicaid. Rikeesha Phelon, a spokeswoman for Chicago-based NextLevel, said the state did not invite the carrier to present its proposal in person. NextLevel’s sole business is its current Medicaid contract, which ends in 2020. The insurer now oversees more than 50,000 Medicaid enrollees.

A spokesman for the state health care and family services department declined to comment. Representatives for other insurers that bid for a new contract, including Aetna Better Health (a subsidiary of national insurance giant Aetna) and dominant Blue Cross & Blue Shield of Illinois, said they hadn’t received a formal notice from the state one way or the other, or they did not return messages to comment.

In total, nine health plans bid this spring for what could be $9 billion in contracts over four years to administer medical benefits to most of the state’s roughly 3 million Medicaid recipients.

Medicaid is the federal-state health insurance program for the poor and disabled. In managed care, private insurers are paid by the state to not only administer benefits, but also to focus on prevention and steer enrollees away from expensive ER and hospital visits. The overall goal is to keep recipients healthy, and ultimately save taxpayers money.

News of the winning and losing bidders comes about six months after Rauner announced he wanted to rebid Medicaid managed care contracts to rein in savings. He did so while Illinois was without a budget for two years (one was passed in July) as the Republican governor and Democrat-controlled General Assembly bickered over forging a deal.

Caught up in the financial chaos were the insurers, who were owed a combined $3 billion as the state’s pile of unpaid bills to vendors soared without a state spending plan. While Illinois is starting to chip away at its IOUs, Aetna Better Health was among carriers that threatened to leave Medicaid because the insurer was owed so much—Aetna’s tab was $698 million. Illinois Medicaid is Aetna’s only business.

Not paying insurers created a domino effect that still continues. They didn’t pay doctors in full or on time, or stopped paying them altogether. Doctors in turn curbed access to patients, cutting back hours and giving expensive vaccines to kids.

Meanwhile, state Medicaid programs nationwide are bracing for potentially huge funding cuts from D.C., making cost-saving programs like managed care (if they work as intended) even more crucial.

Currently, the state contracts with 12 insurers to manage the benefits for about 65 percent of Medicaid recipients. There are four managed care programs, though the one that focuses on families and people who joined Medicaid when the program expanded under the Affordable Care Act is by far the largest.

Under Rauner’s overhaul, he plans to shrink the number of participating insurers to up to seven, have most operate statewide (CountyCare would continue to operate locally), and focus on mental health and addiction. Medicaid enrollees who are diagnosed with or treated for a behavioral health issue make up just a quarter of all recipients in the state, but account for more than half of total costs.

Rauner also wants insurers to provide better quality care. In a 2015 state report card that measured the quality of nearly all of the participating insurers, most received average to high marks on indicators such as vaccinating children and preventive visits. But among the two benchmarks for behavioral health—addiction treatment and continued care for the mentally ill—a third received below-average grades.

In July, a Crain’s investigation found a troubling pattern if the state wants to rein in Medicaid spending. Insurers are doing a lousy job of tracking down and working with Medicaid recipients who chose them or were assigned to them. To be sure, these patients can be tough to track, and some people brush off any help to connect with a doctor.

Illinois pays the insurers regardless of whether they find people, but the state does withhold some money that insurers can earn back by hitting certain quality benchmarks. In 2015, the state withheld about $63 million and paid out just $12 million.

Rauner is expected to officially announce winners of new Medicaid managed contracts soon, potentially next week. The new contracts are projected to begin on Jan. 1.



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