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Illinois Governor Pat Quinn

Illinois governor offers Medicaid 'transformation' plan

By Steven Ross Johnson
Posted: February 12, 2014 - 2:00 pm ET

Illinois Gov. Pat Quinn this week unveiled a five-year plan aimed at restructuring healthcare delivery and payment processes in the state's Medicaid program.

The plan looks to increase access to community-based health providers while reducing health costs. It will focus more than in the past on addressing social determinants identified as having a negative impact on the health outcomes of lower-income populations in particular.

Called the “Path to Transformation,” the $5.2 billion plan is due to be submitted next as a federal 1115 waiver application for consideration by the CMS.

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“Illinois has made tremendous progress in recent years reforming and improving our healthcare system to control costs and deliver better quality care,” Quinn said in a written release. “This plan will help take our healthcare system to the next level—improving the health of people and communities across Illinois while significantly lowering our long-term costs.”

Some of the initiatives being proposed within Illinois' Medicaid demonstration include an expansion of risk-based, managed-care plans, as well as an increase in public health campaigns that focus on positive lifestyle changes such as tobacco cessation and healthier eating.

The plan would establish a statewide health information exchange where healthcare providers throughout Illinois would be able to share clinical and administrative data on Medicaid patients. The demonstration also would call for the creation of supportive housing for Medicaid patients and an expansion of behavioral health services and supports.

The overall goal of the project is to create a system that does a better job of coordinating care since a larger number of people are covered thanks to Medicaid expansion through the Patient Protection and Affordable Care Act. The state projects that an additional 500,000 Medicaid beneficiaries will be enrolled in the program by 2017.

If the waiver is approved, the governor estimates the demonstration will save the CMS about $2 billion by the end of year five, with a 20% reduction in emergency room visits by Medicaid and Children's Health Insurance Program beneficiaries by the third year.

The plan has received support from Illinois healthcare providers, who lauded its community-based approach.

“We support the general direction of the waiver to bring in critically needed federal funding to transform the Medicaid program to ensure effective, coordinated care for the most vulnerable citizens of Illinois,” said Maryjane Wurth, president and CEO of the Illinois Hospital Association, in a written statement.

The plan is scheduled to be submitted to the CMS March 12.

Follow Steven Ross Johnson on Twitter: @MHSjohnson

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