Illinois Gov. Bruce Rauner today outlined his reboot of the state Medicaid managed care program, which he said now operates "in name only."
Insurers picked through a competitive bidding process will be held more accountable for patient outcomes, and the state wants them to redouble their efforts on prevention. The goal: squeeze out savings for Medicaid, a $21 billion health insurance program for the poor and disabled and one of the most expensive parts of the Illinois budget.
"We can leapfrog ahead," Rauner said during a news conference at Mount Sinai Hospital on the West Side, a safety net hospital with nearly 70 percent of patients on Medicaid.
The Illinois Department of Healthcare and Family Services, which oversees Medicaid, issued a call for proposals today outlining how insurers can vie for a piece of the state's managed care business. Previously, insurers bid for specific types of patients in managed care, such as those who have disabilities, but now they'll have to pitch themselves as a one-size-fits-all insurer.
Rauner inherited managed care from Democratic Gov. Pat Quinn, who backed a law aggressively placing 50 percent of Medicaid enrollees into a health plan that would keep close tabs on their medical care. Now about 65 percent of the state's 3.1 million Medicaid recipients are in managed care.
Rauner wants to expand managed care services statewide and add another 15 percent of all Medicaid enrollees to the program. In Central Illinois, for example, Medicaid recipients have little access to managed care.
At the same time, the governor plans to cap the number of insurers that can participate to between four and seven. While the number has shrunk from roughly 30 to 12 insurers now, Rauner said the vast system still is an administrative headache for doctors, hospitals and patients.
Illinois has been gleaning lessons from other states, including Arizona, which requires all Medicaid recipients to be in managed care. The idea of managed care is to surround patients with teams of nurses, social workers and doctors to coordinate treatment and therefore lower medical costs.
"There remains so much work to be done," said Felicia Norwood, director of the state healthcare and family services department. "To truly succeed, there must be … a system that rewards quality and measures outcome. Unfortunately, there remain too many obstacles and limitations in our current managed care framework."