Nationally, the plans that are best at managing care for Medicaid patients are those that effectively coordinate their care, said Robert Saunders, an associate vice president at the National Committee for Quality Assurance. His company has annually ranked plans based on the quality of their services for more than decade.
But Illinois' Medicaid plans haven't been doing well on care coordination, some providers say. There has been little effort to ensure patients are taking their medications or have transportation to appointments. And plans haven't done a good job of keeping primary care providers informed about their patients' specialty care.
“The secret sauce of managed care is supposed to be care management,” said Dr. John Jay Shannon, CEO of the Cook County Health & Hospitals System based in Chicago. “Certain plans attempted to do it on the cheap using phone banks to make the occasional call, instead of a more proactive approach.”
His system's Medicaid managed-care plan, CountyCare, relies on a face-to-face strategy with a care manager meeting with patients to discuss the care they need.
Fallon Health, a Massachusetts-based plan that the NCQA ranks as one of the nation's top Medicaid plans, uses predictive modeling to identify beneficiaries who are overusing emergency departments. The plan connects those patients with a care coordinator, said Dr. Thomas Ebert, the plan's chief medical officer.
As the Rauner administration moves forward in revamping the Illinois Medicaid managed-care program, providers are concerned that the administration hasn't learned the lessons about why the previous program had so many problems.
Scott Kiriakos, senior vice president for clinical integration for Memorial Health System based in Springfield, Ill., said the governor's timetable is far too ambitious to ensure a smooth rollout.
“There isn't the necessary amount of time to do the preparation that must occur,” Kiriakos said. “The governor's proposed program is even more ambitious than the last one. We're concerned we're going to recreate the same administrative issues we had the first time around.”