Rauner names winners in Illinois Medicaid overhaul
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • merrill goozner
      Healthcare groups should end all political donations—permanently
      Sticking to Mediterranean diet is good for the brain
      Joe Biden
      Revamp of the nation's vaccination effort may not be enough
      A man in a room with servers.
      Momentum grows to outsource hospital tech functions in 2021
    • COVID-19 hastens hospitals' revenue cycle outsourcing moves
      Operation Warp Speed Dr. Moncef Slaoui, Pfizer Group President Angela Hwang, Moderna CEO Stephane Bancel, CVS Health Executive Vice President Karen Lynch and McKesson CEO Brian Tyler participate in a panel discussion on the COVID-19 vaccine.
      Hospitals, drug companies strive to stand out virtually at JPM
      Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
      Joe Biden
      Revamp of the nation's vaccination effort may not be enough
    • Trenda Ray
      Q&A: Arkansas nursing leader looking for creative staffing solutions as COVID cases surge
      The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      Cook Lydia 4x6_i.jpg
      Northeast Ohio health systems increase community benefit values in 2019
      Vaccine rollout hits snag as health workers balk at shots
    • CMS approves rule forcing insurers to ease prior authorization
      COVID-19 still a big uncertainty for insurers in 2021
      Health insurers' outlook boosted after Dems' Georgia win
      humana_i.jpg
      Humana supports Ohio not-for-profits with $500,000
    • Joe Biden
      Revamp of the nation's vaccination effort may not be enough
      CMS will raise Medicare Advantage plan payments by 4.08% in 2022
      CMS approves rule forcing insurers to ease prior authorization
    • Operation Warp Speed Dr. Moncef Slaoui, Pfizer Group President Angela Hwang, Moderna CEO Stephane Bancel, CVS Health Executive Vice President Karen Lynch and McKesson CEO Brian Tyler participate in a panel discussion on the COVID-19 vaccine.
      Hospitals, drug companies strive to stand out virtually at JPM
      Intermountain, Trinity, Memorial Hermann behind $300M private equity fund
      Operation Warp Speed to bump up McKesson's stock price
      Reporter's notebook: J.P. Morgan's 2021 health conference
    • A man in a room with servers.
      Momentum grows to outsource hospital tech functions in 2021
      5 things to know about Google's $2.1B Fitbit acquisition
      Providence bets on machine-learning, consolidating data centers
      Mental health treatment was most common telehealth service during COVID
    • Sticking to Mediterranean diet is good for the brain
      Chance of COVID-19 triage care looms over Arizona hospitals
      U.S. ramps up vaccinations to get doses to more Americans
      367146427.jpg
      Should businesses mandate that staff get the COVID vaccine?
    • Cone Health CEO, CFO to depart amid pending Sentara merger
      Tower Health's finance chief resigning after years of steep losses
      AHRQ director Gopal Khanna resigns in response to Capitol riot
      Brigham president stepping down after Moderna controversy
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
      Yale New Haven's COVID-19 nurse-staffing model has long-term benefits
    • Modern Healthcare InDepth: Breaking the bias that impedes better healthcare
      Videos: Healthcare industry executives describe their encounters with racism
      Michellene Davis
      Healthcare leadership lacks the racial diversity needed to reduce health disparities
      Dr. James Hildreth
      How medical education can help fight racism
      Quotes from rebadged employees
      Outsourcing IT, revenue cycle takes toll on internal culture
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      self service station
      COVID-19 pushes patient expectations toward self-service
      Targeting high-risk cancer patients with genetics
      A nurse holds up a phone with a message to a family member saying surgery has started.
      Texting, tablets help hospitals keep family updated on patient care
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Highmark Health inks six-year cloud, tech deal with Google
      Study: 1 in 5 patients report discrimination when getting healthcare
      HHS proposes changing HIPAA privacy rules
      Android health records app launches at 230 health systems
    • California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
      Healthcare was the hardest hit by supply shortages across all U.S. industries
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      New care model helps primary-care practices treat obesity
      How hospitals are building on COVID-19 telehealth momentum
      Researchers: Hospital price variation exacerbates health inequities
    • MedPAC votes to boost hospital payments, freeze or cut other providers
      Most Next Gen ACOs achieved bonuses in 2019
      Congress recalibrates Medicare Physician Fee Schedule after lobbying
      CMS approves rule to encourage value-based drug pricing
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
      Dr. Bruce Siegel
      Why taking a hospital not-for-profit was Dr. Bruce Siegel’s boldest move
    • Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
      Mark C. Clement and David Cook
      We all need to 'do something' to fight inequities and get healthcare right, for every patient, every time
    • Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
      Healing healthcare: some ideas for triage by the new Congress, administration
      Dr. Sachin H. Jain
      Medicare for All? The better route to universal coverage would be Medicare Advantage for All
      Connectivity: a social determinant of health that can exacerbate all the others
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - Health Care Hall of Fame
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Social Determinants of Health Symposium
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala (2022)
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
      Next Up Podcast: COVID-19, social determinants highlight health inequities — what next?
      Ceci Connolly
      Next Up Podcast: How to navigate the murky post-election waters
      Next Up Podcast: Saving Rural Health
    • An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
      doctor burnout
      Beyond the Byline: How healthcare supply chain struggles contribute to employee burnout
      Beyond the Byline: Covering race and diversity in the healthcare industry
      Beyond the Byline: How telehealth utilization has impacted investor-owned company earnings
    • Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      The Check Up: Dr. Kenneth Davis
      The Check Up: Dr. Kenneth Davis of Mount Sinai Health System
      The Check Up: Dr. Thomas McGinn
      The Check Up: Dr. Thomas McGinn of CommonSpirit Health
      The Check Up: Mark Ganz
      The Check Up: Mark Ganz of Cambia Health Solutions
    • Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
August 14, 2017 01:00 AM

Rauner names winners in Illinois Medicaid overhaul

Kristen Schorsch
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print

    The Rauner administration has awarded bids to six insurers in his quest to overhaul a major Medicaid cost-saving initiative in Illinois, cutting in half the number of participating carriers.

    The winners are Blue Cross and Blue Shield of Illinois, the largest carrier in the state, and the following insurers affiliated with national or regional carriers: Harmony Health Plan, IlliniCare Health Plan, Molina Healthcare of Illinois and Meridian Health, according to the Illinois Department of Healthcare and Family Services, which implements the Medicaid health insurance program for the poor and disabled. They will administer medical benefits to Medicaid recipients statewide.

    Also winning is CountyCare, a health plan run by the Cook County Health and Hospitals System, that will operate in Cook County only. IlliniCare also will cover children in the custody of the Illinois Department of Children and Family Services.

    Here's which insurers lost: Aetna Better Health, which threatened to leave the state Medicaid program earlier this summer because the state owes it so much money in overdue bills; NextLevel Health, a plan founded by Obama friend Dr. Cheryl Whitaker; and Trusted Health Plan out of Washington, D.C.. NextLevel said last week that the insurer was out of the running and would appeal the state's decision.

    In total, nine health plans bid for contracts to oversee the coverage of most of the state's 3.2 million recipients on Medicaid. In what's known as managed care, insurers are paid by the state to focus on prevention and steer enrollees away from expensive ER and hospital visits. The overall goal is to keep Medicaid recipients healthy, ultimately saving taxpayers money.

    "The reboot brings enhanced care coordination and stronger quality controls to fulfill the promises of managed care to Medicaid beneficiaries," Felicia Norwood, director of the state healthcare and family services department, said in a statement. "By operating with an ideal number of plans, overhead costs will be reduced while we make sure every beneficiary receives powerful choice. This means more of the program's money going to real people instead of bureaucracy."

    OVERDUE BILLS

    The news comes about six months after Republican Gov. Bruce Rauner announced he wanted to rebid Medicaid managed care contracts to squeeze out more 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 budget. Aetna Better Health was owed $698 million. Illinois Medicaid is that insurer's only business here.

    Not paying insurers created a domino effect. They didn't pay doctors in full or on time, to stopped paying altogether. Doctors in turn curbed access to patients, cutting back hours and even expensive vaccines.

    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.

    In Illinois, 12 insurers currently manage the benefits for about 63% of Medicaid recipients, though only nine carriers bid for contracts. Under Rauner's overhaul, 80% of Medicaid enrollees must choose or be assigned to a managed care plan.

    While the state now spends about $10.5 billion on managed care, the cost is expected to swell to between $12.8 billion and $13.5 billion. That's partly because enrollment will increase, and health plans are paid a fixed amount of money per enrollee. The initiative also is expanding from 30 to all 102 counties in the state.

    Recipients in counties where managed care already exists will become part of new health plans on Jan. 1. Enrollees who will be new to managed care will join on April 1, 2018.

    The new contracts are expected to save between $200 million and $300 million a year through such things as cost-cutting incentives for the insurers, the healthcare and family services department said in its statement.

    When the carriers bid, they committed to getting paid less money per enrollee, department spokesman John Hoffman added in an interview. There will be efficiencies too, such as a universal credentialing process for doctors to participate in insurers' networks, rather than each carrier having its own process.

    Hoffman said state officials could not comment on why they picked some insurers over others, saying the procurement was still ongoing. But he said the selection process involved a multi-agency evaluation team with experts in everything from health care quality to finance and information technology who analyzed insurers' bid applications.

    The winning contracts, still to be negotiated, are effective Jan. 1 for an initial four-year term, and will include an option to renew for up to an additional four years. Losing bidders can appeal.

    A spokesman for Aetna declined to comment. In a statement, Cook County Health CEO Dr. John Jay Shannon said CountyCare, one of the largest Medicaid managed care plans in the region, "looks forward to continuing to care for Cook County residents enrolled in Medicaid. Cook County Health has proudly served individuals in our community who are most in need for more than 180 years."

    Representatives of other insurers did not provide comment or could not immediately be reached.

    MISSING RECIPIENTS

    In his revamp, Rauner wants insurers to do a better job on the type of care they provide. 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 names winners in Medicaid overhaul" originally appeared in Crain's Chicago Business.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Revamp of the nation's vaccination effort may not be enough
    Revamp of the nation's vaccination effort may not be enough
    Verma: CMS tried to 'infuse' free-market competition across healthcare during Trump era
    Verma: CMS tried to 'infuse' free-market competition across healthcare during Trump era
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
        • Social Determinants of Health Symposium
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala (2022)
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing