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After years of foot-dragging and excuse-mongering, the Illinois General Assembly passed a Medicaid reform bill earlier this month. A bill zipped through both chambers with hardly any opposition in a matter of hours. Gov. Pat Quinn signed the bill on Tuesday.
That's great news. Modernizing the state's $14 billion Medicaid program — the largest single state budget expense — should save money and improve health care for the poor and disabled. Democratic state Sen. Heather Steans of Chicago, a sponsor of the law, says the reforms could save the state $800 million to $1.4 billion over four years.
One of the new law's most significant changes: moving Medicaid patients into managed care, or what the state calls "coordinated care." What does that mean? Illinois hasn't settled on which protocol it will follow. But in theory, doctor and hospital fees are geared to delivering better health care, not just more of it.
The new Illinois law says half of Illinois' Medicaid patients need to move into managed care by 2015. If the state meets that goal, it would be a strong (if long overdue) start toward bringing Illinois in line with the rest of the country.
Nationwide, about 46 percent of Medicaid patients were in managed care in 2009, according to the Kaiser Family Foundation. In Illinois, the apples-to-apples figure hovers around 7 percent — a paltry 197,000 out of the 2.6 million Illinoisans on Medicaid. That 2.6 million, by the way, is one of every five Illinoisans — one measure of how urgently state government needs to get a handle on this program.
Studies show that states can reap millions in managed care savings, largely by improving preventive care and reducing preventable hospitalizations. In Pennsylvania, moving recipients to managed care saved the state roughly 5 percent of its outlays over a five-year period. If Illinois can do at least as well, the savings might be some $3.5 billion over five years.
More potential savings: The new law also encourages the state to move more developmentally disabled patients from nursing homes and costly state-run institutions into better, less expensive community settings.
It won't be easy. Department of Healthcare and Family Services Director Julie Hamos can expect plenty of blowback from hospitals, health care providers, patient advocates and unions that defend the status quo. Some complain about having to accept reduced reimbursements; others warn that Medicaid patients may face restricted access to care. But other states have found smart ways to deal withthose hurdles, delivering good care and curbing costs. It can be done.
The details of how this will work are still to be negotiated. But "we can't fool ourselves into thinking it's just going to be a walk in the park and everyone is behind it," Michael Gelder, the governor's chief health care policy adviser, told us.
In other words, Illinois could witness a Medicaid revolution or … not.
Quinn has praised the reforms as a way to "streamline services and eliminate inefficiencies, saving the state hundreds of millions of dollars." But those savings and efficiencies will only happen if Quinn and Hamos and all the lawmakers who voted for these changes keep pushing to fulfill the 2015 timetable. Earlier would be better.
Illinois has plenty of models around the country for how to ramp up managed care and deliver better health care while controlling costs.
No more delays. The revolution starts now.
Copyright © 2011, Chicago Tribune
