NASHVILLE, Tenn., Nov. 12 HealthLeaders-InterStudy, aleading provider of managed care market intelligence, reports that under aSenate amendment currently before the Illinois legislature, the state wouldcreate a pilot mandatory managed care program with up to three managed carecompanies participating. According to the latest Illinois Health PlanAnalysis, critics of the proposal are mounting a campaign to lobby legislatorsand keep their current primary care case management (PCCM) system intact.
"The issue has become a recurring discussion as the rest of the countryshifts toward HMO-style managed Medicaid while Illinois prefers its primarycare case management model," states Roy Moore, analyst for HealthLeaders-InterStudy and author of the report.
Under the proposed legislation, the pilot would serve as a testing groundfor savings and improved quality. The state is looking at having up to threemanaged care organizations run the program. Each plan would maintain case-specific data and produce reports based on care type and frequency and wouldbe paid on a capitated basis. Enrollment in the managed care program would bemandatory for all Medicaid beneficiaries who are not in the spend-down programor who are excluded from state-based mandatory managed care by federal law.
Critics of the proposal believe that any change could endanger federalpayments to hospitals and add further pricing pressures in a state alreadyknown for poor Medicaid payments. Illinois governor Rod Blagojevich andinsurers have been somewhat quiet on the measure, but the Illinois HospitalAssociation (IHA) argues the pilot would jeopardize the current Medicaidfinancial system and endanger the future of the hospital assessment program,which generates $730 million per year in federal funds for Illinois healthcareprograms. Instead, the IHA supports primary care case management and othernon-risk managed care techniques.
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