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Thursday, Dec. 2, 2010 01:55 am

Impatient with Medicaid patients

Committee hears personal responsibility is key to savings

“Patient responsibility” was the phrase of the day Monday for the Republican co-chair of a special state Senate committee formed to review and recommend reforms for the state’s Medicaid system.

The bipartisan committee, charged with issuing a report and legislative recommendations by Jan. 3, was formed in an effort to sway Republicans, who have sought Medicaid reforms for years, to support borrowing legislation that would ease the state’s short-term fiscal woes. The committee’s first hearing, during which it heard from state agencies and provider groups, was held Monday in Springfield.

Department of Healthcare and Family Services director Julie Hamos, who until April was a Democratic state representative, offered a number of short- and long-term reform goals, including tightening up eligibility verification. She says that giving state agencies that deal with Medicaid patients more tools – such as the ability to match data with other state departments, like revenue or employment security – would help HFS to eliminate Medicaid patients from the rolls should they prove no longer eligible.

But the committee’s Republican co-chair, Senator Dale Righter of Mattoon, questioned why the onus of proving eligibility wasn’t more squarely on the patient. He also asked provider groups, including the Illinois Hospital Association, if the state could encourage personal responsibility, through co-pays or premiums, to get patients to use the most appropriate services. He says that part of the problem lies in patients going to the more costly emergency room when a doctor’s office visit would suffice.

IHA executive vice president Howard Peters says co-pays likely aren’t the answer but agrees that a lack of patient responsibility – from sticking to follow-up appointments and following doctors’ orders to avoiding unnecessary emergency room visits – is a problem that must be overcome in order to see real Medicaid savings.

“I think in part because of the enormous difficulty of doing it, we really kind of backed off or abandoned the notion that Medicaid beneficiaries are going to have to take some responsibility,” Peters says. “If we really do want to drive down unnecessary utilization and unnecessary costs, that’s going to have to be one of the challenges we take on.”

Ann Ford, who observed the hearing and serves as executive director for Illinois Network of Centers for Independent Living, spoke to Illinois Times following the meeting. She says that personal responsibility is a good thing but that lawmakers and agencies often don’t factor in Medicaid patients’ reality.

“A lot of people aren’t able to or don’t read when they get massive written material, because it’s too much and it’s over their heads a lot,” Ford says. “As long as people understand, I am big on personal responsibility, but let’s make sure they know what you’re talking about, that they know that means you don’t go to the emergency room, that you call your doctor. Sometimes it’s as simple as that.”

Hamos also suggested expanding care coordination models, the new version of managed care. Instead of payment for each service performed, providers are paid based on health outcomes. “We definitely see this as the future and we should be starting that right now,” Hamos says, adding that healthier patients are cheaper patients.

She adds that whatever changes the legislature approves, lawmakers should remember that by 2014 the federal Affordable Care Act could result in about 700,000 more Medicaid patients in Illinois, increasing the Medicaid population from 19 percent to 24 percent of the health care market. She says that the additional patients will give the state more leverage in bargaining with providers to improve access and care.

Contact Rachel Wells at rwells@illinoistimes.com.
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