Illinois Academy of Family Physicians

Testimony to the Senate Medicaid Oversight Committee

Provided by: Asim K. Jaffer, MD, IAFP First Vice President


My name is Dr. Asim Jaffer and I’m a family physician in Peoria. I’m providing testimony on behalf of the Illinois Academy of Family Physicians. 

I’d like to first thank the state of Illinois for expanding Medicaid and maximizing the opportunities provided by the Affordable Care Act. We have improved patient access to care and increased the number of Illinoisans with coverage.
Our collective work to achieve the Triple Aim continues: we remain committed to -
• Achieve better outcomes for patients.
• Provide better experience of care for patients and caregivers, and
• Provide better value through effective coordinated care, resulting in reduced cost to taxpayers.

My comments today will focus on how some modest measures can vastly improve Medicaid managed care for patients and providers in the system. First and foremost, communication between the managed care organizations and providers should be clear and open. IAFP was among several provider organizations invited to participate in a dialogue with the managed care organizations and the Department of Healthcare and Family Services. The meeting provided one opportunity to openly communicate on challenges and opportunities we face in this new era of managed care. While we eventually received some standard replies to questions raised at that meeting in October 2015, we need responses and actions on our concerns that clear and open communication could have solved by this time.

For example, panel management and re-determination questions could be answered with a uniform, query-able database, which means an upgrade to MEDI, the Medicaid Eligibility Verification system. HFS would be able to manage provider panels across the MCOs to ensure providers do not have more than 1800 Medicaid patients assigned to them across all the MCOs. Currently, the HFS maximum patient panel limit is only managed independently by each MCO. Providers could be able to pull reports on those patients from their overall Medicaid managed care panels who will be struck from Medicaid through the process of redetermination so that providers can assist these patients at the time of service. If the database were query-able, this valuable information would be at the provider’s fingertips.While the final federal rules on Medicaid managed care have yet to arrive, Illinois already took steps toward implementing data reporting in Public Act 99-0086. Clear and open communication on the status of what steps have been taken to implement this law are hard to find. The most recent data tracking posted on the HFS Info Center website was from February 2015.

As for encounter data, we’ve gleaned information only by our presence at the Medicaid Advisory Committee’s Quality Care Subcommittee meeting that HFS is re-doing auto assignments. While this switch to the algorithm that Michigan uses for their Medicaid MCO auto assignments will allow enrollees to select an MCO based on about 20 measures within the 60 day allotted timeframe, the “churn” that will invariably happen. Patients and providers are currently struggling to navigate through the confusing complexities of Medicaid managed care. Some examples include changing formularies, disrupting specialty care (ie cancer care), different providers for moms and babies and other children disrupting continuity of care for families. The reality is that many patients that just don't have the time or understanding of the system to keep or select their primary care providers in those 60 days. Furthermore, patients face network adequacy issues when the number of plans decreases. Will they have access to the care they need in a place they can reach?
Where is all this information and how do we clearly and openly communicate it with those who will be impacted?

Another simple strategy that would vastly improve Medicaid managed care is meaningful care coordination. Our physicians receive care plans by third party care management contactors that are useless to us and our patients. Meanwhile, the turnover of the care management staff at each of the MCOs has been very high. Simply changing the state’s required form for third party care management contractors to deliver meaningful actionable information to the primary care physician would work better AND improve care coordination.
Centralized credentialing exists in other states (such as Iowa): Illinois needs an accurate and timely provider credentialing and re-credentialing process. Currently, a provider has to be credentialed with the Department of Healthcare and Family Services before claims can be submitted under that person: this is not a smooth nor quick process, and the delays and difficulties are disrupting patient care. We’ve asked before and are asking again, will the credentialing process be streamlined once IMPACT is done so that a provider enrolled in IMACT need not re-credential with each Medicaid MCO? In addition, commercial MCOs require their own credentialing, which causes additional lag.

We also believe MCO network transparency needs high attention. Perhaps, HFS could host a demographic profile for each MCO by county to improve their transparency as well as assist providers and patients in meaningful care coordination? The MCOs would supply uniform data regarding provider networks, hospitals, FQHCs and large clinics, and health systems mapped out geographically so that clients enrolling could select their best fit. That data should include any co-pays, medication formularies, and referral prior approval rules and grievance procedures, etc.
I’d like to conclude my remarks on a positive note and acknowledge our hopes that the recently created Department of Innovation and Technology will indeed specifically address the benefits that a technology transformation will provide for the healthcare system, Medicaid, and our patients.
We look forward to working with you, the Department of Healthcare and Family Services and the managed care organizations in an effective system that enables physicians and providers to achieve better outcomes for patients, and provides better experiences of care for providers, patients, and caregivers. With improved communication in an effective system, we can provide better value at a reduced cost to taxpayers. Thank you.