Illinois Health Law Implementation: Race to the Starting Line

December 12, 2012

Cristal Thomas: As far as the exchanges go, we announced that we will be entering into a federal partnership exchange for the first year. We’re leaving a question open about what we’ll be doing in years after that. We submitted our blueprint application to Federal Health and Human Services last month, in November, for the Partnership Exchange.

That means that the federal government will be operating the exchange, they’ll be administering the bulk of the functions, the enrollment, the eligibility, the premium assistance.

The state, we have indicated that we want to retain some functions, particularly around the plan management.

Bruce Japsen: You are going to see many Republican governors, states led by Republicans, that are going to A) have an exchange and B) join in the Medicaid program from the expansion, because as Crystal said, which we often forget about in things to watch, this is going to be a stimulus that not a lot of people are talking about. There are going to be, and you do hear a lot of complaints from providers, but I often write in my stories, you’re talking 30 million paying customers.

Sabrina Corlette: On the essential health benefits benchmark selection, which with the minimum standard is going to be for health benefits on the private side. That is also an area where Illinois has moved forward and made a decision, along with 24 states and the District of Columbia. Of those 24 states, the vast majority, except for six, have chosen this small group plan, or one of the largest small group plans for small businesses in the state. And for the states that have not selected a plan, they’re also going to end up with the largest small group plan in their state. I think you’ll see, in the vast majority of states, with very few exceptions, that the coverage package will look a lot like what’s currently being marketed and sold in this small group business market today.

David DiLoreto: We take care of, on an annual basis, about 1.2 million people. About 25-percent of the primary service areas that we’re in. We’re going to be moving them, incrementally, into some form of shared extend we can control it. For instance, last year, we had 50,000 commercial members that we manage under a risk arrangement with a health plan partner so that we’re actually developing very important capabilities.

We’ll move our own employees into this type of narrow network. We’re directly contracting; we awarded a major direct-to-employer contract with a narrow network, no health plan intermediary for Home Depot and Wal-Mart in the Chicago land area.

We had our federal ACO application approved last night, so we’ll be moving our Medicare beneficiaries into that. Over the span of about four years movement of Medicaid into managed care in Illinois, we’ll probably have about 600,000 of those 1.2 million people in some form of a shared-savings capitation risk-based arrangement. We’re building those capabilities right now, trying to do in a way where we don’t get so good at it that we can’t survive losing the volume-based business.


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