Suffredin- An Advocate for All of Us  
 

Accountability
Forest Preserves
Public Safety
Cook County Budget
Forest Pres. Budget
Property Tax Appeal
Health & Hospitals
Land Bank Authority
Policy Resolutions
Unsung Heroine

 

   
 
   
   
 
   
     
  Office phone numbers:  
   
 
 

Search current and proposed Cook County Legislation in Larry's exclusive legislative library.

   
 

The Cook County Code of Ordinances are the current laws of Cook County.

   
  The Cook County Law Library is the second largest County law library in the nation.
   
     
     
     



County health system to award $1.8 billion contract to run CountyCare

Thursday, March 27, 2014
Crain's Chicago Business
by Andrew L. Wang

The Cook County Health & Hospitals System is seeking approval for a $1.80 billion contract with a St. Louis-based insurer to run the day-to-day operations of its Medicaid managed care initiative, CountyCare.


The mammoth deal with IlliniCare Health Plan Inc. comes as CountyCare's architect, Dr. Ramanathan Raju, the CEO for Cook County Hospital, leaves Chicago to become head of the New York City Health and Hospitals Corp. County officials are trying to transform CountyCare from a temporary demonstration project into a permanent part of how the cash-strapped system does business.


Often the Chicago area's provider of last resort, the health system is trying become an insurer, too. The move is designed both at administering care more effectively and to ensure its financial stability.


In the long term, county officials hope CountyCare will serve as the template for other managed care plans for patients who have too much income to qualify for Medicaid and, someday, perhaps Medicare beneficiaries. Both potentially are more generous revenue sources than Medicaid.


“It provides the foundation to get us there,” said Steven Glass, the health system's executive director of managed care.
To take effect, the five-year contract with IlliniCare, part of the insurer Centene Corp., needs approval by the health system's 11-member board, which will consider it a meeting Friday. That is also Dr. Raju's last with Cook County. The county solicited bids in the fall. IlliniCare CEO Jeffrey Joy declined to comment on the contract before it has been finalized.

BROUGHT TO YOU BY OBAMACARE

President Obama's Affordable Care Act allows states to expand Medicaid eligibility to adults at 138 percent of the federal poverty level. The federal government covers the entire cost of new enrollees for the first three years, tapering to 90 percent by 2020. Dr. Raju started CountyCare in November 2012 under a federal waiver that allowed the health system to start enrolling the newly eligible a year early.


Currently, the federal Centers for Medicare and Medicaid Services pays the health system $632 per month for each member of the plan. If the health system can keep patients healthy while holding costs below that amount, it keeps the savings. If costs exceed the federal payment, the system eats the loss.


With the demonstration phase of the CountyCare program set to end on June 30, the system is applying to the state Department of Healthcare and Family Services to operate CountyCare as a "managed care community network," in which the state -- starting on July 1 -- would distribute federal money to pay the per member-per month fees. County officials are still in negotiations with the state over that contract.


At the moment, operations of the program are being handled by a handful of contractors, including Pittsburgh-based Automated Health Systems Inc., which is providing administrative and support services, and Schaumburg-based Catamaran Corp., which is managing pharmacy benefits. The new deal would combine those services under IlliniCare, officials said.
As part of the agreement, IlliniCare would be paid up to $1.20 billion to distribute to doctors and other providers such as community health clinics for medical treatment of CountyCare members. The total dollar amount spent will depend on how many services are claimed.


Other parts of the contract -- totaling $600 million -- are to be paid on a per-member, per-month basis. The health system would pay $37.34 per member per month for managed care services that IlliniCare would provide, such as coordinating care across facilities and providers. The total contract amount, up to $257.6 million, assumes 115,000 members in the program.
It would also pay $18.72 as a flat per member fee, up to $129.2 million, that IlliniCare would pay to subcontractors for behavioral health, pharmacy and optometry services. The system would pay $30.38 per member per month to cover IlliniCare's administrative costs, or up to $212.7 million for the contract term.

FOR PATIENT CARE


County officials said administrative expenses make up only 11 percent of the total $1.80 billion, with the balance for patient services and other clinical purposes.

“This is not billions of dollars going to a private company,” said Dr. John Jay Shannon, the health system's chief of clinical integration who will become interim CEO next week, replacing Dr. Raju. “It's money going to a huge population of people who didn't have a payer source before.”


When Dr. Raju started CountyCare, the first-year goal for membership was 115,000, though enrollment hasn't reached that level in part due to a backlog of applications at the state Department of Human Services. There are currently about 87,000 members in CountyCare, with 15,000 applications pending.


The program generated $132 million in fiscal 2013, which ended Nov. 30. County officials are estimating it will bring in $468.2 million in 2014, about half of the projected $950.7 million in revenue from the health system.
County officials said they were not concerned that IlliniCare, which already runs a local managed care plan for 36,000 elderly, blind and disabled Medicaid beneficiaries, didn't meet certain quality benchmarks in its first year of operation, 2012.
“We believe that's more reflective of the nature of a startup,” Mr. Glass said.



Recent Headlines

Cook County forest worker was going 76 mph in 30 mph zone, had THC in system during fatal crash while on job: prosecutors
Thursday, July 19, 2018
Chicago Tribune

Judge faces ‘tough day’ in court answering charges he brought loaded gun to work
Thursday, July 19, 2018
Chicago Sun-Times

Preckwinkle, Evans end budget battle
Wednesday, July 18, 2018
Crain's Chicago Business

How Transparent and Accountable Are Chicago, Cook County Governments?
Wednesday, July 18, 2018
WTTW Chicago Tonight

2 Cook County courthouses to close, employees spared layoffs under budget settlement: officials
Wednesday, July 18, 2018
Chicago Tribune

Troubled detainee at center of unusual court fight between Loyola hospital, Cook County
Monday, July 16, 2018
Chicago Tribune

Cook County Commissioners Confounded by Hiring of Health System Consultant
Monday, July 16, 2018
WBEZ Chicago Public Radio

Doctor fired by Cook County medical examiner now under the microscope in Indiana
Sunday, July 15, 2018
Chicago Sun-Times

County officials defend Forest Preserves police in wake of man harassing woman over Puerto Rican flag shirt
Friday, July 13, 2018
Chicago Tribune

Familiar questions about ‘bystander effect’ arise after man berates woman for Puerto Rico shirt
Friday, July 13, 2018
Chicago Tribune

Berrios' analysts used Zillow, other shortcuts in assessing property values, documents show
Friday, July 13, 2018
Chicago Tribune

Northbrook to revisit Cook County paid sick leave policy after opting out last year
Friday, July 13, 2018
Chicago Tribune

Cook County Forest Preserves officials discuss officer's resignation
Friday, July 13, 2018
Chicago Tribune

Amid video fallout, Cook County Forest Preserve District reveals fatal crash involving worker and governmental truck
Friday, July 13, 2018
Chicago Tribune

Transformation in the outdoors
Friday, July 13, 2018
Special to suffredin.org

Forest preserve cop resigns after apparently failing to help woman being harassed over Puerto Rico shirt
Thursday, July 12, 2018
Chicago Tribune

5 things: A civics lesson on Puerto Rico after man rants about woman's flag T-shirt, questions citizenship
Thursday, July 12, 2018
Chicago Tribune

Cook County Commissioners: Get Rid of Forest Preserve Police
Thursday, July 12, 2018
WTTW Chicago Tonight

Schneider wants hearing over fatal crash blamed on Cook forest preserve driver
Thursday, July 12, 2018
Daily Herald

Man who harassed woman for Puerto Rican flag shirt charged with hate crime
Thursday, July 12, 2018
WLS ABC 7 Chicago

all news items

Paid for by Larry Suffredin and not at taxpayer expense. A Haymarket Production.
^ TOP