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ISMS Medicaid Managed Care Survey Highlights Physicians' Concerns
Posted on: 11/10/2016

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The state’s initiative to transition the majority of Illinois Medicaid patients to managed care organizations (MCOs) is causing significant confusion and unease among health care professionals and patients.

As a result, ISMS conducted the ISMS Medicaid Managed Care survey, which brought to light the frustrations and hassles experienced by health care professionals as a result of the transition to MCOs.

The survey findings show that improvement is needed in four key areas to expand patient access and reduce physician burdens:

  • A common credentialing system is desperately needed to reduce hassles and duplication of effort by busy physicians.
  • A baseline state-maintained drug manual is essential to protect patients by requiring MCOs to abide by the coverage guidelines and product offerings included on the existing Medicaid drug manual and preferred drug list.
  • Greater transparency is vital, including reliable staff contacts within the MCOs, enabling physicians to obtain information, determine patient eligibility, clarify complex issues, and discuss coverage of medically necessary treatment and drugs.
  • Widespread public reporting on the quality and effectiveness of MCOs is critical for assessing the success of the program and shaping the future of Medicaid in Illinois; as evidenced by the survey, physicians would welcome the opportunity to have input into the plans’ overall evaluations.

ISMS thanks all who took the time to provide their input for the survey, which will inform and amplify ISMS advocacy during the Medicaid managed care transition.

We will keep you informed about any further developments.



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