This past week, Health News Illinois (HNI) hosted the Managed Care Organization (MCO) CEO Roundtable event presented by MATTER on November 13, 2019. The discussion was moderated by Tim Stumm, the founding editor of HNI. The two panelists were Karen Brach, President of Meridian Health Plan Illinois and James Kiamos, CEO of CountyCare Health Plan. Our colleagues Eric Gonzalez and Tori Anderson attended the breakfast to learn from these knowledgeable executives at the event. Topics that were discussed included today’s issues that Medicaid managed care is facing in IL, payers current state relationship with providers, and new, innovative ways MCOs are addressing member’s needs.

The most impeding roadblock MCOs are experiencing today is paying and submitting claims correctly. The five MCOs in IL have a weekly meeting with the Illinois Department of Healthcare and Family Services (HFS) and this has been at the top of the list of initiatives for months. Late payments and denials keep payers and providers from moving forward to transitioning to value based care models, better wraparound services for members, and case management. The panelists also spoke about the increased care coordination. This means embedding someone from the health plan physically onsite to a hospital. The earlier the health plan knows about a hospital admission, the more likely they will get engagement and communication from the member about their discharge plan to avoid readmission. The two leaders of the MCOs both agreed that more needs to be done for behavior health (BH) and substance use disorder (SUD) in the Chicago Land Area, and the biggest determinant of this issue is housing. Karen and Jim stated they felt the future is brighter as BH and Integrated Health Homes (IHH) pilots are rolling out in April 2020.

MCOs are seriously beginning to look at data in ways they never have done before. CEO James Kiamos explained that CountyCare Health Plan is beginning to dip a toe into the AI world to predict the different care coordination programs that members should be in – before having a traumatic experience or an avoidable hospital admission. We as a company understand the importance of data, how it can influence strategy execution for our healthcare clients and the impact it has on the business – especially with MCOs.

Moving away from fee-for-service into value-based contracting was the predominant topic and is clearly the future for payers, providers and all of healthcare. The Medicaid managed care has been an organization in Illinois for only two years, so it is a new concept and will likely take time for providers to fully trust the payers and want to opt into value based care. When there is regular data sharing, transparency between organizations, and accurate claims being paid in a timely manner, value-based care can and will be a win-win-win for the member, provider, and payer!

Photo courtesy of Health News Illinois