State workers would have more choices if Health Alliance is dropped, independent physicians group says
SPRINGFIELD -- Quite a few doctors in downstate Illinois, including Springfield, would be glad to see state employee health insurance programs sever their connections with Health Alliance.
A group called the Independent Physicians Network said it supports the state’s plans to drop the Health Alliance and Humana health-maintenance organizations from managed-care options available through the state’s group health insurance program.
“We believe it will actually result in greater choice of physicians for State of Illinois employees at fair market rates,” according to a letter the network sent April 26 to the Illinois General Assembly’s Commission on Government Forecasting and Accountability.
“Most of the Independent Physicians Network providers are excluded from Health Alliance and Humana products,” the network’s letter states.
Represents 284 providers
The 17-year-old network negotiates managed-care contracts for a total of 284 doctors and other medical providers in central and downstate Illinois. Included are physicians from Hospital Sisters Health System, Physicians Group Associates, Prairie Eye Center, Orthopedic Center of Illinois and Central Illinois Allergy and Respiratory Clinic.
Health Alliance, which has a larger presence in the Springfield area than Humana, serves state employees mainly through doctors at Springfield Clinic and Memorial Health System. Both HMOs are protesting the state’s selection process.
Almost 100,000 patients insured through Health Alliance, including 28,000 in the Springfield area, would have to switch health plans, and in some cases get new doctors, if the state contracts aren’t changed.
However, Greg Timmers, chief executive officer of Prairie Cardiovascular Consultants, argues that the new contracts would allow some people with state insurance to return to network doctors they have had to leave as the state’s health-insurance plans put more restrictions on patient’s choices over the years.
Prairie’s doctors, unlike most physicians in the Independent Physicians Network, are included in Health Alliance’s HMO, but Timmers said Prairie doctors support the network’s letter.
Most doctors in the network participate in the state’s managed-care “open-access” plans. More patients are expected to join those plans if Health Alliance and Humana remain excluded from state employees’ options, Timmers said.
Health Alliance members wanting to retain Springfield Clinic doctors would have to join one of the open-access plans. Those plans have the same monthly premiums as the HMOs, but out-of-pocket expenses are higher. Timmers called that difference unfortunate.
Health Alliance officials have said the state’s savings estimates for the new managed-care contracts are unrealistic.
The new contracts include two HMOs operated by Chicago-based Blue Cross and Blue Shield of Illinois. Those HMOs contain relatively few downstate doctors.
Health Alliance chief executive Jeff Ingrum has said Health Alliance can get the state better discounts from doctors and hospitals than the state can obtain through open-access plans because HMOs can offer a select group of doctors a high volume of patients.
Health Alliance officials have pointed out that the state has documented open-access plans are more costly for the state than HMOs.
Timmers, however, said control of health-care costs can best be achieved through efficient and effective care — not through overt discounts.
Network doctors “have no problems being judged based on their quality,” he said.
Dean Olsen can be reached at (217) 788-1543.
Legislators seek financial information
Thirty-four members of the Illinois Senate — Democrats and Republicans from Chicago, its suburbs and downstate — sent a letter to Gov. Pat Quinn’s administration Friday asking for the “detailed financial information” state officials used in dropping Health Alliance and Humana as HMO options for state employees.
The Illinois Department of Healthcare and Family Services’ estimate that the new managed-care contracts would save the state more than $100 million a year “appear to be based on hypothetical assumptions and not reality,” the letter stated.
“It appears that the DHFS decision will, in fact, cost the state more rather than less,” according to the letter.
Senators signing the letter included Republicans Larry Bomke of Springfield, Darin LaHood of Peoria, Bill Brady of Bloomington, Dave Syverson of Rockford, Dale Righter of Mattoon and Kirk Dillard of Hinsdale, and Democrats Dave Koehler of Peoria, John Sullivan of Rushville, Emil Jones III of Chicago and Michael Frerichs of Champaign.
Brauer asks for audit
State Rep. Rich Brauer, R-Petersburg, said he will call for an audit of the way the state selected health insurance options to be available to state employees next year.
Brauer said he has “great concerns” about the way the Department of Healthcare and Family Services went about the selection process that resulted in two popular HMOs being dropped as health care options.
A member of the General Assembly’s Legislative Audit Commission, Brauer said he will ask the commission to direct Auditor General William Holland to audit the selection process.
Among other things, he wants Holland to determine if the selection process followed all procurement laws, whether vendors were evaluated uniformly, whether the plans selected by DHFS have the capacity to provide care for thousands of state workers previously in Health Alliance and Humana, and whether the cost savings touted by the state can be substantiated.
Brauer said he was told the audit could take several months.
-- Doug Finke