The state's rejection of Health Alliance from its new menu of health plans for state employees has prompted the Urbana-based medical plan provider to mount a campaign in its own defense --- including the filing of a formal protest with the state.
Health Alliance officials note that they provide exclusive HMO coverage for several providers including Carle (Health Alliance and Carle Physicians Group are both owned by the Carle Foundation). Without a Health Alliance plan, state employees and retirees will have no access to those doctors under an HMO plan.
But the new health plans for state employees offer other plans that include Carle. They are open access plans --- three-tier plans that work like HMO's at their lowest tier, but offer more expensive access to more doctors at their 2nd and third tiers. Two open access plans from PersonalCare and HealthLink would offer access to Carle doctors at their 2nd tier.
Without giving specific numbers, PersonalCare CEO Todd Petersen says the price difference between Tier One and Tier Two is not a big one.
"There is a difference in deductible and co-payment," Petersen said. "They (the 2nd tier prices) would be a little bit higher. But it's still --- compared to the general market --- it would still be one of the richest benefits on the market today."
Petersen predicts that Carle and and other providers with exclusive contracts with Health Alliance will make arrangements with other health plans --- but not until after Health Alliance's formal protest is heard.
"But then, I do expect that the market will adjust to the new realities and you're likely to see providers participating in products that they have historically not participated in," Petersen said.
In the meantime, Petersen notes the bottom tier of PersonalCare's open access plan includes several central Illinois medical groups and hospitals, including Christie Clinic, Provena, Sara Bush Lincoln and hospitals in Gibson City and Decatur.
Illinois' Junior Senator remains optimistic that a deal will be struck just short of midnight and that Congress will avoid a government shutdown.
Republican Mark Kirk says in general, Democrats should give on spending proposals, and the GOP should give on 'extraneous' policy measures to avoid the shutdown.
"I think congressional negotiators typically work up to the last minute," said Kirk. "But my guess is because President Obama doesn't want a shutdown, Speaker (John) Boehner doesn't want a shutdown, and Senate Majority Leader (Harry) Reid doesn't want a shutdown, you have a succesful end to the negoations today."
Kirk says there was also discussion in the Senate late Friday about a short-term continuing resolution that could last as long as 4 days, that fully funds military troops.
During a separate conference call earlier, Democratic Senator Dick Durbin said a budget deal hinged on funding for Planned Parenthood. Kirk says the program shouldn't be singled out for a 100-percent cut, but rather a broad-based, shared sacrifice.
Senator Kirk also says he won't keep his congressional pay if the government, instead giving it to charity.
The HMO plans that the Quinn administration wants to offer to state employees starting in July only covers 27 Illinois counties.
Blue Cross/Blue Shield of Illinois' two HMO plans would serve the state's most populous counties, covering Chicago, Rockford, Springfield, Peoria and the Metro East. But the health plans have no health care providers signed up in most of east-central, southeast, southern and western Illinois would not be included.
Blue Cross spokesperson Mary Ann Schultz says in a press release that they're working to sign up more providers in other counties. In the meantime, she says state employees could use the other available plans. Those are the Quality Care preferred provider plan, which offers access, but a lower level of coverage; and two open access plans from HealthLink and PersonalCare. They offer HMO-level prices for physicians in their lowest tier, and higher prices if you want access to other doctors.
The state Department of Healthcare and Family Services says the new plans will save the state over $100 million a year. But State Representative Chapin Rose says the state's research erroneously projects Blue Cross' lower operating costs in urban areas onto the state of Illinois as a whole.
Rose's Illinois House district stretches from Charleston to Champaign, one of the areas not covered by the Blue Cross HMO plans. The Mahomet Republican says the alternatives have their flaws, too. He predicts how those in his region would use the new health plans.
"You have a bunch of people that either migrate on to (the) QualityCare plan, which will be incredibly expensive to the state taxpayers," Rose said. "Or they will dump into PersonalCare, and go to Christie Clinic. The problem is, Christie Clinic does not have the capacity to suddenly have 55-thousand people at its doors. Just can't do it."
Rose says many of those seeking care from Champaign-based Christie Clinic will be former patients of Urbana-based Carle. Health Alliance, which has an exclusive HMO arrangement with Carle, was turned down in the bidding for the new health plans. The open access plans would offer Carle at its more expensive tiers, and Christie Clinic at the lower-priced tier.
Health Alliance is filing a formal protest against the new health plans, and Rep. Rose says that should make documentation available that he believes will show the flaws in the health plan selection process. In the meantime, a legislative commission will review the plans on Monday, April 11th. The meeting of the Illinois Commission on Government Forecasting and Accountability is set for 10 AM at the Illinois State Capitol Building in Springfield. Rose says he's worried that the commission will vote to approve the plans before those documents are available.
The lawmaker says the best course of action would be for the commission to take its time on the matter. But he argues that an even better course would be for the Quinn administration to withdraw the health plans, and start over.
Criticism and confusion continues with the Quinn administration's proposed health plans for state employees and retirees in the next fiscal year.
The proposal would remove Urbana-based Health Alliance from the mix, raising difficulties for patients who use doctors at Carle, Springfield Clinic and McDonough District Hospital in Macomb. Those hospitals and clinics have exclusive HMO contracts with Health Alliance (a Carle subsidiary).
Instead, HMO coverage for state employees would only be offered by Blue Cross/Blue Shield of Illinois which has no primary care physicians under HMO contracts in the Champaign County area. A spokesman for BCBS says they do not have HMO providers in every county.
But a spokesman for the Illinois Department of Healthcare and Family Services says there are other options in their proposals --- namely the open access plans offered by HealthLink and PersonalCare. Mike Claffey says those plans offer medical coverage at different levels. He says Tier 1, the least expensive, works like an HMO. Claffey says it's his understanding that Champaign-based Christie Clinic is part of the provider network at Tier 1 levels in the open access plans, while Urbana-based Carle is available at the more expensive Tier 2 and Tier 3.
State Representative Chapin Rose says the proposed health plan lineup goes before a legislative advisory panel in Springfield on Monday. And Rose says he thinks the Commission on Government Forecasting and Accountability is predisposed to approve the proposal. The east central Illinois Republican says the commission needs more accurate numbers on the new health plans --- numbers he says won't be available until after Health Alliance files its formal protest.
"Filing their protest is what gives them the cost document they need to officially disprove these cost issues," Rose said. "If the (commission) votes on Monday, they will be voting without the actual real numbers to prove or disprove what's going on."
Meanwhile, an organizer with Champaign County Health Care Consumers is urging state employees not to panic. Anne Gargano Ahmed says if the state's decision is approved, it should give Carle the incentive to negotiate with Blue Cross Blue Shield for HMO coverage.
Urbana-based Health Alliance says it will file a protest with the state over its decision not to continue their HMO contract for state employees and retirees.
The state Department of Healthcare and Family Services announced Wednesday it was awarding HMO contracts for the next fiscal year to Blue Cross Blue Shield, with Open Access Plan contracts to PersonalCare and HealthLink. The state said the new contracts would save taxpayers over $100 million a year, and over one billion dollars over the next ten years.
Health Alliance CEO Jeff Ingrum argues the savings aren't really there --- in part because people who had been under Health Alliance will be required to either change doctors, or go to the more expensive Open Access Plans selected by the state, or to the Quality Care Preferred Provider plan, which offers less coverage.
"One, it will increase the costs to state workers," Ingram said. "But it will also increase the costs to the state of Illinois, because those programs are anywhere from 10 to 20 percent higher than the Health Alliance HMO program."
Ingrum says Carle, Springfield Clinic and McDonough District Hospital in Macomb had signed exclusive agreements with Health Alliance that barred them from working with other state HMO plans.
In a statement, Carle says it's studying the implications of the DHFS decision. The company calls on their patients who are Health Alliance members to "share their concerns with the state and with elected officials."
The company says it will be reviewing options "for state employees to continue accessing Carle physicians and hospital services", but that the plans and costs for such access will change if the state's decision stands.
And the state Department of Healthcare and Family Services says --- in a fact sheet on its managed care announcement --- that while Carle and other hospitals and clinics may not be available through their new HMO plans immediately, it expects them to "adjust to market needs" over time.
Carle says that Carle Foundation Hospital has a long-standing contract with Blue Cross/Blue Shield, for hospital services. But Health Alliance's Ingram says the contract is for a Preferred Provider plan, not the HMO plans which the state approved its employees and retirees in FY 2012.
State Representative Naomi Jakobsson (D-Urbana) has complained about the state's decision not to use Health Alliance next year. She says the company was not given sufficient advance notice of the decision. Jakobsson is inviting people concerned about the change to sign a petition on her legislative website.
NOTE: This story was updated to show additional comments from the Illinois Department of Healthcare and Family Services.
The Cherry Orchard Village apartments lie just south of the abandoned Chanute Air Force Base near Rantoul - and like the base itself, Cherry Orchard has seen better days. Now the two landlords who manage the eight-building complex are charged with failing to maintain it - to the detriment of its tenants, mainly migrant worker families. Illinois Public Media's Sean Powers has been collaborating with the investigative journalism group CU-Citizen Access. He reports on the legal battle to bring Cherry Orchard up to code.
(English language voice over by Jenn Kloc)
(With additional reporting from Pam Dempsey and A. H. Gorton of CU-CitizenAccess)
A dismal ranking of overall health in Vermilion County for the second straight year has prompted a call to action from the county's health department.
Department administrator Shirley Hicks says about 130 people in affected areas have been invited to a meeting Thursday morning at her offices. She notes a lot of the findings in the county's ranking of 98th place out of the state's 102 counties have nothing to do with her department, like unemployment and education levels.
But Hicks says Illinois' fiscal woes will just force her department to work that much harder with social service agencies, primary care providers and others to seek solutions.
"The state of the Illinois economic crisis is a player as part of all of this," said Hicks. "So I think it's going to take all disciplines to look at what part can we do, and how can we best utilize resources that we do have."
Hicks commends the work of the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute for putting the findings together. She says the ranking for the county isn't nearly as important as the process researchers used to arrive at that figure.
"Any time you're looking at those reports, you're looking at where did the data come from, how did they ask the questions, so you can better understand the root cause of the problem," said Hicks. "I don't have any dispute with the actual data, it's really trying to dissect it down the the most common denominator and say 'how can we target our initiatives and our resources and pull those together to make an impact."
Hicks commends the work of the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute for putting the findings together. Thursday's meeting at the Vermilion County Health Department is expected to include primary care providers, social service agencies, law enforcement, hospitals, and members of the Vermilion County Board.
Trace amounts of radiation from Japan have shown up in Illinois, but state officials say there's no reason for concern.
Minute levels of radioactive materials have been detected in both northern and central Illinois. The state's Emergency Management Agency says radioactive iodine was found in grass clippings in Will County and in an air sample collected at a lab in Springfield.
The materials are believed to be related to the troubled nuclear reactors in Japan, but Illinois' Director Jonathon Monken says the levels are extremely low and present no danger. For example, the air sample is 200,000 times lower than what is allowed for nuclear plant effluent.
Traces of iodine have shown up in other states. In Illinois, the state has stepped up its monitoring of grass, air, milk and eggs in the wake of the Japan crisis.
Both houses of the Indiana Legislature have now approved bills that would restrict access to abortions.
The Indiana House voted 72-23 on Wednesday to require that women seeking an abortion be told that human life begins at conception and ban the procedure after 20 weeks unless the woman's life is in danger.
The bill also requires those seeking abortions to be told in writing that they faced a greater risk of infertility and breast cancer.
Republican Rep. Eric Turner of Cicero says it's the responsibility of lawmakers to protect the unborn and that he hoped the additional requirements would lead to fewer abortions.
The bill now goes to the Senate, which last month approved a bill with many of the same provisions.
A second annual ranking of the overall health of each of Illinois' 102 counties shows a mixed bag of results for East Central Illinois.
The annual report of County Health Rankings serves as a kind of 'check up' on how people in Illinois live, according to 28 different factors. Vermilion County ranked among the worst, finishing 98th, but Piatt County finished 15th, McLean County was 13th, Ford County ranked 11th, and Champaign County finished in 34th place.
The report was put together by the Robert Wood Johnson Foundation and University of Wisconsin's Population Health Institute to show counties where they can improve. Julie Willems Van Dijk is an Associate Scientist with the Institute.
"We want to be able to describe those things you can change," she said. "Because you can change your economic environment. You can work to attract new businesses to locate in your community. You can work to support your schools to have higher graduation rates. You can work to make your community more accessible for people who want to walk and bike."
Each report starts with health factors among residents, like the rate of premature death and the number of those in poor physical and mental health. They include social and economic factors like the number of uninsured adults, and the high school graduation rate. It also relies on physical features, like a county's quality of air and access to healthy foods. Van Dijk says the report is also intended to inspire local leaders to help themselves.
"When those leaders get together from different areas, they can talk about what resources are already available in your community, and how they might use them even better than they are now," she said. "Because we all know budgets are tight, and we're living in tough economic times. So it's really important that we use the resources we have to the best of our ability."
The majority of higher-ranking counties are in the north and west, including Jo Daviess, Lake, and McDonough, while the many of the lowest-ranked counties are in the south, including Marion and Alexander counties. The Robert Wood Johnson Foundation is providing grants for up to 14 communities in the U.S. seeking to improve their overall health.