Illinois – Medical Homes

Illinois Health Connect is the state’s primary care case management (PCCM) program for certain populations covered by Medicaid, CHIP, and the state-funded program for children who would otherwise be uninsured. The program launched in July 2006. Participating primary care providers (PCPs) sign an agreement that specifies expectations, such as standards for afterhours access to care. In return, PCPs receive an enhanced fee schedule and ongoing monthly per member per month (PMPM) care management fees. They are also eligible for performance incentives. Illinois Health Connect assists providers with the use of appropriate screening tools and billing procedures, online resources, clinical data feedback, and access to claims-based information on patient service use. In April 2010, the Illinois Department of Healthcare and Family Services announced that Illinois Health Connect saved the state approximately $150 million in fiscal year 2009. Currently, more than 1.5 million Illinois residents receive services through Illinois Health Connect.

In accordance with Public Act 96-1501, Illinois’s Medicaid reform legislation, the Illinois Department of Healthcare and Family Services (the Medicaid agency) is to enroll at least half of all beneficiaries in a “coordinated care” program by January 1, 2015. Coordinated care is defined to include a full range of health care and support services around the needs of the client, using care models other than just traditional managed care organizations. Payment for medical home services is specifically mentioned.

To meet the goals of Public Act 96-1501, the Illinois Department of Healthcare and Family Services has launched a Care Coordination Innovations Project, which relies on alternative models of care delivery based on two structures: Care Coordination Entities (CCEs) and Managed Care Community Networks (MCCNs). To learn more about this project and other accountable care activity in Illinois, visit the Illinois page of NASHP’s State Accountable Care Activity Map.

Further information on Illinois Health Connect is available online here.

Last Updated: April 2014

Forming Partnerships
Representatives from Illinois’s Title V program participated in stakeholders meetings to help develop Illinois Health Connect. Currently, Illinois Health Connect maintains several advisory subcommittees to offer feedback on the design and ongoing operation of the Illinois Health Connect. Participation on the advisory subcommittees is open to any interested patient or provider.
The following stakeholder types are among those represented on the advisory subcommittees:
  • Providers and provider professional associations
  • Foundations
  • Hospitals
  • State agencies, including the Division of Alcoholism and Substance Abuse and the Division of Mental Health
Defining & Recognizing a Medical Home
Definition: According to the Illinois Health Connect website, “your medical home is the doctor’s office or clinic where you go to see your Primary Care Provider.”
Recognition: Primary care providers in Illinois Health Connect sign a participation agreement that includes the following requirements, among others:
  • Develop, “a symptom-based action plan of care to be shared with Enrollees with chronic diseases including asthma, diabetes, coronary artery disease, congestive heart failure and chronic obstructive pulmonary disease.”
  • “Provide direct access to enrollees through an answering service/paging mechanism or other approved arrangement for coverage twenty-four hours a day, seven days a week (24/7). Automatic referral to hospital ER does not qualify.”
  • “Perform periodic preventive health screenings in accordance with established standards of care.”
  • “Schedule, or coordinate with a case manager to schedule, diagnostic consultation and specialty visits.”
  • Ensure that, “routine, preventive care appointments [are] available within five weeks, and within two weeks for infants.”
  • Ensure that, “urgent care appointments not deemed emergency medical conditions [are] triaged and, if deemed necessary, provided within 24 hours.”
Under Illinois Health Connect, specialists may be considered primary care providers.
Aligning Reimbursement & Purchasing
Illinois Health Connect pays primary care providers enhanced fee-for-service rates in addition to the following ongoing care management fees:
  • $2.00 per child (under 21) per member per month (PMPM)
  • $3.00 per adult
  • $4.00 per senior or disabled adult
Illinois Health Connect primary care providers are also eligible for performance-based payments. In 2010 years, $3.3 million was been paid for achieving clinical targets. For 2011, 2012, and 2013, bonuses depended on performance in the following six areas:
  • Recommended immunizations
  • Developmental screenings
  • Asthma management
  • Diabetes management
  • Breast cancer screening
  • Lead screening
Information on specific performance targets is available online.
Supporting Practices
Primary care providers participating in Illinois Health Connect receive several types of non-financial support, including:
  • Semi-annual profiles that show aggregated screening rates and how a particular health care provider compares with his/her peers. Early Periodic Screening, Diagnosis, and Treatment (EPSDT) screening rates have dramatically increased, as have the use of other evidence-based services. These profiles are aligned with the Illinois Health Connect pay-for-performance criteria.
  • Illinois Health Connect primary care providers have access to a database listing specialists who are willing to see Illinois Health Connect patients.
  • Every week, Illinois Health Connect staff make 350 visits to provider offices to offer coaching or technical assistance on topics such as requirements for program participation, coding and billing, and enrollment.
  • Illinois’s Enhancing Developmentally Oriented Primary Care (EDOPC) program is a joint initiative of the Illinois Department of Healthcare and Family Services (Medicaid), a health system, and two primary care provider associations (the state chapters of the American Academy of Pediatrics and the American Academy of Family Physicians). EDOPC offers online and in-office training on topics including developmental screening, perinatal depression, and autism. (Office trainings are eligible for continuing medical education credit.) Trainings include discussion of cultural and linguistic competency.
  • Illinois Health Connect is exploring possibilities for creating a primary care extension program to support primary care providers in transforming into medical homes.
Measuring Results
Illinois Health Connect is taking a four-pronged approach to measurement. They are tracking:
  • Patient experience of care, as assessed by surveys
  • Cost savings, as calculated by actuaries
  • Process and clinical outcomes improvements, especially at the population-level
  • Provider satisfaction
The Illinois Department of Healthcare and Family Services has announced that Illinois Health Connect saved the state approximately $150 million in fiscal year 2009. The state has also seen increases in developmental screenings, mammograms, and regular adolescent check-ups since implementing the program.
The Commonwealth Fund has provided $100,000 in funding for the Robert Graham Center to study the impact of Illinois Health Connect and Your Healthcare Plus (a disease management program). The evaluation will draw on claims data from before and after program implementation, as well as data from Medicaid programs in other states. The grant was announced in 2011. Researchers from the Robert Graham Center presented on findings from this evaluation at the 2012 annual conference of the American Public Health Association, estimating savings for the 2007-2010 period at $531 million.