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
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:
|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:
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:
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:
Information on specific performance targets is available online.
Primary care providers participating in Illinois Health Connect receive several types of non-financial support, including:
Illinois Health Connect is taking a four-pronged approach to measurement. They are tracking:
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.