Illinois

As early as 2001, efforts began in the State of Illinois to improve access to medical homes, beginning with children with special health care needs. The Title V Children with Special Health Care Needs Program, Division of Specialized Care for Children (DSCC) partnered with the Illinois Chapter of the American Academy of Pediatrics to begin paying primary care physicians for care coordination services. A statewide medical home learning collaborative was implemented that expanded from pediatrics to physician practices serving adult Medicaid patients with multiple chronic conditions.

In 2006, the Illinois Department of Healthcare and Family Services (HFS) implemented a Primary Care Case Management Program founded on the Medical Home concept called Illinois Health Connect. A study conducted by the Robert Graham Center showed that between 2007 and 2010, Illinois Health Connect saved the state $531 million in healthcare costs with a reduction in emergency department visits and hospitalizations. In June 2012, the Illinois Legislature passed a series of Medicaid reforms known as the SMART Act resulting in sweeping changes to the Medicaid program. Roled into the SMART Act was the 2011 act (PA96-1501) that requires that 50% of Medicaid recipients be enrolled in care coordination programs by 2015. As a result of this ambitious comprehensive care delivery reform, the Department of Healthcare and Family Services (HFS) has incentivized the development of different models of care coordination including: Coordinated Care Entities (CCEs), Managed Care Community Networks (MCCNs), Managed Care Organizations (MCOs), and Accountable Care Entities (ACEs). The newest model for integrated care delivery is the Accountable Care Entity, created by Public Act 98-104 in July of 2013.  

CHIPRA: 
Yes
MAPCP: 
No
Dual Eligible: 
Yes
2703 Health Home: 
Yes
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
No
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
12,797,300
Uninsured Population:
11%
Total Medicaid Spending FY 2013: 
$15.7 Billion 
Overweight/Obese Adults:
64.7%
Poor Mental Health among Adults: 
38.5%
Medicaid Expansion: 
Yes 
CPC+: 

The Payment Reform Landscape: Payment For Non-Visit Functions And The Medical Home

on mar, 2014-05-06 17:32   staci

As I’ve been discussing in Health Affairs Blog each month, payment reforms can pose a spectrum of financial risk for providers, with financial upside only — such as pay-for-performance programs — on one end, and downside-only models — such as nonpayment for care that shouldn’t happen — on the other. In March, we examined pay-for-performance, an-upside only model.  This month, we look at another upside-only model, typically used to support care coordination and patient centered medical homes (PCMH).

Story Date: 
May 6, 2014
News Author: 
Suzanne Delbanco
Source Link: 
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Accountable Care Entities (ACEs)

Accountable Care Entities (ACEs), a new model of an integrated delivery system, were authorized by Illinois state law  (Public Act 98-104 (pdf) in July 2013.  As the fourth model providing “care coordination services” for Medicaid clients, ACEs will incorporate the following elements:

Medicare-Medicaid Alignment Initiative- Illinois

On February 22, 2013, the Illinois Department of Healthcare and Family Services (HFS) received approval from the federal Centers for Medicare and Medicaid Services (CMS) to jointly implement the Medicare-Medicaid Alignment Initiative (MMAI).

Patient-Centered EHR Journey at the Community Health Level

on mar, 2014-04-22 00:00   staci
How one of the nation’s largest federally qualified health centers is transforming its model of care

Implementing an electronic health record is a major undertaking at any provider organization, but is especially challenging in an environment without any IT infrastructure or an information services (IS) department. Yet that’s the goal the Access Community Health Network (ACCESS) set for itself, and met in a short timeframe, to better serve patients in underserved areas of Chicago.

Story Date: 
April 22, 2014
News Author: 
John DeGaspari
Source Link: 
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Cigna Accountable Care Program - Adventist Health Network

Cigna and Adventist Health Network launched a collaborative accountable care initiative to improve patient access to health care, enhance care coordination and achieve the “triple aim” of improved health, affordability and patient experience. The program became effective January 1, 2014 and is Cigna's first collaborative accountable care initiative to launch in Illinois.  Collaborative accountable care is Cigna's approach to accomplishing the same population health goals as accountable care organizations (ACOs).

OSF Healthcare System - CMS Pioneer ACO

OSF HealthCare, owned and operated by The Sisters of the Third Order of St. Francis, Peoria, Illinois, includes OSF Healthcare System consisting of nine hospitals and medical centers, one long-term care facility, and two colleges of nursing. Additionally, OSF Medical Group is a primary care physician network consisting of more than 600 primary care, specialist physicians, and advanced practice providers.

OSF & Blue Cross Blue Shield of Illinois ACO

Blue Cross and Blue Shield of Illinois (BCBSIL) and OSF HealthCare, a system owned and operated by The Sisters of the Third Order of St. Francis, Peoria, Illinois, formed an Accountable Care Organization (ACO) in January of 2014. By doing so, the two organizations aim to deliver improved patient care while also focusing on the overall cost of health care.

Pagine

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