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+: 

Illinois CHIPRA Quality Demonstration Project

Building on the foundation and successes that Illinois has had with Illinois Health Connect, the state’s Primary Care Case Management program, Illinois will be evaluating and furthering the quality of children’s health care utilizing the medical home model.

Illinois Health Connect

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.

Medical Home Network

Medical Home Network unites public and private organizations to improve the health status of people living on the South and Southwest Side of Chicago. The Network works to enhance health care quality and access and to reduce the fragmentation and cost.    Serving as a neutral third party, the Network is dedicated to facilitating collaboration between organizations such as the State of Illinois Medicaid program, South Side area hospitals, federally qualified health centers (FQHCs), and high-volume Medicaid private practices.

CMS State Innovation Model Design Award - Illinois

With this grant, Illinois aims to develop a plan that will build upon the delivery and payment system reforms already underway in the state, including changes implemented under Illinois' Care Coordination Innovations Project, and the Center for Medicare & Medicaid Services Coordinated Care for Medicare-Medicaid Enrollees Demonstration, as well as innovations being spearheaded by private insurers. The planning activities will include the development and integration of three models: a Provider-Driven Model; a Plan-Provider Partnership Model; and a Plan-Provider-Payer Model.

PCORI Funding Award - University of Illinois at Chicago

Bringing Care to Patients: A Patient-Centered Medical Home for Kidney Disease. The purpose of this project is to compare a Patient-Centered Medical Home (PCMH) model of care with the usual care of End Stage Renal Disease (ESRD) patients and their caregivers. The project proposes to enhance the usual care team for ESRD patients by providing a primary care doctor in the context of regularly scheduled dialysis sessions and by adding health promoters to help support patients and their caregivers.

Integrated Inpatient/Outpatient Care for Patients at High Risk of Hospitalization

In July 2012, the University of Chicago received a Health Care Innovation Award to test a model of care delivery that reasserts the importance of an ongoing doctor-patient relationship. The project will use multidisciplinary teams - including registered nurses, licensed practical nurses, social workers, and medical assistants led by comprehensive care physicians (CCPs) - to provide consistent care to Medicare beneficiaries before, during, and after hospitalizations. CCPs will perform rounds in hospitals 48 weeks per year, ensuring they see patients and monitor their health consistently.

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