Illinois Health Connect
Program Location:
Springfield, IL
Number of Practices:
5 537
Payer Type:
Medicaid
Payers:
Medicaid
Reported Outcomes
Description:
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 PCCM program is a model in which each enrollee has a medical home with a primary care provider (PCP). Medical homes ensure that each PCP knows about the healthcare their enrollees receive in order to: ensure that patients get immunizations and other preventive healthcare, prevent duplication of services, ensures that the most appropriate level of care is received, and improves the quality of care received. 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.
Advisory Subcommittees on (1) Behavioral Health and (2) Provider and Quality Management meet quarterly to provide input into the development, implementation and management of the PCCM program. Participation is voluntary and open to any consumer or health care professional.
Payment Model:
PCPs enrolled in the program receive a monthly care management fee for each person they are responsible for managing
- $2 PMPM per child (under age 21)
- $3 PMPM per adult
- $4 PMPM for senior or disabled adult
PCPs are eligible to receive annual bonus payments for qualifying services under a bonus measurement.
- Bonus payments will be at least $20 per patient
- In 2008-2010, bonus payments were $25 per qualifying patient
Fewer ED / Hospital Visits:
- The adjusted hospitalization rate for IHC-eligible beneficiaries fell by 18.1% between 2006 and 2010
- The bed-day rate fell 15.6% between 2006-2010
- The adjusted ED visit rate decline 5% over the study period
- From 2006 to 2010, the overall Medicaid program also realized substantial reductions in hospitalization (15.1%), bed-day rates (18.6%) and avoidable hospitalizations (19.4%).
Improved Health:
- Quality improved significantly for 9 out of 10 metrics
Improved Patient/Clinician Satisfaction:
2012 physician satisfaction survey results:
- 80.2% agreed or strongly agreed that the IHC Panel Roster helped them manage patients’ care (12.2% reported not using it).
- 67.3% agreed or strongly agreed that IHC Provider Portal provided useful tools such as Claims History and online Panel Rosters (25.3% reported not using them)
- 81.9% agreed or strongly agreed that the mailed Provider Profiles, which featured physicians' quality measures, were useful for quality improvment (10.7% had not seen them)
- 75.2% agreed or strongly agreed that the bonus payment program stimulated quality improvement in their practice (10.6% were unaware of the bonus program).
- 36.6% agreed or strongly agreed that the IHC Quality Assurance Nurse (academic detailing) service was helpful for understanding their Profile quality measures and how to achieve maxiumum bonus payments (61.8% had not used the Quality Assurance Nurse service).
- 85.8% agreed or strongly agreed that they would recommend IHC to their colleagues (2.5% strongly diagreed).
Cost Savings:
- estimated gross savings from 2007 to 2010 of $237 million
- The rate of estimated annual savings increased about 2% per year to 6.5% in 2010
Increased Preventive Services:
-
Most prevention measures show substantial improvements, particularly those with low levels of compliance in 2007 (early in the PCMH intervention)
Other Outcomes:
- In 2011, nearly 90% of eligible participating physicians received bonus payments (amounting to $5,349,900 in bonus payments
Data Source(s):
Last updated February 2015
