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+: 

Blue Cross Blue Shield of Illinois Intensive Medical Home (IMH)

Intensive Medical Homes (IMHs) are a value-based care model (VBCM) that are part of BCBSIL's larger vision to lower health care costs, and improve accessibility and quality of care. Its aim is to move away from fee-for-service payment models that focus on volume, to providing incentives for quality outcomes and improved population health in a given physician practice. 

Blue Cross and Blue Shield of Illinois announces four more commerical Accountable Care Organization Agreements

on mer, 2015-04-29 00:00   lisabeth

Blue Cross and Blue Shield of Illinois (BCBSIL) announces four new, strategic agreements aimed at improving patient care while slowing health care cost trends. Accountable Care Organizations are a value-based care model that seeks to move the healthcare industry's payment structure from one based on fee-for-service, or volume, to one that reimburses based on the quality of patient outcomes and patient care. In an ACO, both the payer and provider share financial risk, and in return, shared savings, while improving the care that is delivered.

Story Date: 
April 29, 2015
Source Link: 
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Public Act 098-104

The Act created Medicaid Accountable Care Entities (ACEs), which provide an innovative approach for achieving the triple aim (increasing quality of care, lowering costs, and improving population health outcomes) for the Medicaid population.

Blue Cross Blue Shield Value-Based Care Program

The Blue Cross and Blue Shield Association (BCBSA) and BCBS Plans are spearheading initiatives to assure their 100 million members receive safe, high-quality, coordinated, and affordable care. Blue initiatives use an interconnected approach involving:

University of Illinois CHECK program

The University of Illinois is receiving a $19.6 million federal grant to test a medical care model that focuses on poor children and young adults with chronic conditions such as asthma and diabetes.

Illinois Medicaid Program Achieved Savings While Boosting Quality of Care

on jeu, 2014-10-02 10:50   caroline

Medicaid has offered an attractive venue for states and the federal government to pursue patient-centered medical home (PCMH) innovation experiments, but one state initiative that launched before PCMH certification even began offered potential lessons before it was curtailed for budget reasons, according to a recent study.

Story Date: 
October 1, 2014
News Author: 
Michael Laff
Source Link: 
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Humana medical home program - Quincy Medical Group

This program is offered to practices that are either patient-centered medical home (PCMH) certified or in the certification process. These practices must meet HEDIS and clinical initiative targets and have made progress addressing some of the requirements necessary to transform their practice in order to become successful population health managers. For example PCMH program participants have implemented electronic medical records and likely use electronic prescribing systems. Additionally, they have made other infrastructure changes, including the use of a care coordinator in the practice.

Humana medical home program - OSF Healthcare System

This program is offered to practices that are either patient-centered medical home (PCMH) certified or in the certification process. These practices must meet HEDIS and clinical initiative targets and have made progress addressing some of the requirements necessary to transform their practice in order to become successful population health managers. For example PCMH program participants have implemented electronic medical records and likely use electronic prescribing systems. Additionally, they have made other infrastructure changes, including the use of a care coordinator in the practice.

When health innovation leads to personalization, care costs drop

on mer, 2014-05-28 00:00   lisabeth

Imagine you are the adult child of Susan. She’s just been discharged from her fourth hospital stay in six months and you’re at a loss as to how to prevent the fifth. Susan has diabetes, chronic heart disease and is obese. As you are getting her settled back at home, the phone rings and on the other end is a nurse calling to introduce herself as the person who would be taking charge of your mother’s care plan from here on out.

Story Date: 
May 28, 2014
News Author: 
Steve Hamman
Source Link: 
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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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Pagine

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