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.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
Accountable Care Entities (ACEs)	Medicaid	Statewide
CMS State Innovation Model Design Award - Illinois	Grant	Statewide	CMS State Innovation Model (SIM)
Illinois CHIPRA Quality Demonstration Project	Grant	Statewide	CHIPRA Quality Demonstration Grant
Illinois Health Connect	Medicaid	Statewide
Integrated Health Homes	Medicaid		ACA Section 2703 Health Homes
Integrated Inpatient/Outpatient Care for Patients at High Risk of Hospitalization	Grant		CMS Health Care Innovation Award (Round 1)
Medical Home Network	Other	South & Southwest Side of Chicago
Medicare-Medicaid Alignment Initiative- Illinois	Medicare, Medicaid	Chicago Area and Central Illinois	CMS Dual Eligible Demonstration
OSF Healthcare System - CMS Pioneer ACO	Grant	Central Illinois	CMS Pioneer ACO
PCORI Funding Award - University of Illinois at Chicago	Grant	Chicago
University of Illinois CHECK program	Grant	Chicago area	CMS Health Care Innovation Award (Round 2)

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
Blue Cross Blue Shield of Illinois Intensive Medical Home (IMH)	Commercial	Chicago, Joliet, Bolingbrook, Blue Island, Quincy, Springfield, Geneva, Elgin, Princeton, Skokie	Blue Cross Blue Shield Value-Based Care Program
Cigna Accountable Care Program - Adventist Health Network	Commercial	Chicago Metro Area	Cigna Collaborative Care Program
Humana medical home program - OSF Healthcare System	Commercial	Peoria	Humana Medical Home Program
Humana medical home program - Quincy Medical Group	Commercial	Quincy	Humana Medical Home Program
OSF & Blue Cross Blue Shield of Illinois ACO	Commercial	Pontiac, Bloomington, Galesburg, Peoria, and Rockford	Blue Cross Blue Shield Value-Based Care Program

State Legislation

Legislation	Status	Year
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.	Enacted	2013