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

Private Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
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

State Facts:

Uninsured Population:
Total Medicaid Spending FY 2013: 
$15.7 Billion 
Overweight/Obese Adults:
Poor Mental Health among Adults: 
Medicaid Expansion: 

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