 The department plans to work with the other provider organizations not selected
in the first round to explore possible enhancements to the project proposals.
"Illinois continues to make real progress in transforming its Medicaid program,"
Quinn said. "These six health care provider groups understand what the future of
health care will look like. Each has designed innovative care coordination
models that will deliver better care and outcomes for our most vulnerable
populations."
The Innovations Project is one of several initiatives the state is employing
to meet the requirements of the state's 2011 Medicaid reform law to enroll 50
percent of clients into care coordination. The goal is to redesign the health
care delivery system so that it is more patient-centered, with a focus on
improved health outcomes and evidence-based treatments, enhanced patient access
and patient safety. Care coordination is also the key strategy to contain the
Medicaid budget.
Through this solicitation, the Department of Healthcare and Family Services
is testing innovative models that offer risk-based care coordination through
care coordination entities, or CCEs, and managed care community networks, or
MCCNs. These models are an alternative to traditional health maintenance
organizations.
Under a solicitation released in January, HFS sought proposals from CCEs and
MCCNs that would form provider-based networks to provide care coordination
services to seniors and adults with disabilities who have the most complex
health and behavioral health conditions and are therefore the most expensive to
serve. The state required that these CCE and MCCN partners would include
participation from hospitals, primary care providers, and mental health and
substance abuse providers. The role of care coordination is to facilitate the
delivery of appropriate health care and other services and to manage needed
transitions in care among providers and community agencies.
"The health care and social service providers who participated in the
Innovations Project have shown a tremendous willingness to collaborate and test
new models of delivering care to our most vulnerable populations," said HFS
Director Julie Hamos. "(Tuesday's) announcement is a big step forward in our
effort to transform the Medicaid program and work with health care providers
across the state to do a better job of keeping residents healthy and a better
job of treating them when they do become sick."
The solicitation invited providers to collaborate and demonstrate that they
can build new networks that offer care coordination services and achieve better
health outcomes and cost savings than under the current fragmented system.
HFS selected the six proposals -- four in northeastern Illinois and two in
downstate Illinois -- that presented the most comprehensive models and took a
holistic approach to serving clients and coordinating services for all of their
needs. The state expects to select additional participants in the next year.
The agency recognizes that these CCE and MCCN entities will need time to
build their infrastructure, including the use of electronic health records, to
be able to serve the eligible enrollees as envisioned under each care
coordination model. The initial awards are anticipated to extend for a
three-year term, with possible extensions based on specific quality and savings
measurements assessed under each model during the initial term.
Each entity will serve 500-1,000 Medicaid clients in the first year as they
establish and test their care coordination models before expanding in the
following years. Care coordination fees will be paid based on performance, but
the plan must be at least cost-neutral over three years through reduced use of
emergency rooms, reduced hospital admissions and readmissions, follow-up care,
and other strategies.
HFS will collect detailed data from each model, and the data will be used to
measure and assess the performance of the various models of care coordination.
Following are the entities selected in the initial award and a brief summary
of each care coordination model:
Care coordination entities:
Be Well Partners in Health -- As a CCE, the proposed care coordination
model will be led by MADO Management LP, Bethany Homes and Methodist Hospital,
Norwegian American Hospital, and Neumann Family Services. It includes a network
of collaborators within the community that are primary care physicians, mental
health providers, substance abuse providers and others. The focus of this model
is on improving health outcomes for adults with severe mental illness and
chronic health conditions, including substance abuse, on the North Side of
Chicago. This Innovations Project will test a care coordination model organized
by a nursing facility group, with its unique insight into long-term services and
an additional focus on care coordination services within long-term care
settings.
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Healthcare Consortium of Illinois -- As a CCE, the proposed care
coordination model will be led by the Healthcare Consortium of
Illinois, a community-based, nonprofit organization, and includes a
network of collaborators within the community that are primary care
physicians, behavioral health service providers, hospitals and
others. The focus of the consortium's care coordination model is a
comprehensive care plan managed and monitored by an evidence-based
process for seniors and their eligible family members in 13 ZIP
codes on the South Side of Chicago. This Innovations Project will
test a model organized by a community-based organization that
promotes the concept of "networks within networks" with its base of
hospitals, physicians and social service organizations.
Macon County Care Coordination -- As a CCE, the proposed care
coordination model will be led by the Macon County Mental Health
Board, with a collaborating network that includes a federally
qualified health center for primary care, hospitals, behavioral
health service providers, a health department and others. The focus
of the collaboration's care coordination model is to promote
coordination and communication of social support and medical
services across different organizations and providers for adults
with serious mental illness, seniors with chronic illness, including
dual eligibles, and children and family members of adult enrollees
in Macon County. This downstate Innovations Project, organized by a
county-based mental health organization, will be used to demonstrate
the effectiveness of care coordination led by mental health
providers.
Precedence Care Coordination -- As a CCE, the proposed care
coordination model will be led by Precedence CCE, which represents a
newly established collaboration of providers and community
organizations including hospitals, substance abuse entities, clinics
and three established community mental health centers. The CCE is
proposing to serve adults with disabilities, including adults with
serious mental illness or substance abuse disorders, across a
nine-county region in northwest and central Illinois. The area
includes Whiteside, Lee, Rock Island, Bureau, Henry, Mercer, Stark,
Marshall, Putnam and LaSalle counties and combines both rural and
urban demographics. The Innovations Project tests a model organized
through a major hospital system, featuring integration of primary
and behavioral care with community health agencies through health
home hubs.
Together4Health -- As a CCE, the proposed care coordination
model will be led by Heartland Health Organization and includes 37
collaborators: hospitals, primary care providers at federally
qualified health centers, pharmacy, behavioral health providers,
social services and housing providers. The collaborators' care
coordination model is based on the health home setting and will be
an integrated, holistic approach that promotes physical, mental and
social well-being while improving access to care for adults and
seniors with disabilities, including those with serious mental
illness and people who are dually eligible, in Cook County. This
Innovations Project brings a unique focus on serving hard-to-reach
populations, including the homeless.
Managed care community network:
Community Care Alliance of Illinois -- As a MCCN, the
proposed care coordination model will be led by Community Care
Alliance of Illinois, a wholly owned subsidiary of Family Health
Network, and includes over 40 hospitals and 6,000 practitioners.
This MCCN's care coordination model proposes to serve seniors and
people with disabilities, including those with severe mental illness
and intellectual/developmental disabilities, in Anchor Medical homes
that address six domains of care: medical, psychological,
functional, environmental, social support and financial. The MCCN is
proposing to serve eligible individuals in Cook and surrounding
counties. This Innovations Project is unique in that it borrows from
a successful model pioneered by Dr. Robert Master, CEO of the
Community Care Alliance in Boston, who serves on the MCCN's National
Advisory Board. It is the only full-risk proposal submitted to the
department.
For more information about the Innovations Project, go to:
http://www2.illinois.gov/
hfs/PublicInvolvement/cc/Pages/default.aspx.
[Text from
Illinois
Department of Healthcare and Family Services
file received from
the
Illinois Office of
Communication and Information]
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