CHICAGO – Governor Rod R. Blagojevich today announced that the Illinois Department of Healthcare and Family Services (HFS) achieved $34 million in net savings during fiscal year 2007 through more efficient management of its medical programs. The savings resulted from the implementation of a Primary Care Case Management program and a Disease Management program for the almost 1.7 million individuals who receive their healthcare through HFS medical programs, which includes the state’s Medicaid program. Those savings will pay for the first year of the All Kids expansion, which increased eligibility from 200 percent of the federal poverty level to all uninsured children and cost $22.8 million in fiscal year 2007.
“People are healthier when they have access to primary care doctors who can provide regular checkups and preventative care. That good health also translates to the rest of the healthcare system, where we can work to keep our medical costs down,” said Governor Blagojevich. “In Illinois, we are leading the nation not only by providing healthcare to those in need, but also in implementing programs that work to keep our medical costs in check.”
The Primary Care Case Management and Disease Management programs work in concert to prevent inappropriate and costly emergency room visits or hospitalizations by assigning each client a “medical home” where they can receive regular ongoing care. For those patients with various chronic diseases – from coronary artery disease, to asthma to depression – the Disease Management program provides more intensive care coordination to manage patients’ diseases while decreasing hospitalizations and emergency room visits.
Both the Disease Management and Primary Care Case Management programs were launched in July 2006. Statewide implementation of the Primary Care Case Management program, called Illinois Health Connect, was conducted in phases and enrollments concluded in November 2007. All medical program participants were asked to select a medical home for ongoing care coordination or one was assigned to them. About 1.7 million beneficiaries statewide are participating in Illinois Health Connect.
The statewide Disease Management program, called Your Healthcare Plus, provides additional support to about 220,000 clients - including disabled adult Medicaid beneficiaries, children with asthma and frequent emergency department users - and is one of the largest and most comprehensive programs of its kind in the country. No other state has tried to implement disease management in a metropolitan area as large as Chicago, and no other state has realized annual savings as significant as Illinois’.
The program takes a comprehensive approach to client needs, assessing and supporting all of a member’s chronic healthcare conditions to reduce the incidence of costly medical crises. For example, health professionals help participants gain better control of their situation by working with clients on issues that range from food and housing to managing multiple chronic health conditions. Nurses and social workers work closely with healthcare providers to ensure participants get help they need. As a result, during the program’s first year, Your Healthcare Plus lowered inappropriate inpatient and emergency department admissions, and improved key clinical indicators for clients, which helped result in the savings.
Savings figures are calculated through a complex set of formulas that estimate the average cost of a client prior to the programs and compare that figure to the average cost of a client after the programs have been implemented. The net savings figure of $34 million is on top of the cost of the increased care coordination.
“Both of these programs represent a major change in the way the state delivers health care,” said Illinois Department of Healthcare and Family Services Director Barry Maram. “Instead of just determining eligibility and paying medical bills, the state is now an active participant in the process, to make sure that our clients are getting regular checkups and preventative care. By targeting efforts to those with chronic disease we are further reducing the number of unnecessary and costly hospital stays and emergency room visits.”
Through extensive outreach efforts, Illinois Health Connect has enrolled more than 5,200 medical homes, which includes physicians and Federally Qualified and Rural Health Centers. These medical homes provide enough capacity to serve 5.3 million patients, which more than exceeds the eligible clients statewide. In almost all counties throughout Illinois, the capacity for patients is more than double than what is needed to serve clients in that area. Such availability provides options for clients when choosing their medical home.