HFS Begins Enrollment in Groundbreaking Integrated Care Program

CHICAGO – The Illinois Department of Healthcare and Family Services (HFS) is announcing that enrollment has begun in the first of its kind Integrated Care Program for seniors and persons with disabilities in the Illinois Medicaid system. This program will improve care for nearly 40,000 Medicaid recipients in the suburban Cook, DuPage, Kane, Kankakee, Lake, and Will Counties.

"This Integrated Care Program is the culmination of efforts to increase efficiency in government and improve care for some of the state’s most vulnerable citizens,” said HFS Director Julie Hamos. “Through this innovative program we will improve outcomes and increase the quality of life for these residents while saving the taxpayers millions of dollars.”

An integrated care delivery system brings physicians, hospitals, nursing homes and other service providers into a network connected with electronic medical records and other coordination processes. Care is organized around an individual’s needs in order to improve health and quality of life outcomes while assuring the efficiency and effectiveness of state resources.

The Integrated Care Program will save the state an estimated $200 million over the next five years, compared to costs under the current fee-for-service delivery system. These savings will be achieved by improving the overall health of those enrolled and focusing on their individual needs which will in turn, reduce unnecessary hospitalizations, emergency room visits and nursing home placements. The program will also save money by shortening lengths of hospital stays, eliminating duplicate testing and procedures.

“Illinois is reforming the way we deliver care to individuals in the Medicaid Program”, said HFS Administrator of Medical Programs, Theresa Eagleson. “This is value-based purchasing, meaning we are holding a portion of the total contract amount to pay only if certain benchmarks for service provision are met. This is achieved through better care coordination for the individuals we serve.”

HFS last fall selected Aetna and Centene-IlliniCare to provide the care for this program. The contracts have pay-for-performance measures that create an incentive for the companies to spend money on care that produces valued outcomes: better health and quality of life, while at the same time reducing the cost of the service over time.

The program will begin with all standard Medicaid medical services, such as physician and specialist care, emergency care, laboratory and x-rays, pharmacy, mental health and substance abuse and will phase in long term care services and waiver services over the next few years. For more information, contact HFS at hfs.medicaiddirector@illinois.gov or by calling 1-800-226-0768.