HFS and Advocate Health Care announce plan to ensure Medicaid coverage for nearly 100,000

Chicago – The largest Accountable Care Entity (ACE) in Illinois has finalized a plan with the Department of Healthcare and Family Services (HFS) to provide ongoing care to nearly 100,000 Illinoisans, the department announces today.

Working under the framework of Governor Bruce Rauner’s proposed budget, Downers Grove-based Advocate Health Care, accelerated its transition to become a fully operational, and risk-based, Medicaid care provider.

“This achievement serves both the taxpayers and patients,” said HFS Director Felicia Norwood. “ It is a model plan for similar provider-led managed care organizations.”

ACEs – along with Care Coordination Entities (CCEs) – are public/private partnerships created recently as part of the move to serve Medicaid clients through managed care. There are 17 in the Illinois, with about 580,000 enrollees. Advocate is the largest ACE, or CCE, with more than 95,000 participants.

During a transitional period, these organizations are receiving both fees for specific services provided through their networks, as well as flat rates for every client, known as capitation. Like other managed care organizations, they were designed to eventually receive only capitation. Through this system, clients are able to receive high quality care, including strong coordination of services, at sustainable costs to the state.

The Governor proposed speeding up this process to help solve the state’s fiscal crisis. Under the agreement announced today, Advocate Health will move to a full capitation system by the end of this year, much earlier than originally anticipated.  HFS estimates that Advocate’s accelerated approach will save the state’s Medicaid program $5.1 million in FY 2016. The agreement with HFS was finalized this week.

“We believe that provider-led care coordination is key to achieving better outcomes and lower costs in the Medicaid program,” said Lee Sacks, MD, Advocate’s executive vice president, and chief medical officer. “We appreciate the Administration's support and look forward to continuing to care for these Medicaid beneficiaries.”

With 12 hospitals, Advocate is the largest integrated health system in Illinois, and one of the largest health care providers in the Midwest. Advocate Physician Partners, a joint venture with 5,000 aligned doctors, has spent the last year developing Advocate Accountable Care that includes nearly 100,000 Medicaid beneficiaries.

Additionally, Advocate’s Accountable Care Organization is recognized as the largest in the nation.