CHICAGO – The Illinois Department of Healthcare and Family Services (HFS) has taken the first step in significantly reforming the delivery of care to the most vulnerable populations covered by the Medicaid Program. HFS has issued a request for proposals (RFP) seeking two managed care organizations (MCOs) to provide adults with disabilities and older adults in the Medicaid program the full spectrum of Medicaid covered services through an integrated care delivery system. The first phase of the program will focus on traditional medical services with later phases coordinating long term care. The pilot program will affect approximately 40,000 individuals in suburban Cook, DuPage, Kane, Kankakee, Lake, and Will Counties.
“Linking clients to integrated delivery systems will encourage greater coordination and preventive care between primary, specialty, home and community based providers,” said Healthcare and Family Services Director Barry S. Maram. “The premise is that good preventive care and coordination of that care among all providers based on a shared treatment plan will produce better treatment of common chronic ailments – like asthma, diabetes and congestive heart failure – and will provide better outcomes, improve quality of life and reduce costs.”
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 for the state’s most disabled and frail citizens, while assuring the efficiency and effectiveness of state resources.
Another feature of the program, to be phased in next year, is to provide individuals with disabilities the support they need to live more independently in the community. The goal of the program is to give individuals with disabilities a greater voice in designing the care plan they need.
HFS will tie some of the compensation to the MCOs to their performance on nationally recognized pay-for-performance measures. In turn, the MCOs will be expected to reward hospitals, physician practices and other providers with incentives based on performance and positive health outcomes.
Enrollment with a managed care organization will be mandatory for beneficiaries in the selected counties, while promoting active consumer choice. Once HFS evaluates the effectiveness of the new approach, the department will determine whether it should be employed in other parts of the state.
Michael Gelder, Senior Healthcare Policy Advisor to Governor Quinn, pointed to statistics from the current Medicaid program that demonstrate the great potential of this pilot program to improve enrollees’ health.
• Research shows that patients who have coordinated follow-up care, such as a visit with their doctor within two weeks of a hospital discharge, have significantly lower readmission rates. Current data shows that only 21 percent of patients in the target group saw their doctor within two weeks of discharge.
• Only 36 percent of patients with congestive heart failure are on an appropriate medication regimen.
• Twenty-five percent of diabetics do not have their blood sugar tested even once a year.
“Integrated care is designed to address these shortcomings in the current delivery system,” Gelder said.
The pilot project is expected to save taxpayers close to $200 million in its initial five-year period. If successful, HFS will identify other areas of the state where this model can work.
Potential bidders can find more information on the managed care RFP, at the Illinois Procurement Bulletin at www.purchase.state.il.us