CHICAGO – Governor Pat Quinn and the Department of Healthcare and Family Services (HFS) today named six healthcare networks that have been chosen initially to launch the state’s transition to greatly expanded coordinated care by 2015. The six provider groups applied to be part of the “Care Coordination Innovations Project” led by HFS Director Julie Hamos. They were selected based on their demonstrated ability to offer a holistic approach to delivering coordinated care for special populations including seniors and adults with disabilities. 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,” Governor Quinn said. “These six healthcare provider groups understand what the future of healthcare 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% of clients into care coordination. The goal is to redesign the healthcare delivery system so that 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, HFS is testing innovative models that offer risk-based care coordination through Care Coordination Entities (CCEs) and Managed Care Community Networks (MCCNs). These models are an alternative to traditional Health Maintenance Organizations.
Under a solicitation released in January, HFS sought proposals from CCEs or MCCNs that would form provider-based networks to provide the 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 healthcare 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. “Today’s announcement is a big step forward in our effort to transform the Medicaid program and work with healthcare 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 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.
Healthcare Consortium of Illinois – As a CCE, the proposed care coordination model will be led by the Healthcare Consortium of Illinois, a community-based, non-profit 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 which is 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 network of collaborators that includes a Federally Qualified Health Center for primary care, Hospitals, Behavioral Health Service Providers, a Health Department and others. The focus of the collaborations 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 and/or substance abuse disorders across a nine-county region in Northwest and Central Illinois. The regions include Whiteside, Lee, Rock Island, Bureau, Henry, Mercer, Stark, Marshall, Putnam and LaSalle counties and combine 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, Inc., 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 persons 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