Wednesday, February 24, 2010

State Funds to Improve Healthcare

Governor Pat Quinn announced that the state of Illinois will receive $18.8 million in federal funds to develop a statewide Health Information Exchange (HIE). The Governor signed an Executive Order to create the Illinois Office of Health Information Technology to be housed in the Governor’s Office. The Office of Health Information Technology will collaborate with the two ARRA funded Regional Extension Centers in Illinois which are led by Northern Illinois University and Northwestern University.

In another move, the Illinois Department of Healthcare and Family Service (HFS) are moving ahead to reform the delivery of care to the most vulnerable populations covered by the Medicaid Program. The goal is to set up an integrated care delivery system to bring physicians, hospitals, nursing homes, and other service providers into a network connected with electronic medical records.

The Department of HFS seeks two HMOs to provide services to disabled adults and older adults eligible for Medicaid but not eligible for Medicare. The contractors to provide the integrated care services are now being procured through an RFP issued on February 5th and due on April 15th, 2010.

The first phase of the program will focus on traditional medical services with later phases implemented to coordinate long term care. The pilot program will affect almost 40,000 individuals in suburban Cook, DuPage, Kane, Kankakee, Lake, and Will counties.

Another phase of the program to be phased in next year will be to provide individuals with disabilities the support they need to live more independently in the community. The goal is to give individuals with disabilities a greater voice in designing the care plan they need.

Department of HFS will tie some of the compensation that would go to the HMOs to their performance on nationally recognized pay-for-performance measures. In turn, the HMOs will be expected to reward hospitals, physician practices and other providers with incentives based on performance and positive health outcomes. Once the Department of 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 the Governor described how the statistics from the current Medicaid program demonstrates the potential for the integrated care pilot program to greatly improve the health of the enrollees.

For example it has been found 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. Follow-up is needed with patients and their medications since only 36 percent of patients with congestive heart failure are on an appropriate medication regimen and 25 percent of diabetics do not have their blood sugar tested even once a year.

The pilot project is expected to save taxpayers close to $200 million in its initial five-year period. If successful, the Department of HFS will identify other areas within the state where this model can work and produce good results.

For more information, email Michelle Maher, Department of HFS Division of Medical Programs at or call (217) 524-7478 or call the Procurement Office Call Center at 1-866-ILL-Buys.