Tuesday, October 30, 2012

1st Round of Networks Selected

Illinois Governor Pat Quinn and the state’s Department of Healthcare and Family Services (HFS) selected six healthcare networks to launch the state’s transition to greatly expanded coordinated care. This will mean that by 2015, about 1.5 million Medicaid beneficiaries will be in coordinated care.

The HFS “Care Coordination Innovations Project” is working to redesign the Illinois healthcare delivery system to reduce costs to the Medicaid and All Kids program, improve health outcomes, and provide higher quality care to 2.7 million residents. The first phase of the Innovations Project is being directed at the 16 percent of Medicaid recipients currently accounting for 55 percent of Medicaid costs in Illinois.

Provider groups applied to be part of the Innovations Project led by HFS Director Julie Hamos. Six applicants 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 Innovations Project is one of several initiatives the state is using to see that 50 percent of clients are enrolled into care coordination. Through this particular program, HFS is testing innovative models that offer risk-based care coordination through Care Coordination Entities (CCE) and Managed Care Community Networks (MCCN).

To jump start the care coordination movement, HFS released an RFP in January for the first phase looking for provider only proposals from CCEs and MCCNs. The goal was to form provider-based networks to provide care coordination to seniors and adults with disabilities who have the most complex health and behavioral health conditions.

The RFP required that these CCEs and MCCNs partners enlist participation from hospitals, primary care providers, and mental health and substance abuse providers. However, other RFPs are open to HMOs, providers, and Medicare Advantage (dual eligibles).

On October 16th, six proposals were selected from four applicants in northeastern Illinois and two in downstate Illinois. The agency realizes that these CCEs and MCCNs will need time to build their infrastructure, including the use of EHRs.

The five CCEs plus one MCCN selected include:

  • Be Well Partners in Health led by MADO Management LP, Bethany Homes and Methodist Hospital, Norwegian American Hospital, and Neumann Services
  • Healthcare Consortium of Illinois led by Healthcare Consortium of Illinois, a community-based, non-profit organization. The consortium includes a network of collaborators such as primary care physicians, behavioral health service providers, hospitals, and others
  • Macon County Care Coordination led by the Macon County Mental Health Board with a network of collaborators to include a Federally Qualified Healthcare Center for primary care, hospitals, behavioral health service providers, health departments, and others
  • Precedence Care Coordination group will be a collaboration of providers and community organizations to include hospitals, substance abuse entities, clinics, and three established community mental health centers
  • Togethr4Health led by Heartland Health Organization, Inc. includes 37 collaborators composed of hospitals, primary care providers at FQHCs, pharmacies, behavioral health providers, social services, and housing providers
  • The MCCN Community Care Alliance of Illinois led by Community Care Alliance of Illinois, is a wholly-owned subsidiary of Family Health Network that includes hospitals, and 6,000 practitioners