Illinois Health Connect
The Illinois Health Connect program is a primary care case management (PCCM) model where each eligible person has medical home through a Primary Care Provider (PCP). The eligible persons receive health coverage through the Medicaid and All Kids programs of the Illinois Department of Healthcare and Family Services (HFS). IHC is administered by Automated Health Systems (AHS).
Recent Program Developments
Provider Profile Reports - IHC will begin sending each PCP (for FQHCs a PCP is a site, not an individual clinician) a semi-annualy Provider Profile report that aggregates each PCP’s performance on 20 clinical indicators based on the PCP’s enrollees as of December 1st. It will also include a benchmark for each measure, most of which are equal to the 2007 NCQA 50th percentile. The measures include immunizations, lead toxicity, developmental screenings, asthma and diabetes management, breast and cervical cancer screenings and well-child visits and vision screening.
• Provider Profile Description
• Sample Profile Summary Table
• Sample Provider Profile
The outcomes are measured by HFS claims data and Cornerstone immunization data. This once again reinforces the importance of including all services that were provided during a visit on each claim, not just the encounter code (T1015) and the office visit CPT code.
Bonus Payments - Besides the incentive to get “credit” for providing quality health care, five of the quality indicators in the profile will be used to calculate Bonus Payments starting next spring. The first year’s payments will be based on Calendar Year 2008 claims so we’re already well into the measurement period. The bonus payments will be based on the benchmarks in the summary above, most of which are fairly high. HFS will pay out at least $5 million for CY 2008. The plan is that the amount paid per enrollee for PCPs that meet a benchmark will be at least $20 but it will likely be higher the first year in order to spend the whole $5 million.
• PCP Bonus Payment Announcement
IHC General Information
IHC main website: http://www.illinoishealthconnect.com/
IHC provider website: http://www.illinoishealthconnect.com/providerinfo.aspx
IHC PCP Handbook: http://www.illinoishealthconnect.com/files/downloads/IHC_PCP_Handbook.pdf
IHC Fact Sheet: http://www.illinoishealthconnect.com/files/downloads/IHCProgramInfo-Provider.pdf
Medical Electronic Data Interchange (MEDI) Authorization System
The Department of Healthcare and Family Services’ MEDI system allows providers and their authorized staff to link to their IHC Panel Rosters and their Patients’ Paid Claims History. In addition, MEDI will provide up-to-date eligibility information, including IHC PCP information, for all HFS clients. For questions about MEDI, call the IHC Provider Services Help Desk at 1-877-912-1999 and follow the prompts for Providers. http://www.illinoishealthconnect.com/files/downloads/MEDIAccessRegistration.pdf
Monthly Provider Webinars
IHC hosts webinars each month on a variety of topics. Some of the topics have included provider profiles, billing overviews, well child preventive care, using MEDI it access IHC and peripartum depression. Anyone is invited to participate. This link provides information on upcoming webinars and copies of past presentations.
http://www.illinoishealthconnect.com/providereducation.aspx
Sample Client Education and Enrollment Materials
http://www.illinoishealthconnect.com/clientmaterials.aspx
IHC Medical Homes by County
This link provides a table of the number of medical homes and the total capacity of those homes by county.
http://www.illinoishealthconnect.com/reports/IHCCountEligibleMedicalHomesWebCounty.pdf