A Diagram: Illinois Wellbeing Associate, Deliberate Oversaw Consideration and Malady Administration.


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An Outline: Illinois Wellbeing Associate, Willful Oversaw Consideration and Illness Administration Who are we?
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An Overview: Illinois Health Connect, Voluntary Managed Care and Disease Management

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Who are we? The Illinois Maternal and Child Health Coalition attempts to advance and enhance the wellbeing and prosperity of babies, kids, moms and families all through the state. We finish these goals, in association without 90+ authoritative individuals, through a blend of promotion, training, group strengthening and arrangement advancement. The Sargent Shriver National Center on Poverty Law makes a move to end neediness. From thought to law to practice to checking, we work to defeat the bunch issues that consolidate to bring about destitution. Our instruments are support, arrangement improvement, and interchanges. Together our work makes a data channel among promoters, grassroots gatherings, analysts, policymakers and officials.

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Who are we? (ct’d) Automated Health Systems (AHS) The State of Illinois (HFS) contracted with Automated Health Systems (AHS) to dispatch and oversee Illinois Health Connect , the Department’s Primary Care Case Management (PCCM) program. Under Illinois Health Connect,  AHS is in charge of selecting, teaching, and supporting suppliers and in addition helping members enlist with a "best fit" Primary Care Provider (PCP). In the six districts that offer enlistment into willful wellbeing arrangements, HFS has contracted with AHS to be the Client Enrollment Broker, to give fair member training about and enlistment  with a wellbeing arrangement and PCP.

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Why are we here? Starting this month, the vast majority in Cook and Collar Counties who get Medical Assistance through HFS will be obliged to pick a Primary Care Provider (PCP)

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Why are we here? (ct’d) What’s In A Name?? “Illinois Health Connect,” “Harmony Health Plan,” “Family Health Network,” “Your Healthcare Plus,” “Healthy Kids” PCCM, DM, EPSDT, PCP, HMO, MCO

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Goals Give you the data you have to answer questions about Illinois Health Connect from the patients/customers you serve Give you the assets you have to get your inquiries replied later on (counting telephone numbers for AHS, Illinois Maternal and the Shriver Center)

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Background: Illinois Health Connect , PCCM and a Medical Home

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Background Illinois embraced Medicaid oversaw mind early, however in a restricted manner MediPlan Plus (1996) – compulsory oversaw care waiver that was never executed Voluntary oversaw consideration has been a Medical\'s piece Assistance program subsequent to 1976, and crested in 1998 with 15 MCOs taking part. Illinois is presently swinging to the Primary Care Case Management (PCCM) model of social insurance to address expense and quality issues. Illinois’ PCCM system is called Illinois Health Connect. It is supported by the Illinois Department of Healthcare and Family Services (HFS). Mechanized Health Systems (AHS) directs the project for HFS

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What is Primary Care Case Management (PCCM) ? A model of medicinal services that joins oversaw administer to benefit, yet is more than essentially oversaw care. Joins the idea of giving every member in the project with a “medical home” In a restorative home, Primary Care Providers (PCPs) are in charge of organizing the procurement of wellbeing administrations required by the buyer (“gatekeepers” and “gate openers”)

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Why is a Change Needed? Essential Tenets of PCCM Increased usage of essential consideration and preventive administrations (counting vaccination and screening tests) Currently, numerous individuals get the lion\'s share of their social insurance from the ER Better progression, coordination and, therefore, nature of consideration Greater buyer consistence and obligation Improved shopper training and comprehension about wellbeing advancing practices Decreased expenses Paves the path for extended scope activities, for example, All Kids Medical Home

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What is a Medical Home? A way to deal with giving essential consideration According to the American Academy of Pediatrics, a restorative home is “primary care that is available, persistent, thorough, family focused, composed, humane, and socially effective” The doctor’s office, facility or wellbeing focus where a patient goes to see their Primary Care Provider (PCP) The spot where the greater part of a patient’s therapeutic records are put away

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Why is having a medicinal home imperative? A therapeutic home gives association and backing to the whole family Simply put, having a restorative home means having better social insurance The best care is given when an individual goes to the same specialist for each visit (The ER is NOT a medicinal home)

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Other Illinois Health Care Programs and Terms All Kids Comprehensive, moderate wellbeing protection for kids, paying little respect to family wage, migration status, or prior therapeutic condition (beforehand known as KidCare) Family Care A qualification system taking into account pay that offers thorough, reasonable wellbeing protection to folks living with their kids age 18 years or more youthful. Additionally covers relatives who are nurturing the youngsters set up of their guardians Moms & Babies A qualification system in light of wage that offers social insurance scope to pregnant ladies and their infants

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Other Illinois Health Care Programs and Terms Fee-for-Service A model of human services where administrations are not planned and from a mixed bag of suppliers (i.e., no restorative home) Voluntary Managed Care 2 Managed Care Organizations (MCOs) in Illinois Harmony Health Plan, Family Health Network Option for customers living in Cook, Madison, Perry, Randolph, St. Clair and Washington districts Participants who choose to be in a MCO pick a wellbeing arrangement and a PCP Your Healthcare Plus Optional Disease Management (DM) program that assists members with betterring deal with their constant conditions

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How will these progressions influence patients and suppliers in Illinois?

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Covered Populations Eligible populace = 1.2 million statewide (out of 1.7 million who get a restorative card from HFS) Includes: Most individuals in All Kids and FamilyCare (1.1 million) Disabled grown-ups (95,000) Some elderly (13,000)

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Excluded Populations Individuals who have Medicare Children under age 21 who get Supplemental Security Income (SSI) Children in child care and kids who get Subsidized Guardianship or Adoption Assistance from DCFS (Department of Children and Family Services) Children under age 21 who are visually impaired or who have an incapacity People who live in nursing offices American Indians and Alaska Natives Individuals with Spend-down

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Excluded Populations (ct’d) People who return home and Community-Based administrations like the Community Care Program, the Home Services Program, or group administrations for persons with formative inabilities Refugees Individuals dwelling in Community Integrated Living Arrangements (CILAs) Individuals in Presumptive Eligibility programs

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Excluded Populations (ct’d) Individuals in constrained advantage projects, for example, Illinois Healthy Women All Kids Rebate and FamilyCare Rebate Illinois Cares Rx (in the past SeniorCare/Circuit Breaker) Transitional Assistance, age 19 and more seasoned Emergency Medical Only Hospice Sexual Assault, Renal, and Hemophilia programs Populations effectively oversaw, for example, High level outsider risk (TPL)/private protection Program though Inclusive Couldn\'t care less for the Elderly (PACE)

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What will this change mean for patients ? Patients will be obliged to pick a Primary Care Provider (PCP) Can be individual specialist or a gathering/facility Patients will require a referral for a few administrations or to see an expert Change in conduct/desires?

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What will this change mean for suppliers ? Most suppliers should enlist as a PCP in Illinois Health Connect. PCPs in Illinois Health Connect: Will get a consideration administration expense of $2-4 for every patient for each month, paying little mind to care given Can set their board size, up to 1800 patients Will have admittance to different bolster administrations given by Illinois Health Connect, including the Provider Helpline and the Referral Resource Directory Referrals Change in conduct/desires?

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FAQs What is the relationship between Illinois Health Connect and All Kids (previously KidCare)? Will there be an adjustment in advantages or qualification? Shouldn\'t something be said about those individuals rejected from Illinois Health Connect? At the point when will these progressions produce results?

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Implementation

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Illinois Health Connect Implementation Phase 1 – Voluntary Began July 2006 PCPs are restricted to FQHCs, RHCs, and CCBHS Phase 2 – Mandatory Geographical statewide usage Cook and Collar Counties: Jan* 2007

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Enrollment Timeline Postcard Primer Initial Enrollment Packet Packets will be sent to families with potential enrollees Packets will clarify the system, PCP decisions, time period for settling on a decision Packets will contain an enlistment structure customized with each client’s name, DOB, and a postage-paid return envelope Clients may pick a PCP via mail, telephone, fax, in individual, or by means of the Internet We are firmly prescribing enlistment by means of our sans toll Illinois Health Connect Helpline

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Enrollment Timeline (ct’d) Reminder Notice – 15 days after the Initial Enrollment Packet 2 nd Enrollment Packet – 15 days after the Reminder Notice Will incorporate the name of the PCP to which every customer will be auto-appointed in the event that they don\'t settle on a decision inside of the following 30 days Auto-task to PCP – 30 days after 2 nd enlistment parcel Prior to auto-task, AHS will put 2 cordial telephone calls to attempt to achieve the individuals

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