PCCM and DM Annual Report 3 July 2011
PROGRAM OVERVIEW
PRIMARY CARE CASE MANAGEMENT
Illinois’ Primary Care Case Management Program, Illinois Health Connect, is a
statewide health plan that is available to most persons covered by an HFS medical
program.
Illinois Health Connect
Illinois Health Connect (IHC) is based on the American Academy of Pediatrics’ initiative
to create medical homes to make sure that preventive healthcare is provided in the best
setting. A doctor's office or clinic is a more suitable setting than an emergency room for
receipt of routine care. Clients who are enrolled in Illinois Health Connect have a
medical home through a Primary Care Provider (PCP).
The goals of Illinois Health Connect are to:
Improve the quality of healthcare and increase the utilization of primary and
preventive care;
Reduce the usage of the emergency room for routine medical care;
Improve access to care through the availability of a provider network and expansion
of providers;
Provide the most appropriate and cost-effective level of care; and
Connect clients with a “best fit” medical home.
The Primary Care Case Management program began in 2007, rolling out by regions of
the state until the program had been implemented statewide. Today, as new clients
become eligible for Illinois Health Connect, they have approximately 60 days to select a
PCP for their medical home. Clients who do not choose a PCP within the 60-day choice
period are assigned to a PCP in Illinois Health Connect.
Eligible clients that must select a PCP for their medical home include most children
enrolled in All Kids, adults enrolled in Family Care and seniors and disabled adults.
Some populations, such as participants that have Medicare, are excluded from enrolling
in Illinois Health Connect. In counties where the voluntary managed care program
operates, eligible clients may opt out of Illinois Health Connect to enroll with a PCP in a
Managed Care Organization (MCO) for their medical home. Clients may choose their
own doctor or clinic as their PCP if that doctor or clinic is enrolled with HFS as a
provider and enrolled as a PCP with Illinois Health Connect. As of June 30, 2011, there
were over 2 million HFS clients that had either chosen or been assigned to a PCP for
their medical home. Of these, over 1.8 million clients are enrolled with a PCP in Illinois
Health Connect for their medical home, while the remaining clients enrolled with an
MCO (See Table 2).
