All Kids launched, where will family physicians land?
An overview of the new program

In October 2005 Governor Blagojevich announced the All Kids program to expanding Medicaid eligibility coverage to the remaining uninsured children in Illinois. Over the interceding months, family physicians and other primary care physicians have learned that the program is much more than eligibility expansion. All Kids is the public-facing part of a much larger project that changes the way Medicaid is managed in Illinois.

The changes to the Illinois Medicaid program from the family physician point of view are two-fold:

A Primary Care Case Management project (called Illinois Health Connect and run by Automated Health Systems under a contract from the Illinois Department of Healthcare and Family Services [IDHFS]) hopes to place 1.1 million of Illinois’ Medicaid recipients into medical homes. Illinois Health Connect will be recruiting primary care physicians to be a primary care provider for the program. Primary care providers will be paid a "per member/per month fee" for each Medicaid patient in their practice in addition to their regular fee-for-service charge. You can learn more about this program by visiting the website www.illinoishealthconnect.com.

It’s important to note that primary care providers who do not participate with this program will not be able to see any Illinois Medicaid patients at all, unless they have a referral from a participating PCP.

A Disease Management project (called Your Healthcare Plus and run by McKesson Health Solutions under a contract from IDHFS) will work with 160,000 Medicaid recipients who are in need of chronic disease management services. Your Healthcare Plus will invite the primary care physicians whose patients qualify for disease management to participate. The primary care physicians may receive information on their patients from a team of disease management specialists (case manager, behavioral specialist, social worker, pharmacist, and nurse). The most important communications may come in the form of a critical alert fax and/or phone call when the nurse finds that the patient is unstable. The Your Healthcare Plus staff is also happy to hear about managed patients whom the PCP feels are at risk and would benefit from additional help. The number to call for questions or concerns is: (800) 973-6792.

Illinois Health Connect is currently being tested in community health centers and rural health clinics. The project will roll out geographically beginning in December to Chicago and Northern Illinois, February to central Illinois and March to southern Illinois. In advance of the project roll-out in those areas, family physicians and other primary care physicians will be recruited to be designated primary care providers. The primary care providers will decide how many Medicaid patients they wish to be in their practice.

Your Healthcare Plus is already rolling out across Illinois. There are 24 different disease management professional teams working across the state. You may have already received a letter from them listing your patients that they have been assigned to enroll in disease management. Participation by physicians and patients is voluntary. McKesson is a world leader in disease management and they believe you will find this service beneficial to you and your patients, and free of administrative hassles.

Medicaid payment cycle woes

In August, Governor Blagojevich announced that the backlog of unpaid Medicaid claims would be paid down. He also asserted that adult medical service claims would now be on an expedited 60 day claims payment cycle. This is in addition to the expedited 30-day payment cycle for pediatric medical claims that began January 1, 2006.

Long-range experience and past difficulties with the Medicaid payment cycle will cause many family physicians to be very wary about the new programs and the new payment cycles. When family physicians see the 30- and 60-day payment cycles actually happen, and continue for several months, their skepticism may wane somewhat.

Physician advisory role

IAFP volunteer leaders attended nearly monthly meetings since October 2005 held by IDHFS to discuss parts of the proposed program. IAFP and other primary care medicine advocates shared their criticisms, ideas, and skepticism. Some of the family medicine ideas were adopted; others were not; and some decisions were postponed.

Illinois Health Connect (the primary care case management project) and Your Healthcare Plus (the disease management project) have developed many advisory committees to help manage the new programs. IAFP leaders will be serving on the overall steering committee, as well as many of the subcommittees. If you have concerns, questions or ideas, please send them to Vince Keenan, vkeenan@iafp.com, to be forwarded to the IAFP leader on the appropriate committee.

Bottom line

Your Healthcare Plus is supposed to provide savings of more than $45 million in order to cover the expanded coverage to Illinois’ uninsured children. By focusing on controlling childhood asthma, reducing emergency room visits, and managing the non-dual eligible aged, blind and disabled patients with chronic health care conditions, Your Healthcare Plus will work closely with the primary care physicians to achieve better clinical outcomes for these patients.

Illinois Health Connect expects to achieve long-term results on health outcomes with a focus on evidence-based preventive services.

Both projects are contracted through 2009.

What do you think?
Please share your experience, questions, comments and suggestions with. IAFP can assist in getting a response to your inquiries.  E-mail us at iafp@iafp.com

 

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