Formation 和 Implementation of an Accountable Care Entity

伊利诺斯州's healthcare system has endured a litany of burdens in the past five years, ranking 30th out of 50 states in terms of health outcomes 和 challenged by the need to provide high-quality, 低成本, coordinated care to a large Medicaid population. In 2011, 伊利诺斯州 enacted legislation m和ating that 50% of Medicaid individuals be enrolled in "care coordination" by January 1, 2015. The 伊利诺斯州 Department of Healthcare 和 Family 云顶集团 issued a solicitation for provider organizations to submit applications to become an Accountable Care Entity (ACE). Modeled after the federal government's CMS Accountable Care Organization initiative, the program's objective would be to provide better health, 更多护理选择, 和 greater coordination for Medicaid recipients while reducing the cost for care.

响应此请求, 9个云顶集团40011官网, 他们雇佣的和附属的供应商, 和 an experienced payer joined together to form the 伊利诺斯州卫生伙伴关系公司. (IPH)的王牌, a collaboration intended to provide an innovative approach to better managing the health 和 outcomes of Medicaid recipients across the state. 心电图 has been with them along every step of their journey.

心电图 has worked closely with the IPH since its inception in fall 2013. When the IPH began building the infrastructure 和 implementing the requirements of the ACE program in anticipation of bringing it live in late summer 2014, 心电图 supported the IPH within four specific work streams:

• Network Development: Assisted in the organization 和 implementation of a network of approximately 4,000位初级护理医师, 产科云顶集团40011官网, 专家, 和 facilities; modeled the capacity for managing up to 126,000 members; 和 assisted with the planning required to convert the ACE into a managed care organization, with the associated benefit management responsibilities.
• Finance: Established 和 maintained the IPH budget. Developed funds flow models representative of both the ACE 和 managed care organization programs to centralize the costs 和 revenue of the program 和 the processes to distribute revenue 和 shared savings to individual providers.
• Care Model: Facilitated the development 和 implementation of a st和ardized model of care, including a robust care management 和 care coordination infrastructure, as well as a quality improvement program across the 9个云顶集团40011官网.
• Information Technology: Assisted in the design 和 implementation of an integrated IT infrastructure to connect the nine different health systems 和 their disparate EMRs 和 HIE solutions in order to facilitate the exchange of data as well as the required analytics across the program. We are currently facilitating the implementation of a centralized population health management system to meet the program's long-term requirements.

今天, 只活了6个月, IPH是该州最大的ACE, 通常被称为“超级王牌”." It spans 64 伊利诺伊州102个县中 和 currently covers more than 45,000 lives. The IPH's provider network is inclusive of all primary, 儿科, 和 specialty care needed to manage the IPH member healthcare needs. To further identify 和 manage these needs, IPH members are stratified by risk level 和 managed through the use of care coordinators. The IPH also relies on a robust 资讯科技基础设施 that includes the development of a centralized population health management system to better manage members 和 improve outcomes.

The IPH is moving toward full risk for the Medicaid population, at which point it will have the opportunity to share in cost savings. 在短期内, the IPH receives care management fees – $9 per member per month (PMPM) for Family Health Plan members 和 $20 PMPM for newly eligible ACA members. The 9个云顶集团40011官网 of the IPH share in the infrastructure costs for population health management systems, 质量分析, 和 other tools that the entities would otherwise need to invest in individually.

In addition to these early successes, the IPH is poised for growth. Enrollment is anticipated to exp和 as the program evolves, 和 additional opportunities for partnerships with other health systems in 伊利诺斯州 have been identified. The IPH represents a true partnership 和 collaboration between 9个云顶集团40011官网 和 their payer partner, 和 that relationship continues to strengthen 和 position the IPH for a successful future.