The Illinois Department of Healthcare & Family Services has implemented a Primary Care Case Management (PCCM) model for most medical
program (HFS and All Kids) clients. This model of healthcare delivery is also known as the "medical home model"
and has been shown to enhance primary and preventive care services. In Illinois, this program is called Illinois Health Connect
and is administered by Automated Health Systems.
Overall, more than 1.9 million patients including children enrolled in All Kids, adults enrolled in Family Care, and elderly or disabled
adults are eligible for Illinois Health Connect and will choose one Primary Care Provider (PCP) to act as their "medical home".
Physicians willing to provide a medical home for patients must enroll as an Illinois Health Connect PCP. They can specify how many
patients they want in their panel from 1 to 1,800 and limit the panel based on existing patients age limits or gender. PCPs will receive
a monthly care management fee in addition to the fee-for-service reimbursements for each visit.
IMPORTANT NOTICE: To continue the ongoing efforts to "connect" Illinois Health Connect (IHC) patients with their medical home
and support continuity of care, IHC implemented Phase I of the Illinois Health Connect Referral System.
Implementation was completed in stages by geographic region. Phase I was effective statewide on April 1, 2010.
Phase I requires IHC patients to see their own IHC PCP, or a provider or clinic affiliated with their PCP. PCPs seeing IHC patients who
are NOT enrolled on their panel or on an affiliated PCP's panel on the date of service, must obtain a referral from the patient's PCP
in order to be reimbursed by HFS for services provided. PCPs are able to submit referrals for their IHC patients to see other IHC PCPs
through the IHC Provider Portal via the secure HFS MEDI system and directly with IHC via fax or phone. Specialists will not require a
referral to ensure payment in Phase I. IHC PCPs will be able to post-date a referral up to 60 days from the date of service.
HFS has also implemented a parallel program for Disease Management called Your Healthcare Plus. Together these programs collaboratively
focus on the promotion of the patient-physician relationship to improve the quality of Healthcare for members, increase primary and
preventive Healthcare services that support continuity of care initiatives, improve access to care through the availability of a
provider network, and reduce unnecessary emergency room visits and hospitalizations with the establishment of a medical home eliminating
fragmented care, and providing better coordination and continuity of care.