Illinois Is a Leader of the Medical Home Concept

Illinois’s Department of Healthcare and Family Services begins an experiment this month to have 1.2 million Medicaid recipients enroll with a primary care provider. The new health care program, Illinois Health Connect, is the state’s attempt to provide better patient-centered care on the “medical home” model.

The financial and health benefits of the “medical home” concept are outlined in “No Place Like Home,” a Commonwealth Fund report by Stephen C. Shoenbaum and Melinda Abrams.

The report argues that, by visiting a medical home, families can see improved health outcomes and avoid costly care. Schoenbaum and Abrams cite the primary care case management model “as [being] part of a broader quality improvement effort … help[ing] patients manage their chronic conditions, and reduce spending on emergency or other acute care….”

The medical community would face real-world challenges if the medical home model became a more prescribed form of care in America. Medical schools would need to restructure their curriculum to include courses on coordination of care and practice management. The medical community would need to encourage more medical students to enter into family medicine and would need more actively to recruit individuals to become nurses or physicians’ assistants, who are “the [extenders] of the nation’s primary care services.”

Although the implementation of the Illinois Health Connect program will be inevitably bumpy, the state is attempting to preempt some of these challenges. First, as of January 1, 2006, payment rates for preventive services increased, bringing them closer to Medicare payment rates. Second, in July 2006 Illinois began expediting payments to physicians to encourage more of them to serve as medical homes for Illinois’s Medicaid patients.

Also touching upon the disease management concept, the report explains: “Nurses would play central roles, working with primary care physicians to develop disease management programs for patients with chronic illness….” In July 2006 Illinois adopted a disease management program, called Your Healthcare Plus. Managed by McKesson, it follows the model outlined by Schoenbaum and Abrams. The program is intended to reach out to high-risk patients—disabled adults, children and adults with asthma, and frequent emergency room users. Nurses, health care educators, and caseworkers connect high-risk patients with primary care providers, coordinate care with patients’ primary care providers, and educate patients about healthy living.

Illinois’s adoption of the medical home model potentially puts Illinois ahead of the pack in establishing what the report calls “the most comprehensive approach to providing care.” Health care providers, case managers, legislators, and patients throughout the state wait with guarded optimism.

For more information, contact Patrick Keenan-Devlin. See the Commonwealth Fund’s article here.