Cost, Utilization, and Quality of Care: An Evaluation of Illinois’ Medicaid Primary Care Case Management Program

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The Issue

In 2006, Illinois reformed its Medicaid program by establishing Illinois Health Connect (IHC), a primary care case management program aimed at promoting preventive care and reducing redundancy of services. In addition to receiving fee-for-service payments, providers received additional monthly payments and bonuses for meeting quality thresholds. The state also implemented a complementary disease management program, Your Healthcare Plus (YHP). Ultimately, these two programs served more than two-thirds of all eligible Medicaid beneficiaries and 15 percent of the total state population. In a Commonwealth Fund–supported study, researchers evaluated whether the programs achieved their goals.

What the Study Found

Using Illinois Medicaid claims and enrollment data, the researchers estimated gross savings from 2007 to 2010 of $237 million for IHC, $518 million for YHP, and $1.46 billion for Medicaid overall. There were also substantial reductions in utilization, with decreases in avoidable hospitalizations, overnight hospital stays, and emergency department visits. Quality improved significantly for nearly all metrics under IHC, and most prevention measures more than doubled in frequency. Despite these successes, the Illinois legislature partially dismantled these programs to slash spending from the state budget.

Conclusions

The authors point out several lessons from Illinois’s experience for other states, including:

  • Enhanced fee-for-service was associated with increased physician participation in Medicaid and improved beneficiary access.
  • It may take three years or longer to reveal the full effects of insurance and practice transformation experiments.
  • Disease and care management programs may work best when there are close relationships between patients and providers.

Publication Details

Publication Date:
September 15, 2014
Authors:
Robert L. Phillips, Jr., Meiying Han, Stephen M. Petterson, Laura A. Makaroff, and Winston R. Liaw
Contact:
Robert L. Phillips, Jr.
E-mail: Bphillips@theabfm.org
Summary Writer:
Deborah Lorber
Citation:
R. L. Phillips Jr., M. Han, S. M. Petterson et al., “Cost, Utilization, and Quality of Care: An Evaluation of Illinois’ Medicaid Primary Care Case Management Program,” Annals of Family Medicine, Sept./Oct. 2014 12(5):408–17.
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