Robert L. Phillips, Jr., Meiying Han, Stephen M. Petterson, Laura A. Makaroff, and Winston R. Liaw
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.
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.
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.
The authors point out several lessons from Illinois’s experience for other states, including: