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  2. Managed Care

Managed Care 

Illinois has three managed care delivery systems, Integrated Care Program (ICP), Primary Care Case Management (PCCM), and Voluntary Managed Care (VMC). 

Integrated Care Program (ICP)

The Integrated Care Program (ICP) is built on a foundation of well-resourced medical homes with an emphasis on wellness, preventive care, effective evidence-based management of Chronic Health Conditions and coordination and continuity of care. It is a program for older adults and adults with disabilities who are eligible for Medicaid but not Medicare. It is a mandatory program and operates in suburban Cook (zip codes that do not begin with “606”), DuPage, Kane, Kankakee, Lake and Will Counties. 

The Integrated Care Program brings together local primary care physicians, specialists, hospitals, nursing homes and other providers to organize and coordinate care around a patient’s needs. It keeps enrollees healthy through more coordinated and better medical care, helping prevent unnecessary healthcare costs. 

With Integrated Care members have

To learn more about the Integrated Care program, please see Integrated Care Fact Sheet.

Participants must choose between two health plans, Aetna Better Health and IlliniCare Health Plan, Inc. For additional information on the two health plans, please see Integrated Care Plans.

The contracts with the two health plans contain 30 performance measures. These measures create an incentive for Aetna Better Health and IlliniCare Health Plan, Inc. to spend money on care that produces valued outcomes. They are rewarded for meeting pre-established targets for delivering quality healthcare services that result in:

Of the 30 measures, 13 are pay-for performance measures, under which each health plan can earn up to 5 percent of their capitation payment in incentives.

To see the measures the plans are striving to meet, please see Performance Measures Quality Indicators Table (pdf).

Voluntary Managed Care (VMC)

All Kids, Moms and Babies, and FamilyCare clients living in certain counties can choose a PCP in a Managed Care Organization (MCO) for their medical home. An MCO is an HMO or HMO-like health plan that has its own network of doctors and hospitals. Clients that enroll in an MCO get all of their services from the doctors and hospitals that are in the MCO network unless they get approval from the MCO. Clients can get their healthcare and may get additional benefits by enrolling in a Managed Care Organization. For additional information please see Managed Care Organizations.

Primary Care Case Management (PCCM)

Illinois' Primary Care Case Management (PCCM) Program, called Illinois Health Connect, is a statewide health plan that is available to most persons covered by an HFS Medical Program. Illinois Health Connect is based on the American Academy of Pediatrics' initiative to create medical homes to encourage delivery of healthcare services in the most appropriate setting and ensure access to preventive healthcare services.

Under Illinois Health Connect, clients can choose their own medical home/PCP while receiving the advantages of care coordination and case management. The program is mandatory state-wide for most clients with the exception of those who choose to enroll in the Voluntary Managed Care program or those who are required to enroll in the Integrated Care Program. For additional information please see Illinois Health Connect.