CHICAGO-A unique managed-care partnership may steer a substantial portion of Illinois' Medicaid population into community health centers located in the poorest and most medically underserved areas of the state.
A for-profit joint venture known as Community Health Choice has been formed between Community Health Care of Illinois, a not-for-profit group of 20 community health centers with more than 60 care sites across the state, and Managed Care Solutions, an investor-owned management firm based in Phoenix. The effort differs from other Medicaid HMOs forming in Illinois because it's provider-based and uses existing community health centers, which are federally designated facilities located in medically and economically underserved areas throughout the state.
"Our program would differ in that our primary-care network is built around our community health centers, whereas other HMOs have hospitals and physicians as their focal point," said Patsy Crawford, executive director of Community Health Choice, known as Choice. "We're focused on providing care in our community health centers to people regardless of their ability to pay. We have a network of primary- and preventive-healthcare (professionals)."
Since the community health centers currently serve about 200,000 Medicaid recipients annually, Choice could tap a major portion of the Medicaid market in Illinois. By comparison, Chicago HMO, a subsidiary of Minneapolis-based United HealthCare Corp., has the largest voluntary Medicaid enrollment in the state with more than 130,000 members.
Choice has applied to the Illinois Department of Public Aid for a license to participate in the state's voluntary Medicaid program. Meanwhile, Choice is awaiting word from the Illinois Department of Insurance for certification to operate an HMO.
"More and more safety-net providers are trying to align themselves into state Medicaid programs to care for the uninsured and underinsured," said Rick Jelinek, senior vice president for Managed Care Solutions' Eastern operations.
The involved parties are using between $3 million and $4 million in capital to launch Choice. Of that, $2 million is considered cash reserves.
Next year, Choice plans to participate in the state's mandatory Medicaid enrollment program, MediPlan Plus, which allows the state to offer managed-care plans to 1.1 million of its 1.4 million beneficiaries. HCFA last month approved Illinois' application to operate MediPlan Plus after almost two years of haggling with federal officials (July 22, p. 24).
Illinois spends about $5.6 billion annually on its Medicaid program.
Terms of Choice's application weren't being disclosed. Executives aren't sure how much money it would save compared with traditional fee-for-service Medicaid payments.
However, Choice expects substantial savings because the community health centers generally employ primary-care professionals. The health centers employ about 200 physicians across the state. They also employ nurses, nurse practitioners, midwives and physician assistants.
In areas of Illinois where community health centers aren't accessible, Choice may link with hospitals and physicians.
Choice executives said five of its eight board members are executives or clinicians at Community Health Centers of Illinois, so providers "have significant input in the ongoing operation of the HMO," Crawford said. Community Health Centers and Managed Care Solutions have 50-50 equity in Choice.
Managed Care Solutions already is assisting and developing HMOs based in community health centers in Colorado, Hawaii, Michigan and West Virginia."The neat thing about Illinois is that we are targeting the entire state," Jelinek said.