OSF Healthcare System and the Illinois Department of Healthcare and Family Services (HFS) announced Monday that OSF will become one of the first health care systems to work directly with Managed Care Organizations (MCO’s) when treating Illinois Medicaid clients.
The department and OSF have been trying to determine the best way to provide care coordination for central Illinois children with complex medical conditions who are currently covered by Medicaid.
Initially, OSF considered serving as a Coordinated Care Entity (CCE), in which many children with complex medical conditions get access to care coordination services. The system received a CCE designation from HFS earlier this year.
But with OSF’s strong history of success with care management processes and its good relationships with various health insurance carriers, both organizations felt clients would be better served if OSF worked directly with MCOs.
The shift will allow OSF to better focus on Illinois Medicaid’s “Triple Aim” – improved care, improved quality and a reduction in the ever-increasing rise in health care costs, said OSF Healthcare System Chief Executive Officer Kevin Schoeplein.
“We are already providing care to many of the children residing in central Illinois who have complex medical conditions through the Children’s Hospital of Illinois at OSF Saint Francis Medical Center and their affiliated specialty providers,” said Schoeplein.
“OSF will look to work with MCO’s to overlay a very active and sophisticated care-coordination process to better assist those families who have children with complex medical conditions.”
The move is a win-win for all, said HFS Director Julie Hamos.
“The extensive coordination of care for these children that OSF can provide is what’s really important, not the organizational or legal arrangement,” Hamos said.
“That’s why the State of Illinois is very comfortable with OSF contracting for such care coordination services directly with Managed Care Organizations.”
The state agency will soon mail informational packets to families whose children have complex medical conditions and might be eligible for Medicaid coverage. About 1,200 central Illinois children could be eligible for coverage, officials said.