Care Coordination Roll-Out by Health Plans
July 2014
Illinois Health Connect (IHC) Primary Care Case Management (PCCM) program - outside mandatory managed care regions
Integrated Care Program (ICP) (SPD-Medicaid only)
Mandatory Managed Care Regions Rockford Region (Aetna, IlliniCare, CCAI)
Seniors and Persons with Disabilities (SPD) - in mandatory managed care regions
Medicare Medicaid Alignment Initiative (MMAI) (SPD-dual eligible)
MCOs Greater Chicago Region: Aetna Better Health
Central IL Region (Molina, Meridian, Health Alliance, My Health Care Coord.)
Blue Cross/Blue Shield of Illinois
Metro East Region (Molina, Meridian)
Illinicare Health
Quad Cities Region (IlliniCare, Precedence)
Meridian Health Plan
HealthSpring of Illinois Humana Health Plan
Greater Chicago Region (Greater Chicago MMAI plans, CCAI, and in Cook County only: CountyCare and Cook County SPD CCEs)
Central Illinois Region:
Targeted start dates in bold red font
Managed Long Term Supports & Services (MLTSS) – All MMAI Plans
Molina Healthcare Health Alliance Connect
Children with Special Needs Care Coordination Entities (CSN- CCEs)
Family Health Plans (Children/family and caregivers)
Newly eligible adults under ACA (Adults 19-64)
Roll-out regionally begins Aug 2014*
Roll-out in mandatory managed care regions begins Jul 2014
Roll-out in mandatory managed care regions begins Jul 2014
Care Coordination Innovations projects (SPD-Medicaid only)
SPD CCEs 1) Be Well Partners in Health (Cook County)2) EntireCareHealthcare Consortium of Illinois (Cook County)
MCCNs Community Care Alliance of Illinois (CCAI) = Subsidiary of Family Health Network (Rockford and Greater Chicago)
3) My Health Care Coordination-Macon County (down state) 4) Next Level Health (Cook County, ACA also) 5) Precedence Care Coordination (down state) 6) Together4Health (Cook County)
MCOs/MCCNs Aetna Better Health Blue Cross/Blue Shield IL CountyCare Family Health Network Harmony Health Plan Health Alliance Connect IlliniCare Health Meridian Health Plan Molina Healthcare
Accountable Care Entities (ACEs) Advocate Accountable Care (no ACA) Better Health Network Community Care Partners HealthCura IL Partnership for Health Loyola Family Care (no ACA) MyCare Chicago SmartPlan Choice UI Health Plus
Types of managed care entities: * CSN-CCEs 1) Lurie Children’s Hospital of Chicago 2) LaRabida’s Children’s Hospital 3) OSF Children’s Hospital (downstate)
MCOs – Accepting full-risk capitation payments MCCNs – Provider-organized entities accepting full-risk capitation payments CCEs – Provider-organized networks providing care coordination ACEs – Provider-organized entities on a 3 year path to fullrisk capitation payments
Illinois Department of Healthcare and Family Services Care Coordination Expansion August 22, 2014 Rockford Region
Greater Chicago Region
Accountable Care Entities (ACEs)*
Integrated Care Program (ICP)
HEALTH PLAN NAME
HEALTH PLAN NAME
Aetna Better Health
Greater Chicago, Rockford
Advocate Accountable Care
Cook, DuPage, Kane, Lake, McLean, McHenry, Will, Woodford
Better Health Network
Cook (certain zip codes)
Blue Cross Blue Shield Greater Chicago
Quad Cities Region
Cigna-HealthSpring
Greater Chicago (Excluding Kankakee)
Community Care Alliance of Illinois
Greater Chicago, Rockford
County Care
Cook
Community Care Partners
Cook, Lake (certain zip codes)
Health Alliance Connect
Central Illinois (N), Central Illinois (S)
HealthCura
Cook, DuPage
Humana
Greater Chicago
IlliniCare
Greater Chicago, Rockford, Quad Cities
Illinois Partnership for Health
Meridian
Greater Chicago, Central Illinois (N), Metro East
Molina
Central Illinois (N), Central Illinois (S), Metro East
Central Illinois (N), Central Illinois (S), Rockford, Quad Cities, Adams, Brown, Cass, Clark, Coles, Crawford, Cumberland, DeKalb, Douglas, DuPage, Edgar, Effingham, Fulton, Grundy, Hancock, Henderson, Iroquois, Jasper, Kane, Kankakee, Kendall, Lake, LaSalle, Lee, Livingston, Macoupin, Marshall, Mason, McDonough, Montgomery, Morgan, Moultrie, Ogle, Pike, Putnam, Richland, Schuyler, Scott, Shelby, Stephenson, Warren, Whiteside, Will, Woodford
Loyola Family Care
Cook, DuPage, Will (certain zip codes)
MyCare Chicago
Cook (certain zip codes)
SmartPlan Choice
Champaign, Cook, Ford, Iroquois, Kane, Kankakee, Vermilion, Will
UI Health Plus
Cook (certain zip codes)
Central Illinois (N) Region
Care Coordination Entities (CCEs) CCE NAME
Be Well
Cook (certain zip codes)
Choices (BH Demo)
Champaign. Ford, Iroquois, Vermilion
Entire Care
Cook (certain zip codes)
Medical Home Network Cook My Health Care Coordination
Macon, Logan, Piatt, DeWitt, Moultrie, Shelby
NextLevel
Cook
Precedence
Quad Cities, Bureau, Carroll, LaSalle, Lee, Ogle, Putnam, Whiteside
Together4Health
Cook
Children with Special Needs (CSN CCE)
Family Health Plans/Affordable Care Act Health Plans (FHP/ACA) *
CCMN NAME
Central Illinois (S) Region
La Rabida Children’s Hospital
Cook
Lurie Children’s Hospital
Cook, Dupage, Kane, Kendall, Lake, McHenry, Will
HEALTH PLAN NAME
Aetna Better Health
Blue Cross Blue Shield Greater Chicago County Care
Medicare Medicaid Alignment Initiative (MMAI) Aetna Better Health
Greater Chicago (excluding Lake)
Blue Cross Blue Shield Greater Chicago Cigna-HealthSpring
Greater Chicago (excluding Kankakee)
Health Alliance Connect
Central Illinois (N) Central Illinois (S)
Humana
Greater Chicago
IlliniCare
Greater Chicago
Meridian
Greater Chicago (excluding DuPage, KankaKee, Lake)
Molina
Central Illinois (N) Central Illinois (S)
*Counties outside of a shaded area are voluntary.
Cook
Family Health Network Greater Chicago, Rockford
Harmony
Greater Chicago, Metro East, Jackson, Perry, Randolph, Washington, Williamson
Health Alliance Connect
Central Illinois (N) Central Illinois (S)
IlliniCare
Greater Chicago, Rockford, Quad Cities
Meridian
Greater Chicago, Central Illinois (N), Metro East, Quad Cities, Rockford, Adams, Brown, DeKalb, Henderson, Lee, Livingston, McLean, Pike, Scott, Warren, Woodford
Molina
Central Illinois (N), Central Illinois (S), Metro East
HEALTH PLAN NAME
Metro East Region
Greater Chicago, Rockford
AALC Managed Care Contacts 2014 By Category Name
Phone
Health Alliance Contracting Clinical/Care Coordination Billing/Claims
Christina Dorsett Christina Dorsett Christina Dorsett
217-255-4663 217-255-4663 217-255-4663
[email protected] [email protected] [email protected]
Molina Contracting Clinical/Care Coordination Billing/Claims
Stacey Harris Kimberly Morton Mary Piecuch
815-641-8724 312-833-4680 331-251-5762
[email protected] [email protected] [email protected]
312-821-0637
[email protected]
Clinical/Care Coordination Billing/Claims
Monika Patel Utilization Management Department Magali Dure
866-212-2851 312-821-0633
[email protected]
BCBS Contracting Clinical/Care Coordination Billing/Claims
Tracy Pacheco Tracy Womack Provider Network Services
312-653-8892 630-824-5478 877-723-7702
[email protected] [email protected] [email protected]
HealthSpring of Illinois Contracting Clinical/Care Coordination Billing/Claims
Andrew Galbierz Grace Martos Melanie Gloss
312-548-2015 312-548-2021 312-548-2081
[email protected] [email protected] [email protected]
Humana (ILS) Contracting Clinical/Care Coordination Billing/Claims
Jaime Hersh-White (ILS) Sarah Vera Jaime Hersh-White
888-262-1292 x7180 888-661-2029 855-430-3616
[email protected] [email protected] [email protected]
IlliniCare (Centene) Contracting Clinical/Care Coordination Billing/Claims
Preston Medrano Kristin Murphy Ron Damasauskas
630-655-7824 630-655-7876 630-655-7879
[email protected] [email protected] [email protected]
Meridian Health Plan of IL Contracting Clinical/Care Coordination Billing/Claims
Sara Jones Sara Jones John Heintz
----312-705-2900 x 2160
[email protected] [email protected] [email protected]
Community Care Alliance of Illinois Contracting Clinical/Care Coordination
Jessie Morales Kristen Pavle
312-880-1666 312-605-9822
Billing/Claims
Provider Services
866-871-2305
[email protected] [email protected] If no resolution: Contact Jessie Morales 312-880-16666
Aetna Better Health Contracting
Email
AALC Managed Care Contacts 2014 General Contacts - To be used if contacts by category are not available Health Alliance Medical Plans, Inc. 301 South Vine St., Urbana, IL 61801 See Third Worksheet - Reps based on regions Christina Dorsett 217-255-4663 Mary Weisiger 217-255-4539 (office) Cherie Fletcher 217-337-8120 (office)
[email protected] [email protected] [email protected]
Molina Healthcare of Illinois, Inc. 1415 W. 22nd Street - Ste. T, Oakbrook, IL 60523 Stacey Harris Cindy Anderson Sean Fuchs
815-641-8724 331-212-1420 312-912-2590
[email protected] [email protected] [email protected]
312-821-0637
[email protected]
312-653-8892 312-208-5445 312-653-4915 312-401-3805 217-757-8044
[email protected] [email protected] [email protected] [email protected] [email protected]
312-548-2015 312-548-2006 312-548-2081
[email protected] [email protected] [email protected]
305-742-5732 312-923-4344 888-262-1292 262-408-4386
[email protected] [email protected] [email protected] [email protected]
630-655-7842 630-655-7827 630-655-7827
[email protected] [email protected] [email protected]
312-705-2900 x 2160 312-705-2900 866-606-3700
[email protected]
312-880-1666 312-605-9822 312-880-1693
[email protected] [email protected] [email protected]
Aetna 1 S Wacker Dr, Ste 1200, Chicago, IL 60606 Monika Patel BlueCross BlueShield of Illinois 300 E. Randolph St. 24th Flr., Chicago, IL 60601 Tracy Pacheco Karen Brach Tishika Townsend Donna Gerber Jill Hayden HealthSpring of Illinois 175 West Jackson, Suite 1750, Chicago, IL 60604 Andrew Galbierz Nick Hauser Melanie Gloss Humana (ILS) 550 W. Adams St. 6th Flr., Chicago, IL 60661 Katherine Pyde (Provider Relations Rep.) Jaime Hersh-White, Manager LTSS Carol Dall David Petzold IlliniCare (Centene) 999 Oakmont Plaza Dr., Suite 400, Westmont, IL 60559 Preston Medrano Jeff Joy Humberto Torres Meridian Health Plan of IL 222 North LaSalle, Suite 930, Chicago, IL 60654 John Heintz Chicago Office Member Services Community Care Alliance of Illinois 322 S. Green Street, Suite 400 Chicago, Illinois 60607 Jessie Morales Kristen Pavle-Director of LTSS Services Ellen Dooley-COO
AALC Managed Care 2014 Health Alliance Details 1 2 3 4 5 6 7 8 9 10 11 12
County Champaign Christian DeWitt Knox Logan Macon McLean Peoria Piatt Sangamon Tazwell Vermilion
Contact Wendy Camp Sara DeGrofft Donna Donnelly Donna Donnelly Donna Donnelly Wendy Camp Donna Donnelly Donna Donnelly Wendy Camp Sara DeGrofft Donna Donnelly Wendy Camp
Email
[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]
Phone 217-383-8391 217-278-8525 217-278-8654 217-278-8654 217-278-8654 217-383-8391 217-278-8654 217-278-8654 217-383-8391 217-278-8525 217-278-8654 217-383-8391
