Chicago ACO Leads FQHC Medicaid Payment Transformation to Advance Primary Care During COVID-19 Pandemic


  • Published On  Jun 4, 2020

Cook County Health Partnership with Medical Home Network ACO to Preserve Federally Qualified Health Centers Delivery System

CHICAGO – COVID-19 has led many healthcare professionals to hyper focus on hospital care and capacity in Chicago but there is still a need to sustain the community health system underserved neighborhoods depend on.  How can we guarantee safety net providers can continue to deliver primary care to the most vulnerable in our communities – ultimately keeping these patients out of our crowded hospitals?

In response to the pandemic, CountyCare and MHN ACO leadership came together, quickly pivoting their people, processes and payment models to ensure the most vulnerable in our community are cared for – a move other managed care organizations and Federally Qualified Health Centers (FQHCs) across the country are expected to follow. The new arrangement shifts reimbursement structures from traditional fee-for-service to a primary care capitation model, which provides an immediate benefit to public health, as well as long term population health goals.

“We understand the need to transform use of care teams across Cook County to reach patients who rely on primary care to manage their health especially during this crisis,” said Jim Kiamos, CEO, CountyCare Health Plan. Moving away from fee-for-service to a capitation model that covers care will allow patients to receive the care they need in new ways and through new technologies.” 

The new primary care reimbursement agreement will enable complete care team access and services for approximately 120,000 CountyCare Medicaid patients. The value-based arrangement will enable broad scale practice transformation and support the high touch, personalized care model of MHN ACO which is important for public health in the short term and important for population health in the longer term.

“Without access to primary care, these patients are much more likely to end up in the ER – which is exactly what we need to avoid right now,” said Art Jones, MD, Chief Medical Officer, Medical Home Network. “FQHCs are critical for keeping safety net patients engaged in primary care, properly managing their chronic conditions and, as a result, preserving capacity for hospitals during this pandemic and long thereafter.”

Primary Care Innovation in the Era of COVID-19

Safety net providers are instrumental in care delivery for Cook County’s underserved populations. However, traditional fee-for-service payment structures do not provide the flexibility needed for care delivery during COVID-19, and recent adjustments to regulations are not enough.

“Simply relaxing reimbursement models for services like telehealth doesn’t translate to engagement. The care model must support it. This is not just a ‘change the reimbursement’ approach but also a ‘change the model’ commitment,” said Cheryl Lulias, CEO, MHN ACO. “CountyCare is truly taking the lead on population health by adapting this new value-based payment model, ensuring FQHCs can continue to support the most complex and vulnerable in our community.”

Medical Home Network’s approach to ambulatory health during COVID-19 includes proactive outreach to patients for education, screening and a dedicated care coordinator ready to answer questions and assist with basic health needs.

The Federally Qualified Health Centers in MHN ACO have adopted a broad model of care to address COVID-19 including new technologies, telehealth to engage patients in primary care, manage chronic conditions and expansion of services, like wireless blood pressure cuffs to treat hypertension patients –all in the safest way possible to preserve capacity for hospitals.

“We’ve quickly adapted our service delivery model to ensure that we are able to maintain the highest quality of care for our patients and communities during this pandemic,” said Verneda Bachus, Chief Executive Officer of Friend Health, an FQHC member of the Medical Home Network ACO. “This new structure will enable FQHCs to expand our services to meet the growing needs of our communities in a sustainable way.”

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About Medical Home Network 

Medical Home Network is transforming health care delivery for Medicaid patients by fostering collaboration and innovation. Our proven model of care unites communities of providers and patients around a common goal: To redesign health care delivery and transform the way care is delivered and managed, resulting in improved patient care, lower costs and better health in the communities we serve. MHN can be found online at www.MedicalHomeNetwork.org and on LinkedIn at linkedin.com/company/medical-home-network.   

About Medical Home Network Accountable Care Organization Medical Home Network Accountable Care Organization (MHN ACO) is a provider-owned and driven approach to patient-centered healthcare delivery and population health management for Medicaid patients. Our members include ten Federally Qualified Health Centers, three Hospital Systems, and their Physician Practices. Within our ACO we strive to create a different kind of culture – one that includes shared decision-making and is focused on change, innovation, collaboration and delivery improvement for all our member/owners. For more information, visit www.mhnaco.org.