Jun 18 : Digital woes hamper Illinois system’s shift to new Medicaid program

Alexian Brothers Health System is suspending its effort to launch a new Medicaid program, blaming the difficulty of connecting physicians using different electronic records systems.

The Arlington Heights, Ill.-based health system was spearheading a so-called accountable care entity (ACE) to coordinate the care of about 46,000 patients on Medicaid, the state-federal health insurance program for the poor and disabled. The ACEs are a form of managed care, one of Gov. Pat Quinn’s initiatives to focus on preventative treatment to keep patients healthy and reduce health care costs.

Alexian planned to have several partners in its ACE network, including non-profit community clinics and independent physicians. Getting every physician’s electronic health record system to be able to share information within the state’s required time frame was too challenging, said Don Franke, Alexian vice president of clinical integration. He estimated that about 80 percent of physicians in the network are on about 10 different electronic health-record systems, and the network isn’t even fully formed yet.

“We don’t want to be a distraction from (the state’s) efforts,” Mr. Franke said. “We’re going to continue to work on getting our processes in order so that when the second wave comes, we can be a participant in that.”

When asked about the impact of Alexian not immediately leading its own ACE, a spokeswoman for the Illinois Department of Healthcare and Family Services, which oversees Medicaid, said, “They haven’t shut the door, so we are hopeful that they will pursue (an ACE) in the future.”

State officials have said they expected several potential ACEs to team up instead of going it alone.

Alexian’s decision comes as the state delays the rollout of managed care, which was slated to begin on July 1 but will be pushed back in some parts of the state to August, potentially September.

Half of the state’s 2.9 million Medicaid recipients must be enrolled in some form of managed care by 2015 under a Medicaid overhaul backed by Gov. Quinn. The idea is to transform how physicians and hospitals provide and are paid for care by focusing on quality rather than paying them for every service they provide, which can entice providers to perform unnecessary services.

Alexian, which has five hospitals, was one of nine ACEs, eight of which were based in the Chicago area. Other ACEs have been developed by Chicago-based Presence Health, the largest Catholic hospital system in Illinois, as well as by Advocate Physician Partners, which is jointly governed by Downers Grove-based Advocate Health Care, the largest hospital network in the state, and more than 4,400 employed and independent physicians.

Alexian was part of a small group of health systems that failed to make the state’s initial cut earlier this year, but were approved within the last few months.

But as the health system was preparing for a July 1 launch date, Mr. Franke said it was clear its ACE could not meet certain requirements. For example, 60 percent of the network would have to be connected in some way to the Illinois Health Information Exchange within 15 months, with 100 percent participation in 30 months, Mr. Franke said. Known as ILHIE, the state initiative aims to electronically connect the 38,000 physicians and roughly 200 hospitals across the state.

Within 15 months, 70 percent of the network would have to electronically file summaries of care they provided to patients after an ER visit, for example, either through the state’s health information exchange or by having everyone on the same digital records system.