Managed Care Organizations (MCOs)
Abcor Home Health, is a participating provider for the Integrated Care Program (ICP), as well as for the Medicare Medicaid Alignment Initiative (MMAI) in Illinois. In order to respond to the needs of older adults and individuals with disabilities, Abcor has agreements with the following Managed Care Organizations (MCOs):
- Aetna Better Health
- BlueCross BlueShield
- Cigna Health Spring
- Humana—Independent Living Systems
- IlliniCare Health Plan
- Meridian Health Plan
Integrated Care Program (ICP)
The Integrated Care Program (ICP) is a program for older adults and individuals with disabilities who are eligible for Medicaid, but not eligible for Medicare. Illinois’ ICP goal is a redesigned health care delivery system that is more patient-centered with focus on improved health outcomes, enhanced patient access and patient safety. The program operates in suburban Cook, DuPage, Kane, Kankakee, Lake and Will Counties. According to recent statistics reported by the Illinois Department of Healthcare and Family Services, the ICP program is serving approximately 107,407 individuals.
Medicare Medicaid Alignment Initiative (MMAI)
The Medicare Medicaid Alignment Initiative (MMAI) is a state effort to reform the way care is delivered to clients eligible for both Medicare and Medicaid services (known as “dual eligibles”). The goal of the demonstration program is to create a unified delivery system that is easier to navigate for all “dual eligible” beneficiaries. The MMAI program will provide coordinated care to more than 148,000 Medicare-Medicaid enrollees in the Chicagoland area and 20,000 enrollees throughout central Illinois.
Abcor is fully committed to deliver patient-centered services through a process that addresses health and long term care needs in a manner that empowers individuals to be in control of their own health care. Abcor has established solid partnerships with primary care physicians (PCPs), specialists, hospitals, independent and assisted living facilities, rehabilitation centers and other health care providers to improve the quality of care for individuals receiving services through ICP and MMAI programs.
Change in Condition Reporting
Abcor provides comprehensive training to all of its caregivers on how to observe and report changes in condition that may affect the client’s safety and well-being. These reports not only include changes in the client’s health status, but in social and environmental factors that, if unattended, may lead to hospitalization, premature nursing home placement or death. Upon receipt of these alerts, Care Coordinators from Managed Care Organizations (MCOs) are to be promptly notified via critical incident reporting. The goal is to work collaboratively with Care Coordinators to implement the necessary interventions to support older adults and individuals with disabilities to remain living at home for as long as possible, with independence, dignity, and a good quality of life.
Abcor’s Integrated Care Model
Abcor is proud to offer the following integrated care services to our MCO partners (see the integrated care model above):
- Initial and semiannual assessments, as well as home safety evaluations
- Care planning assistance to properly identify service tasks tailored to client needs
- Compassionate and highly trained caregivers (24 hrs. of pre-service training and 12 hrs. annual in-service training) to match client needs with caregiver competencies
- Monthly quality assurance calls and quarterly home visits
- Electronic Visit Verification technology to ensure service delivery per established scheduled appointment as well as Task Verification technology to ensure compliance with the authorized Plan of Care
- Skilled nursing and clinical therapies (physical, occupational and speech)
- Community outreach program to promote education on chronic disease management and healthy lifestyles
- Complimentary Abcor Membership Program which includes additional services coordinated by a Medical Social Worker. These include but are not limited to family caregivers support, providing patient education and counseling, and making referrals for other services
- Continuous quality and performance improvement process through the Community Health Accreditation Program (CHAP) in addition to standards mandated by the IL Department on Aging (IDoA), IL Department of Human Services (IDHS) and the IL Department of Public Health (IDPH) among other regulatory agencies