As part of the on-going Bridging to Preventive Care Project, the Illinois Public Health Institute (IPHI) and the Illinois Alliance to Prevent Obesity (IAPO), in partnership with the National Association of Chronic Disease Directors and Leavitt Partners, LLC., are pleased to release a new concept paper: “Advancing Chronic Disease Prevention and Management Programs: Building a Third-Party Organization to Support Managed Care Coverage of Services in Community-Based Organizations in Illinois.”
With high rates of type 2 diabetes, heart disease and obesity across the state, especially for low-income Illinoisans, the Bridging to Preventive Care Project aims to connect people with Medicaid managed care coverage to community-based chronic disease prevention and management programs. These programs, like the National Diabetes Prevention Program (DPP) and the Stanford model Diabetes Self-Management and Chronic Disease Self-Management Programs (DSMP and CDSMP), are evidence-based programs that focus on healthy lifestyles and help to prevent (DPP) or manage (DSMP/CDSMP) chronic diseases.
IPHI and IAPO began the Bridging to Preventive Care program in 2016 by bringing together public health stakeholders, primary care and community-based service providers, and Medicaid managed care plans to discuss the opportunities and challenges to providing community-based lifestyle disease prevention and management services to Medicaid clients. The stakeholders produced a Roadmap that laid out the key systems that would need to be created for community-based organizations (CBOs) to contract with Medicaid managed care (MCO) plans to provide DPP and DSMP to their clients across the state. The Roadmap called for the creation of demonstration pilot programs, of which 3 are in the process of launching in Chicago/Cook County, Will County, and East St. Louis.
Through the contracting process of the pilots, and from hearing about similar projects in other states, IPHI identified the need for a more streamlined, effective way of connecting CBOs and MCOs in Illinois. This concept paper describes a model in which CBOs and MCOs could more efficiently connect to refer clients to needed community-based programs and ensure proper billing/payment processes, data/IT infrastructure, and legal/technical expertise are in place. Read the full concept paper here.
To learn more about the Bridging to Preventive Care Project or to get involved, contact Janna Simon, Program Director, IPHI at 312-850-4744.