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The gap between coverage and access

As is the case throughout the country, the health care system in Chicago is fragmented. Health care is provided by disparate entities with little to no communication between them. This is particularly problematic when you consider the way in which many Americans utilize health care services. A national study found that only 42% of visits for acute care are made to personal physicians, while the remainder are made to emergency departments (28%), specialists (20%), or outpatient departments (7%).1

This fragmentation points to a fundamental need to transform patient access to the right care, in the right place, at the right time. Medical Home Network exists to facilitate this transformation in a dramatic way.

1 Pitts S.R., Carrier E.R., Rich E.C., & Kellerman A.L., "Where Americans get acute care: Increasingly, it’s not at their doctor’s office." Health Affairs. 2010; 29 (9): 1620-9.

Accountability for ensuring quality patient care

Medical Home Network unites public and private organizations in a partnership to improve the health status of people living on the South and Southwest Side of Chicago. We’re a neutral third party dedicated to facilitating collaboration between organizations such as the State of Illinois Medicaid, South Side area hospitals, federally qualified health centers (FQHCs), and high-volume Medicaid private practices. The Medical Home Network model is designed to bring together these providers to be accountable for strengthening the health care delivery system and improving the health status of South and Southwest Side Chicago residents.

Together, we’re working to improve health care coordination and access, and reduce fragmentation and cost. Key leaders in South Side FQHCs, hospitals, and the State of Illinois Medicaid are already partners in the Network.

A catalyst and facilitator

Medical Home Network brings together health care providers and connects them around a shared goal: to serve as an innovative new model for collaborative, patient-centered care.

Medical Home Network performs the following responsibilities:

  • Develop a provider network that establishes the framework and infrastructure for initiatives to improve the health status of residents on Chicago’s South Side
  • Enhance specialty and diagnostic referral center capacity focused on pediatric and maternal health services to ensure that medical homes have a reliable source of consultation and referral for their patients
  • Build public/private partnerships among city, county and state health care entities, federally qualified health centers, private hospitals, physicians and clinical social support services that ensure effective and seamless utilization of the system and sharing of core competencies
  • Establish connectivity through virtual integration of the MHN participants to leverage the value of health information technology to facilitate improved care coordination, improved clinical decision support and population management activity
  • Promote and enable reimbursement strategies for network providers that will encourage and reward efficacy, access, quality and comprehensive care management for target populations
  • Foster commitment to patient-centered medical homes among providers and patients. Improve understanding of the benefits of the medical home and ensure that patients receive the right care in the right place at the right time through culturally and linguistically appropriate means
  • Facilitate increased after hours/immediate care center capacity to conserve Emergency Department resources for true medical emergencies and to provide effective urgent care in lower-cost venues that will aggressively manage patients back into medical homes
  • Build a learning laboratory and document successes to become a blueprint for replication and geographic expansion

Enabling real-time connectivity

MHNConnect is a secure web-based platform that enables virtual integration between provider participants. MHNConnect improves care coordination, tracks patient activity throughout the delivery system, arms participating providers with pertinent patient clinical history, and facilitates near real-time information exchange between emergency departments, hospitals, and medical home primary care practice sites. Together, these features help our provider participants effectively monitor the health status and health care quality for their patient population.

MHNConnect model


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The health care system in Chicago is fragmented. Care is provided by disparate entities with little to no communication between them. Medical Home Network is facilitating an innovative partnership between providers to reduce this fragmentation and improve the health status of vulnerable populations in the region.




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