Enterprise-level Care Management Software for an Urban Health System

About the Program

Category: Information Technology (Best in Category)

Year: 2023

Cook County Health operates Illinois’ largest Medicaid Managed Care Organization, CountyCare. Over the past ten years, CountyCare dramatically increased the number of insured individuals seeking medical care through Cook County Health’s clinical operations. To meet requirements for Illinois’ Medicaid administrative agency and to improve patient outcomes, CountyCare provides care-coordination services that assess a member's risk for poor health outcomes, assists them with services such as clinical appointments, and health-related social needs to include transportation, housing, food security, and clothing. Over 200,000 CountyCare members receive care from more than 300 care coordinators. After three prior costly, failed attempts for care coordination solutions with external software vendors, we developed a system with internal developers. This system integrated data from the State; our electronic health record, which includes jail healthcare, and several ancillary software vendors. Our Care Management Information System (CMIS) went live in January 2021. Our system evolved to provide real-time alerting for outside hospitalizations and emergency department visits, productivity reports, logic-driven interventions (see CMIS Attach F3) based on National Committee for Quality Assurance (NCQA), and HEDIS quality measures.