Illinois Rural Community Care Organization partners with national payer
The Illinois Rural Community Care Organization (IRCCO) took a giant step forward and entered into a partnership with national and publicly traded Centene and its management arm, Collaborative Health Systems (CHS) in January, to offer a new Medicare Advantage product for rural residents. This new rural provider and payer partnership is touted as a pioneer model for rural providers to advance safely value-based care participation.
ICAHN established IRCCO LLC in 2014 as an accountable care organization (ACO) for the purpose of participating in the Centers for Medicare & Medicaid Services' (CMS) new Medicare Shared Savings Program (MSSP) initially and other managed care and value-based payer programs. CMS approved IRCCO, which included 20 hospital members, in 2015 as a MSSP and the journey began. CMS approved IRCCO’s MSSP again in 2018 and 2022. IRCCO joined Blue Cross Blue Shield’s shared savings program in 2017 and remains in the program having earned >$4 million for years 2019 and 2020.
Today, IRCCO has 24 hospital members and associated 96 clinics and two independent physician practices. IRCCO has a strong and solid history of working together and having put in place necessary pieces for payer programs such as Medicare Advantage (MA). IRCCO conducted a strategic planning session in 2019, noting the growing percentage of Medicare beneficiaries choosing MA plans with some rural counties at close to 50 percent. IRCCO hospitals were losing Medicare beneficiaries to MA plans that were not including the local hospital and medical provider. In response, IRCCO solicited six MA plans and selected Centene/CHS and its Wellcare program in Illinois in 2021 with roll-out planned for 2022.
Why a national payer partnership?
Rural facilities do not have the necessary financial reserves to take on risk, and it would require years to build an MA plan. Therefore, finding the right partner who is willing to work closely, gain trust with rural providers, and build something special was important for long-term success. Centene was that good fit and brings their experience with value-based care and other products, such as Medicaid managed care plans and even MSSP direct contracting, that IRCCO can consider. The value of IRCCO is that the organization can leverage its numbers and infrastructure for better contracting and network positioning. IRCCO participants meet April 21 to expand their strategic planning efforts and evaluate other product options. CMS has commented many times that by 2030 all providers will be in a value-based care program. IRCCO hospitals and their providers will be ahead.
Centene/CHS and IRCCO call their new rural MA plan, Rural Community Health Services, and will soon be marketed in IRCCO hospital county areas. The first few months requires contract set-up and marketing so that beneficiaries recognize that their local hospital is now part of a MA program. IRCCO hospitals and Centene/CHS are excited about the future and how they can better serve their communities. IRCCO will open its membership enrollment in June 2022.
IRCCO hospitals members include Boyd Healthcare Services, Carlinville Area Hospital, Community Hospital of Staunton, Crawford Memorial Hospital, Ferrell Hospital, Franklin Hospital, Gibson Area Hospital and Health Services, Hillsboro Area Hospital, Horizon Health, Iroquois Memorial Hospital, Jersey Community Hospital, Kirby Medical Center, Lawrence County Memorial Hospital, Marshall Browning Hospital, Mason District Hospital, Massac Memorial Hospital, Memorial Hospital Association, Midwest Medical Center, Morrison Community Hospital, Pana Community Hospital, Pinckneyville Community Hospital, Salem Township Hospital, Sparta Community Hospital, and Warner Hospital and Health Services.