Medical Home Network

Program Location: 
Chicago, IL
Number of Practices: 
Payer Type: 
Illinois Medicaid

Reported Outcomes


Medical Home Network unites public and private organizations to improve the health status of people living on the South and Southwest Side of Chicago. The Network works to enhance health care quality and access and to reduce the fragmentation and cost.    Serving as a neutral third party, the Network is dedicated to facilitating collaboration between organizations such as the State of Illinois Medicaid program, 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.

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.  The Network performs the following responsibilities:

  • Develop a provider network
  • Enhance specialty and diagnostic referral center capacity
  • Build public/private partnerships
  • Establish connectivity through virtual integration
  • Promote and enable reimbursement strategies
  • Foster commitment to patient-centered medical homes
  • Facilitate increased after hours / immediate care center capacity
  • Build a learning laboratory and document

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 provider participants effectively monitor the health status and health care quality for their patient population.


Fewer ED / Hospital Visits: 

Medical Home Network (January 2015)

  • 10.3% decrease in seven-day hospital readmissions (for patients served by La Rabida Children's Hospital in one year)

Medical Home Network (December 2014)

  • 25% decrease in 30-day hospital readmissions (for patients served by Esperanza Health Centers since December 2012)
Improved Access: 

Medical Home Network (January 2015)

  • 145% increase in timely follow-up visits to a primary care physician after hospital discharge, with some months reaching as high as 45.7%. The follow-up care target after hospital discharge is 29 percent (for patients served by La Rabida Children's Hospital in one year)

Medical Home Network (December 2014)

  • As high as a 130.4% increase in timely patient follow-up visits (for patients served by Esperanza Health Centers since December 2012)
  • "Illinois Medicaid patients who were a part of Medical Home Network's program and visited their assigned primary care physician at Esperanza Health Centers within seven days after being discharged from the hospital or Emergency Department, increased from a 25.3% pre-implementation baseline to as high as 58.3% in certain months (Esperanza's first intervention year averaged a 47.2% follow-up rate)" (for patients served by Esperanza Health Centers since December 2012)
Cost Savings: 

Medical Home Network (December 2014)

  • "A decrease in the overall cost of care for each patient since the introduction of the new care model in December of 2012" (for patients served by Esperanza Health Centers)
Last updated February 2015
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