Transcript Family Health Network and Community Care

a Managed Care Community Network (MCCN) contracted with the
IL Department of Health and Family Services (HFS)
Family Health Network and
Community Care Alliance of Illinois
Overview
Keith Kudla, CEO
([email protected])
Presentation is incomplete without oral comments
FHN Overview
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Sinai Health System is one of five Family Health Network Sponsors
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Family Health Network (FHN) provides access to cost effective quality health care for
people who could not otherwise afford it through enrollment in our health plan and the
support FHN provides Safety Net Providers.
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FHN is contracted with IL HFS to participate in the Voluntary Medicaid Managed Care
Program. Founded in 1995, FHN is a not-for-profit corporation directed by “safety net”
hospitals with all operations located in Illinois.
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Operational for 17 years, FHN is the only surviving Managed Care Community Network
(MCCN) in Illinois. Approximately 15 MCCNs and HMOs have come and gone.
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FHN’s model has been successful because it aligns provider incentives and results in
quality care for enrollees. Providers, including hospitals, are rewarded for efficiencies
and quality outcomes.
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Low administrative expense. General and Administrative (excl. marketing) expenses less
than 7%. Consistently one of the best performing plans in the country.
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FHN pays providers timely
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Provider/Member services unit ranked as one of the best in the country.
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Growth enables Investment
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Planning & Positioning
In 2010 Family Health Network embarked on a multi-year,
multi-million dollar strategy to:
1. Expand access to care by increasing contracted provider
network.
2. Enhance care coordination capabilities through
implementation of the McKesson Clinical Care
Management System and a more robust patient centered
care coordination model.
3. Make FHN “scalable” and improve overall health plan
performance through migration to the industry leading*
information system platform and participating in the Metro
Chicago Health Information Exchange.
*TriZetto’s
QNXT system as rated by Gartner Group and Forrester Research
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Financial Integration – align incentives
Illustrative: Hybrid Global Cap
OOA,Burns,
Transplants,
Reinsurance,
Solvency Contribution
11.5%
Med. Mgt, PFQ*, Add'l
Member Incentives,
Admin., 7.0%
Outreach,Education,
Enrollment, 5.0%
Model is designed to:
 Compensate providers
fairly and reward excellence
by allowing top performers to
earn more
 Offer direct and powerful
incentives for providers to
drive efficiency and better
outcomes
Hospital Services
Pool, 31.5%
Medical Services
Pool, 45.0%
*FHN PFQ program funded out of
Admin Pool and HFS withhold/bonus
 Encourage medical
providers to work in teams
and take collective
responsibility for a patient’s
health
 Provide a realistic
framework to transform a
fragmented and inefficient
system into one that is
integrated, accountable, and
focused on creating healthy
communities
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Sinai Partnership with FHN
• Summer 2011- FHN established a partnership with
Asthma CarePartners of the Sinai Urban Health Institute.
• 213 of FHN’s members with severe Asthma have been
enrolled
• Results achieved:
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ED Visits have declined 76%
Hospitalizations have declined 82%
Hospital Days have declined 96%
School/work absenteeism is down 78%
Quality of Life scores up 26%
• FHN’s Financial Model rewards Health Systems for
successful population health management
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State of Illinois Goal
A redesigned health care delivery system that is more patient-centered,
with a focus on improved health outcomes, enhanced patient access, and
patient safety.
Our Response
FHN, in partnership with Access Living of Chicago, Health and Medicine
Policy Research Group, and Sinai Health System; formed the not-for-profit
Community Care Alliance of Illinois (CCAI) to serve Illinois’ most complex
Medicaid and Medicare populations. CCAI has built an organization of
local experts to form a local entity designed for the population. Few
entities have experience in this field so we have sought guidance from
national experts.
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The Health & Medicine Mission is to promote social justice and challenge
inequities in health and health care. We are a 30-year old independent policy center
that conducts research, educates and collaborates with other groups to advocate
policies and impact health systems to improve the health status of all people.
Chicago’s Center for Independent Living, fostering an
inclusive society and programs that empower people with
disabilities to live independent and self-directed lives,
including having consumer controlled and fully accessible
health care options.
Sinai Health Systems and
Schwab Rehabilitation Hospital
Located on the west side of Chicago, Sinai Health System is recognized as a
national model for urban health care delivery.
A provider governed health plan that manages the full continuum of care and is
accountable for the overall cost and quality of care for a defined Medicaid
population and regulated by HFS. Illinois’ only Managed Care Community
Network with a mission to support Safety Net Providers.
Salient features of clinical care model
• Non-profit
• Comprehensive care coordination across all levels of care
Stakeholder (incl. consumer) representation throughout
• Integration of medical & long-term care services
• Focus on prevention, health and wellness
• Anchor Medical Homes - specialized primary care networks:
Disability accessible, knowledgeable
– Sinai Anchor Medical Homes: Physical Disability (Schwab), Behavioral
Health, Sinai Medical Group
• Interdisciplinary Care Team: Disability Competent, Specialized
Primary Care Team
• Centers of Excellence: Specialty Services – Rush, RIC
COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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Strategic Growth for FHN and CCAI:
1. CCAI - HFS Seniors and Persons with Disabilities Integrated
Care Program (ICP)
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Cook, Collar Counties and Rockford
HFS Proposal submitted – Award Received!
2. CCAI – CMS Medicare Advantage (MA-PD) and Dual Eligible
Special Needs Plan (D-SNP)
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Application in process
3. FHN - HFS TANF and ACA Expansion Population
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Cook, Collar Counties and Rockford
4. FHN – Health Exchange Product designed to serve low
income populations
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Deferred until year 2
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