Transcript Illinois: Care Coordination and Healthcare Reform By Region

ILLINOIS: CARE COORDINATION
AND HEALTHCARE REFORM
Illinois Department of
Healthcare and Family Services
August 2014
Medicaid Reform Law
The Medicaid reform law [PA 96-1501],
requires that by January 1, 2015, at
least 50 percent of the individuals
covered under Medicaid be enrolled in a
care coordination program that organize
care around their medical needs.
Care coordination
is the centerpiece of Illinois’
Medicaid reform. It’s aligned
with Illinois’ Medicaid reform
law and the federal Affordable
Care Act
What HFS is doing
to implement care coordination
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Initially focus on the most complex, expensive clients
Take an ‘integrated’ approach to care
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Bringing together local primary care providers (PCPs),
specialists, hospitals, nursing homes, behavioral health and
other providers to organize care around a patient’s needs.
Measure quality and health outcomes
Continue to work closely with stakeholders and
sister agencies on the most effective way to bring
this new healthcare delivery system to Illinois
WHAT EXISTS NOW
Current HFS Managed Care
Programs
Current Programs –
Primary Care Case Management (PCCM)
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Called Illinois Health Connect (IHC)
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Became fully operational in November 2007
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A mandatory program; eligible enrollees may opt out of IHC if
enrolling in a managed care plan
Operates statewide for most individuals covered by an HFS
Medicaid Program
1.7 million IHC clients have a medical home through a PCP.
The PCP makes referrals to specialists for additional care or
tests as needed
* PCCM is NOT an MCO. It is a FFS model that includes care
coordination
Current Programs –
Integrated Care Program (ICP)
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HFS implemented the first Integrated Care Program
(ICP) on May 1, 2011
For seniors and persons with disabilities (SPD) who
have Medicaid, but not Medicare (cannot be a ‘dual’)
Mandatory program for SPD 19 and over
Enrollment occurs through client enrollment broker
Individuals have at least two plans to choose from
ICP –Geography and Timeline
ICP is a mandatory program currently operating in:

Greater Chicago Region – began 5-1-11,
expanded to include City of Chicago 3-1-14
Rockford Region – began 7-1-13
 Central Illinois Region – began 9-1-13
 Metro East Region – began 9-1-13
 Quad Cities Region – began 11-1-13
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ICP Managed Care Organizations (MCOs)
HFS contracts with several health plans to serve the
ICP population. Different regions are served by
different health plans
1.
2.
3.
4.
5.
6.
7.
8.
Aetna Better Health
IlliniCare Health Plan (Centene)
Meridian Health Plan of Illinois
Molina Healthcare
Health Alliance Medical Plan
Blue Cross Blue Shield
Cigna-HealthSpring
Humana Health Plan
Managed Care Community Networks (MCCNs)
1. Community Care Alliance of Illinois (CCAI)
2.
County Care
ICP –MCOs and MCCNs
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How are MCOs and MCCNs different?
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MCOs are licensed Health Maintenance Organizations (HMOs) by the
Dept of Insurance
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MCCNs are provider‐owned and governed entities that operate like
MCOs, but are certified by HFS rather than Dept of Insurance
How are MCOs and MCCNs the same?
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MCOs and MCCNs both operate on a full‐risk capitated basis
HFS eligibility systems look identical for both MCOs and MCCNs
To the member, the enrollment process is the same and so is the level of
benefits provided
ICP Care Coordination Entities (CCEs)
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Care Coordination Entities are provider based networks that
offer care coordination to clients
Clients remain Fee-For-Service
HFS contracts with several of CCEs to serve the ICP population.
Different regions are served by different CCEs.
1.
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6.
Be Well Partners in Health
Healthcare Consortium of Illinois (Entire Care)
Macon County Care Coordination (My Health Care Consortium)
Precedence Care Coordination
Together4Health
Next Level
Current Programs –
Medicare Medicaid Alignment Initiative (MMAI)
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3-way contract between HFS, Federal CMS, and MCO
Impacts those who are dually eligible for full Medicaid &
Medicare benefits
Clients will have access to all services under one MCO, another
step away from fragmented care
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Includes both community and LTSS clients
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Individuals are passively enrolled with option to opt out. If they
are receiving Long Term Services and Supports (LTSS) however,
they are required to select a health plan for those specific
services.
MMAI – LTSS
LTSS : Long Term Services and Supports
Under MMAI, the LTSS population includes nursing
home residents and those receiving Home and
Community Based Services(HCBS) waivers:
1.
2.
3.
4.
5.
Elderly (Community Care Program participants)
Traumatic Brain Injury
HIV/AIDS
Physically Disabled
Supportive Living Facility
MMAI- flexibility for the Consumer
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All services currently received are covered plus care
coordination under an integrated health care delivery system.
Additionally, all of the MMP health plans offer added benefits
at no cost to consumer.
Ability to switch health plans under MMAI, though it may be
best to stay with one health plan as that health plan’s care
coordinator will get to know and understand their needs.
To aid in transition to the MMP, Continuity of Care for the first
180 days is available. Existing care plans and providers are
covered during this time period with hopes of a more
permanent relationship between MMP and provider.
MMAI – Number Eligible
Geographic Region
Number of Dual
Beneficiaries Eligible
for MMAI
Greater Chicago
128,000
Central Illinois
20,000
MMAI – Geography and Timeline
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The MMAI demonstration operates in the Greater Chicago
Region and the Central Illinois Region. The program is still
rolling out as indicated in the timeline below:
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March 2014: Voluntary Enrollment for Community population began
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June 2014: Passive Enrollment for Community population began
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July 2014: Voluntary Enrollment for LTSS population began
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October 2014: Passive Enrollment for LTSS population Begins
MMAI - Managed Care Organizations
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Greater Chicago Area:
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2.
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6.
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Aetna Better Health
IlliniCare Health Plan (Centene)
Meridian Health Plan of Illinois
Cigna-HealthSpring
Humana Health Plan
BlueCross/Blue Shield of Illinois
Central Illinois:
1.
2.
Molina Healthcare of Illinois
Health Alliance Medical Plans
OTHER MANAGED CARE
INITIATIVES
Brand New HFS Managed Care
Programs
Brand New –
Family Health Program (FHP)
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FHP is a mandatory program that began in Summer 2014
For children and their families as well as the newly eligible
Affordable Care Act (ACA) adults
Estimated 1.5 million potential enrollees
Excluded Populations:
 DCFS Foster children
 Children whose case is coordinated by DSCC
 Those in spenddown, or in other partial benefit programs, such as the
Illinois Breast and Cervical Cancer program
 Those who have comprehensive Third Party Insurance
FHP- Geography and Timeline
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In August 2014, FHP began enrollment in the Metro East
Region (Clinton, Madison, and St Clair counties) first and is
currently expanding to the other four mandatory
regions including:
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Central IL Region- estimated September 2014
Quad Cities Region- estimated October 2014
Rockford Region- estimated October 2014
Greater Chicago Region- estimated November 2014
FHP Managed Care Organizations (MCOs)
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HFS has contracted with several health plans to serve the FHP population.
Different regions will be served by different health plans.
1. Aetna Better Health
2. Blue Cross Blue Shield
3. Harmony Health Alliance Medical Plan
4. IlliniCare Health Plan (Centene)
5. Meridian Health Plan of Illinois
6. Molina Healthcare
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Managed Care Community Networks (MCCNs)
1. County Care
2. Family Health Network (FHN)
FHP- Care Coordination Entities for Children
with Special Needs (CSN CCEs)
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CSN CCEs are provider based organizations that offer care
coordination to children with complex medical needs.
All Medicaid covered services remain Fee-For-Service
HFS will contract with three CSN CCEs to serve the FHP
population. Different regions will be served by different CSN
CCEs.
1.
2.
3.
La Rabida Coordinated Care Network for CCMN
Lurie Children’s Health Partners CCE
OSF Healthcare System Children’s CCE
FHP Accountable Care Entities (ACEs)
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ACEs are provider based organizations that will offer care
coordination to the FHP and ACA adult population.
Must include, at a minimum, a hospital, PCP, specialist and BH
provider
Begin as a Fee-For-Service model, but are on a 3 year path to
a full-risk capitated payment model
Minimum served: 40,000 clients in Cook County, 20,000 in
collar counties, and 10,000 downstate
FHP Accountable Care Entities (ACEs)
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HFS will contract with 10 applicants working to become ACEs.
Different regions will be served by different ACEs.
1.
Accountable Care Chicago
2.
Advocate Accountable Care
3.
Better Health Network
4.
HealthCura
5.
Illinois Partnership for Health
6.
Loyola Univ health System ACE
7.
Population Health of IL (Alexian Brothers)
8.
NorthShore Physician Assoc ACE
9.
SmartPlan Choice (Presence)
10.
UI Health Plus (UIH+)
Brand NewManaged Long-Term Services and Supports (MLTSS)
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Begins fall 2014
For those who opt out of MMAI & receive LTSS
Mandatory enrollment in a health plan to receive:
 LTSS
 Behavioral Health
 Transportation
Same health plans as MMAI
Clients are locked in for their LTSS services for one year and
cannot switch health plans until their anniversary month
Care Coordination 2014 Roll Out Plan
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February 2014 – Additional CCEs began serving SPD in ICP
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March - June 2014 – MMAI (voluntary enrollment began in
March, passive enrollment began in June)
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March 2014 – ICP Expansion began in the city of Chicago
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August 2014 – Family Health Program (FHP) began in the
Metro East Region with plans to expand to all remaining
mandatory regions
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Fall2014 – MLTSS begins for those who opt-out of MMAI
Getting the Word Out
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HFS engages various stakeholders to educate,
discuss, and get feedback on our managed care
initiatives.
We give presentations
 We participate in meetings via conference call and in
person
 We meet with our sister agencies every week to improve
managed care in IL
 We are on the web! Stakeholders and providers can access
all sorts of information on our website
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TO FIND OUT MORE INFORMATION ON HFS’ CARE
COORDINATION INITIATIVES:
http://www2.illinois.gov/hfs/PublicInvolvement/
cc/Pages/default.aspx