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.
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 OverviewKeith Kudla, CEO([email protected])Presentation is incomplete without oral comments
Growth enables Investment
Planning & Positioning
In 2010 Family Health Network embarked on a multi-year, multi-million dollar strategy to:
*TriZetto’s QNXT system as rated by Gartner Group and Forrester Research
Financial Integration – align incentives
Illustrative: Hybrid Global Cap
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
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
*FHN PFQ program funded out of Admin Pool and HFS withhold/bonus
Sinai Partnership with FHN
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.
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.
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.
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.
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.
Located on the west side of Chicago, Sinai Health System is recognized as a national model for urban health care delivery.
COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
Strategic Growth for FHN and CCAI:
CCAI - HFS Seniors and Persons with Disabilities Integrated Care Program (ICP)
Cook, Collar Counties and Rockford
HFS Proposal submitted – Award Received!
CCAI – CMS Medicare Advantage (MA-PD) and Dual Eligible Special Needs Plan (D-SNP)
Application in process
FHN - HFS TANF and ACA Expansion Population
Cook, Collar Counties and Rockford
FHN – Health Exchange Product designed to serve low income populations
Deferred until year 2