Illinois: care coordination and healthcare reform

1. Illinois Department of Healthcare and Family Services Illinois: care coordination and healthcare reform March 2014

2. 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.

3. Care coordination is the centerpiece of Illinois’ Medicaid reform. It’s aligned with Illinois’ Medicaid reform law and the federal Affordable Care Act

4. What HFS is doing to implement care coordination • Initially focus on the most complex, expensive clients • Take an ‘integrated’ approach to care • 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

5. What EXISTS NOW Current HFS Managed Care Programs

6. Current Programs – Primary Care Case Management (PCCM) • Called Illinois Health Connect (IHC) • Became fully operational in November 2007 • A mandatory program; eligible enrollees may opt out of IHC if enrolling with an MCO • Operates statewide for most individuals covered by an HFS Medicaid Program • 1.6 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

7. Current Programs – Voluntary Managed Care (VMC) • VMC program in Illinois since 1976 • Serves only children and their parents living in certain Illinois counties • Can choose a PCP in a Managed Care Organization (MCO) for their medical home  • Clients have a choice of three health plans • Harmony Health Plan • Family Health Network • Meridian Health Plan • 253,936 clients have voluntarily enrolled

8. Current Programs – Integrated Care Program (ICP) • 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

9. Integrated Care Program (ICP) ICP is a mandatory program currently operating in: • Suburban Cook and Collar counties - excludes 606 zip codes – began 5-1-11 • 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 • City of Chicago – began 3-1-14

10. 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. Aetna Better Health 2. IlliniCare Health Plan (Centene) 3. Community Care Alliance of Illinois (CCAI) 4. Meridian Health Plan of Illinois 5. Molina Healthcare 6. Health Alliance Medical Plan 7. Blue Cross Blue Shield 8. Cigna-HealthSpring 9. Humana Health Plan

11. Integrated Care Program Expansion Suburban Cook and Collars Region Counties: Lake, Kane, DuPage, Will, Kankakee and suburban Cook (excludes 606 zip codes) Rockford Region Counties: Winnebago, Boone, McHenry Central Illinois Region Counties: McLean, Logan, DeWitt, Sangamon, Macon, Christian, Piatt, Champaign, Vermillion, Ford, Menard, Tazewell, Knox, Peoria, Stark Metro East Region Counties: Madison, Clinton, St. Clair Quad Cities Region Counties: Rock Island, Mercer, Henry * (Henry Co. is not mandatory) CITY OF CHICAGO: MARCH 2014

12. OTHER managed care initiatives

13. Medicare Medicaid Alignment Initiative (MMAI) – also known as “Duals” • Will impact those who are dually eligible for Medicaid & Medicare • Clients will have access to all services under one MCO • Will operate in Greater Chicago and Central Illinois • Individuals will be passively enrolled with option to opt out* • 3-way contract between HFS, Federal CMS, and MCO • Six MCOs have been selected to serve MMAI clients in the Greater Chicago area • Two MCOs will serve clients in Central Illinois • Begins March 2014 for voluntary; June 2014 for passive enrollment * Those receiving LTSS will be mandated to enroll in a health plan for their LTSS services (can opt out on Medicare side)

14. MMAI Providers • Greater Chicago Area: - Aetna Better Health - IlliniCare Health Plan (Centene) - Meridian Health Plan of Illinois - Cigna-HealthSpring - Humana Health Plan - BlueCross/Blue Shield of Illinois • Central Illinois: - Molina Healthcare of Illinois - Health Alliance Medical Plans

15. Who is eligible for MMAI • Seniors and Persons with Disabilities who are enrolled in Medicare Parts A and B, and receive full Medicaid benefits • Excluded Populations – Individuals who: • Are under 21 years of age; • Have a Developmental Disability and who receive DD services in an institutional setting or through a HCBS waiver • Are in spenddown • Are in the Illinois Breast and Cervical Cancer program and other partial benefit programs • Have comprehensive Third Party Insurance

16. Potential Enrollees in the Greater Chicago Region: 128,137 Potential Enrollees in the Central Illinois Region: 19,400

17. Innovations Project • HFS is testing innovative models that offer risk-based care coordination through provider-organized networks of fee-for-service Care Coordination Entities (CCEs) and Managed Care Community Networks (MCCNs) • Each CCE will serve approx. 1,000 Medicaid clients in the first year as they establish and test their models before expanding (not MCCNs). • 5 CCEs and 1 MCCN all now have signed contracts. • 3 have enrollment • 3 will receive enrollment as early as February 2014

18. CCEs/MCCNs • Care Coordination Entities - Be Well Partners in Health - Healthcare Consortium of Illinois (Entire Care) - Macon County Care Coordination (My Health Care Consortium) - Precedence Care Coordination - Together4Health • Managed Care Community Network (MCCN) - Community Care Alliance of Illinois

19. Children with Complex Medical Needs (CCMN) • Awarded 3 proposals from CCEs to provide care coordination services to Children with Complex Medical Needs • Lurie Children’s Hospital • LaRabida • OSF • Contracts are being negotiated with all 3 entities • Expect signatures by early spring • Anticipated July 2014 start date

20. ACEs (Accountable Care Entities) • Provider-organized • Must include, at a minimum, a hospital, PCP, specialist and BH provider • Will coordinate a network of Medicaid services for children and their family members (initially), with an option to enroll ACA Medicaid adults • Minimum served: 40,000 clients in Cook County, 20,000 in collar counties, and 10,000 downstate  • 11 proposals received January 2014; currently being evaluated

21. County Care • Approved to provide services for ACA adults • Waiver was approved and coverage began November 2012 through December 2013 • Coverage included a specific service package that included mental health (inpatient and outpatient) for BH and SA • Extended waiver to March 31, 2014 and now includes Medicaid State Plan Services • MCCN contract will begin April 1, 2014

22. Care Coordination 2014 Roll Out Plan • February 2014 – Additional CCEs begin serving SPD • March - June 2014 – MMAI (voluntary enrollment begins in March, passive enrollment begins in June) • March 2014 – ICP Expansion begins in the city of Chicago • July 2014 – Children with Complex Medical Needs • July 2014 – Children & Families • July 2014 – Accountable Care Entities

23. To find out more information on hfs’ care coordination initiatives: http://www2.illinois.gov/hfs/PublicInvolvement/cc/Pages/default.aspx