1. Transforming Illinois Health Care Illinois Medicaid 1115 Waiver

2. Transforming Illinois Health Care State’s Vision to Achieve Triple Aim  Transform Illinois’ Medicaid program and health care delivery system  Transition from fee for service system to an integrated, patient- centered delivery model  Strengthen community based & primary care infrastructure  Empower providers to manage care and incentivize quality and improved patient outcomes

3. Transforming Illinois Health Care Illinois hospitals have the infrastructure to bring together a wide range of providers

4. Accountable Care Entities  Unique to Illinois  Established by IL law in 2013  Provider owned and operated  A group of doctors and hospitals; not an insurance company  Doctors and hospitals within an ACE are connected to easily share information  Responsible for all care provided 4

5. What is a Medicaid 1115 Waiver? 5  Allows states to apply for program flexibility from the Centers for Medicare & Medicaid Services to test new approaches to financing & delivering Medicaid  Provides incentives to providers to develop new models of care  Lasts five years, but can be renewed/amended  Must be budget neutral, leading to overall savings  Allows states to apply for program flexibility from the Centers for Medicare & Medicaid Services to test new approaches to financing & delivering Medicaid  Provides incentives to providers to develop new models of care  Lasts five years, but can be renewed/amended  Must be budget neutral, leading to overall savings Our State’s Waiver ApplicationOur State’s Waiver Application  Called the Path to Transformation Waiver

6. Four Pathways to Transformation State Waiver Application 6 Pathway 4 Pathway 1Pathway 2 Pathway 3 Goals: Better Health Outcomes Lower Costs Delivery System Transformation Population Health Workforce Home- & Community- Based Supports

7. 1st Pathway: Delivery System Transformation Waiver promotes care coordination & integrated delivery system development 7  Hospital performance & integration pool  Institution transition pool  Access Assurance Pool  Innovation and transformation resource center  Public hospital pool Delivery System Transformation

8. 2nd Pathway: Population Health 8  Fund regional public health collaboratives  Expansion of maternal-child home visitation program Population Health

9. 3rd Pathway: Workforce Strengthen the state’s health care workforce  Provide incentives for training physicians  Funding for loan repayment programs  Safety Net and Critical Access Hospital loan program  Establish training and certify community health workers 9 Workforce

10. 4th Pathway: Home & Community-Based Supports Consolidation of nine existing home- & community-support waivers 10 Home- & Community- Based Supports  Increase funding & uniformity in benefits  Increase capacity of care provided in the community  Behavioral health expansion & integration

11. Challenges 11  Many needs  Limited funding  Negotiatons with CMS will determine final funding allocations.  Incentive pools, workforce, behavioral health home, transformation resource center, and public health integration provisions are critical for hospitals and continued transformation.  Waiver often has general descriptions of proposals. Will need provider input when finalizing details.  Incentive funding provisions need to have realistic expectations.  Many needs  Limited funding  Negotiatons with CMS will determine final funding allocations.  Incentive pools, workforce, behavioral health home, transformation resource center, and public health integration provisions are critical for hospitals and continued transformation.  Waiver often has general descriptions of proposals. Will need provider input when finalizing details.  Incentive funding provisions need to have realistic expectations.

12. How is a Waiver Financed? Costs Not Otherwise Matchable (CNOM)  One of the most powerful provisions in Section 1115 allows CMS to grant approval of Costs Not Otherwise Matchable or CNOM  Includes services not normally qualifying as Medicaid expenditures  Must be budget neutral 12

13. Budget Neutrality Under 1115 Waiver 13 CNOM counts toward budget neutrality gap

14. Waiver Examples Aligned With Hospital Transformation Efforts 1115 Waiver Payments and Initiatives Integration & Incentive Pool Institution Transition Pool GME funding Loan forgiveness Community-Based Training and certification Behavioral health homes Integration with public health Enhanced home and community supports 14

15. What does Waiver Mean for Providers?  Financial & Technical Assistance to transform care models  Incentives for quality improvement, transformation and integration activities  Increased capacity for behavioral health referrals  Funding to recruit, train and retain qualified health care workforce  Better crisis, referral and discharge services

16. Model Test Grant- CMMI  $100 million- four years  Six integrated delivery systems  Public and private payer participation  Align quality metrics across plans  Linkages with community supports via public health 16

17. How is state receiving input? Alliance for Health  Alliance Steering Committee All major stakeholders  Five workgroups Integrated Delivery System Reform Public Health Integration Workforce Data and Technology Services and Supports 17

18. Conclusion  Waiver and Model Test are consistent with IHA goals  Key hospital provisions are critical to achieving waiver goals  Funding needs to reach providers  State can set criteria and standards  Rural health and health literacy needs can be enhanced  Waiver provides up-front investment for transformation 18