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

2. Medicaid Reform Law
The Medicaid reform law [PA ], 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 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

7. 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

8. ICP is a mandatory program currently operating in:
ICP –Geography and Timeline
ICP is a mandatory program currently operating in:
Greater Chicago Region – began ,
expanded to include City of Chicago
Rockford Region – began
Central Illinois Region – began
Metro East Region – began
Quad Cities Region – began

9. 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. Meridian Health Plan of Illinois
4. Molina Healthcare
5. Health Alliance Medical Plan
6. Blue Cross Blue Shield
7. Cigna-HealthSpring
8. Humana Health Plan
Managed Care Community Networks (MCCNs)
1. Community Care Alliance of Illinois (CCAI)
2. County Care

10. ICP –MCOs and MCCNs How are MCOs and MCCNs different?
MCOs are licensed Health Maintenance Organizations (HMOs) by the Dept of Insurance
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?
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

11. ICP Care Coordination Entities (CCEs)
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.
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

12. Current Programs – Medicare Medicaid Alignment Initiative (MMAI)
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
Includes both community and LTSS clients
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.

13. 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:
Elderly (Community Care Program participants)
Traumatic Brain Injury
HIV/AIDS
Physically Disabled
Supportive Living Facility

14. MMAI- flexibility for the Consumer
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.

15. MMAI – Number Eligible Geographic Region
Number of Dual Beneficiaries Eligible for MMAI
Greater Chicago
128,000
Central Illinois
20,000

16. MMAI – Geography and Timeline
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:
March 2014: Voluntary Enrollment for Community population began
June 2014: Passive Enrollment for Community population began
July 2014: Voluntary Enrollment for LTSS population began
October 2014: Passive Enrollment for LTSS population Begins

17. MMAI - Managed Care Organizations
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

18. Other managed care initiatives
Brand New HFS Managed Care Programs

19. Brand New – Family Health Program (FHP)
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

20. FHP- Geography and Timeline
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:
Central IL Region- estimated September 2014
Quad Cities Region- estimated October 2014
Rockford Region- estimated October 2014
Greater Chicago Region- estimated November 2014

21. FHP Managed Care Organizations (MCOs)
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
Managed Care Community Networks (MCCNs)
1. County Care
2. Family Health Network (FHN)

22. FHP- Care Coordination Entities for Children with Special Needs (CSN CCEs)
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.
La Rabida Coordinated Care Network for CCMN
Lurie Children’s Health Partners CCE
OSF Healthcare System Children’s CCE

23. FHP Accountable Care Entities (ACEs)
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

24. FHP Accountable Care Entities (ACEs)
HFS will contract with 10 applicants working to become ACEs. Different regions will be served by different ACEs.
Accountable Care Chicago
Advocate Accountable Care
Better Health Network
HealthCura
Illinois Partnership for Health
Loyola Univ health System ACE
Population Health of IL (Alexian Brothers)
NorthShore Physician Assoc ACE
SmartPlan Choice (Presence)
UI Health Plus (UIH+)

25. Brand New- Managed Long-Term Services and Supports (MLTSS)
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

26. Care Coordination 2014 Roll Out Plan
February 2014 – Additional CCEs began serving SPD in ICP
March - June 2014 – MMAI (voluntary enrollment began in March, passive enrollment began in June)
March 2014 – ICP Expansion began in the city of Chicago
August 2014 – Family Health Program (FHP) began in the Metro East Region with plans to expand to all remaining mandatory regions
Fall2014 – MLTSS begins for those who opt-out of MMAI

27. Getting the Word Out
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

28. To find out more information on hfs’ care coordination initiatives: