+ All Categories
Home > Documents > Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential...

Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential...

Date post: 04-Jul-2020
Category:
Upload: others
View: 0 times
Download: 0 times
Share this document with a friend
41
Health and Human Services Transformation Illinois HHS Medicaid Waiver Advisory Committee Discussion January 19, 2017 Discussion document
Transcript
Page 1: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

Health and Human

Services Transformation

Illinois HHS Medicaid Waiver Advisory

Committee Discussion

January 19, 2017

Discussion document

Page 2: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

1

DRAFT - Confidential and Proprietary

Medicaid Waiver Advisory Committee members (1/2)

Meeting Chair

▪ Howard A. Peters (Vice-Chairman, Medicaid Advisory Committee)

Committee members

Role and locationName

▪ Safer Foundation (Chicago)▪ Victor Dickson

▪ CEO, Egyptian Health Department (Eldorado, Harrisburg, Carmi)▪ Angie Hampton

▪ President/CEO, Aunt Martha’s (Chicago Heights)▪ Raul Garza

▪ EVP/COO, Children’s Home and Aid (Chicago) ▪ Arlene Happach

▪ Board President, Association of Managed Health Plans (Chicago)▪ Cathy Harvey

▪ EVP, Children’s Home Association of Illinois (Peoria) ▪ Cindy Hoffman

▪ President/CEO, Rosecrance Health Network (Rockford)▪ Philip Eaton

▪ President, Robert Young Center/Unity Point Health (Quad Cities)▪ Dennis Duke

▪ SVP, Catholic Charities (Chicago)▪ Kathy Donahue

▪ Executive Director, Irving Harris Foundation (Chicago)▪ Phyllis Glink

▪ Youth and Family Peer Support Alliance (Champaign County)▪ Regina Crider

▪ COO, Centerstones Illinois (Alton, Marion, Carbondale)▪ Jennifer Craig

▪ EVP, Cook County Health and Hospital System (Chicago)▪ Doug Elwell

▪ CEO, IL Association of Behavioral Health (Springfield)▪ Sara Howe

Page 3: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

2

DRAFT - Confidential and Proprietary

Medicaid Waiver Advisory Committee members (2/2)

Committee members

Role and locationName

▪ DuPage Federation ▪ Kathryn Nelson

▪ CEO, Illinois Hospital Association (Naperville)▪ AJ Wilhemi

▪ President/CEO, IARF (Springfield)▪ Janet Stover

▪ Associate Professor, Chairperson of Psychiatry, SIU (Springfield)▪ Kari Wolf, MD

▪ Illinois State Psychiatric Society▪ Daniel Yohanna, MD

▪ Illinois State Medical Society ▪ TBD

▪ CEO, Health and Disability Advocates (Chicago)▪ Barb Otto

▪ Thresholds (Chicago)▪ Heather O’Donnell

▪ VP, Illinois Policy, Ounce of Prevention▪ Gail Nourse

▪ President/CEO, Lutheran Social Services of Illinois (Chicago)▪ Mark Stutrud

▪ Mado Management ▪ Mark Mroz

▪ CEO, CBHA (Chicago)▪ Marvin Lindsey

▪ CEO, Easter Seals (Peoria)▪ Jim Runyon

▪ Illinois Mental Health Partnership▪ TBD

▪ Lawndale Christian Health Center (Chicago)▪ Thomas Huggett, MD

▪ Executive Director, Illinois Public Health Association (Springfield)▪ Tom Hughes

Page 4: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

3

DRAFT - Confidential and Proprietary

Agenda for today’s discussion

Objectives of Waiver Advisory Committee

Introduction to Integrated Health Home model

Path forward

Care delivery model topics for input today

3Proprietary and Confidential

15 minutes

20 minutes

60 minutes

10 minutes

Context of the Illinois HHS Transformation 15 minutes

Page 5: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

4

DRAFT - Confidential and Proprietary

Introduction

Page 6: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

5

DRAFT - Confidential and Proprietary

The HHS transformation has been enabled by an historic level of

collaboration

Thirteen agencies / departments / offices are

participating in HHS transformation…

1. Governor’s Office

2. Department of Healthcare and Family Services (DHFS)

3. Department of Children and Family Services (DCFS)

4. Department of Human Services (DHS)

5. Department of Juvenile Justice (DJJ)

6. Department of Corrections (DOC)

7. Department of Aging (DOA)

8. Department of Public Health (DPH)

9. Department of Veteran’s Affairs (DVA)

10. Illinois Housing Development Authority (IHDA)

11. Department of Innovation and Technology (DoIT)

12. Illinois State Board of Education (ISBE)

13. Illinois Criminal Justice Information Authority (ICJIA)

…and focusing on five

pillars

1. Prevention and

population health

2. Pay for value, quality and

outcomes

3. Moving from institutional

to community care

4. Education and self

sufficiency

5. Data integration and

predictive analytics

Page 7: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

6

DRAFT - Confidential and Proprietary

As a pressing issue that transcends agencies and populations across

Illinois, behavioral health is a lynchpin in the transformation effort

Groundwork laid in

Healthy Illinois 2021

plan, supported by State

Health Assessment, SIM

grants, and State Health

Improvement Plan

Governor’s Office and

12 Illinois agencies with

shared sense of mission

Rapid increase in

opioid-related deaths

Disproportionate level of

spend on members with

behavioral health needs,

i.e., mental health and

substance use issues

Underutilization of

community services and

overutilization of

intensive institutional

care

Large undiagnosed or

untreated

subpopulations

Page 8: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

7

DRAFT - Confidential and Proprietary

FY2015 members and spend

Medicaid individuals with diagnosed behavioral health needs make up

~25% of the population, but ~56% of the total spend

44%

48%

8%

7%6%

62%

25%

0%

Individuals with diagnosed

behavioral health needs

Spend

10.53.1

Members

Medical spend

Behavioral health core spend

Individuals with only care

coordination fee spend

Spend for non-behavioral

health members

Individuals with no claims

Individuals with no diagnosed

behavioral health needs

100% =

Spend for members with only

care coordination fee spend

Annualized members (millions), dollars (billions)

SOURCE: FY15 State of Illinois DHFS claims data

Page 9: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

8

DRAFT - Confidential and Proprietary

Objectives of the Illinois HHS Transformation to address these

challenges

Data inter-

operability

and

transparency

High intensity

assessment,

care planning,

and care

coordination /

integration

6

Low-intensity

assessment,

care planning,

and care

coordination /

integration

7

8

Structure,

budgeting,

and policy

support

10

Integrated,

digitized

member data

2

Enhanced

identification,

screening &

access

1

Best practice

vendor and

contract

management

9

Core and

preventive

behavioral

health

services

3

Behavioral

health

support

services

4

Workforce

and system

capacity

5

The nation’s

leading

member-centric

behavioral

health strategy

Page 10: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

9

DRAFT - Confidential and Proprietary

The 1115 waiver will allow Illinois to realize a set of high-priority benefits,

alongside initiatives that will maximize their effectiveness

Demonstration waiver benefits

# Benefit

1 Supportive housing services

2 Supported employment services

3 Services to ensure successful transitions for

IDOC- and Cook County Jail (CCJ)-

incarcerated individuals

4.1 Services for individuals with substance use

disorder in short-term stays in IMDs

4.2 SUD case management

4.3 Withdrawal management

5.1 Services for individuals with mental health

issues in short-term stays in IMDs

4.4 Recovery coaching for SUD

5.2 Crisis beds

6 Respite care

Demonstration waiver initiatives

# Initiative

1 Behavioral and physical health integration

initiatives

2 Infant/Early childhood mental health

interventions

3 Workforce-strengthening initiatives

4 First episode psychosis (FEP) programs

Page 11: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

10

DRAFT - Confidential and Proprietary

The State will also pursue initiatives outside the waiver to advance its

behavioral health strategy

Other

demon-

stration

grants

1115

waiver

Other

waivers

Advance

Planning

Documents

State Plan

Amendments

General

revenue

funds

Other initiatives

▪ State Plan Amendments (SPAs),

including, but not limited to:

– Integrated physical and

behavioral health homes

– Crisis stabilization and mobile

crisis response

– Medication-assisted treatment

(MAT)

– Uniform Child and Adolescent

Needs and Strengths (CANS)

and Adult Needs and

Strengths Assessment (ANSA)

▪ Advance Planning Documents

(APDs)

– Data interoperability through

360-degree view of behavioral

health member

Non-waiver initiatives covered here

Page 12: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

11

DRAFT - Confidential and Proprietary

Overview of transformation journey to date

Jan

Transformation journey

Jun Jul Aug

Town hall

meetings –

Chicago and

Springfield

1115 waiver

public

comment

period

Feb Mar Apr May Feb

Stakeholder

working group

sessions

▪ Consumer

advocates

▪ Providers

▪ Community

services

▪ MCOs

Submit 1115

waiver and

related

SPAs to

CMS

State of the

state address

initiates the

call for HHS

trans-

formation

Ongoing 1:1 and small group engagement

Sep Oct Nov Dec Jan

Initial

feedback

from CMS

Initial

Integrated

Health

Home SPA

submission

to CMS

Regular cross-

agency Trans-

formation

working group

meetings

Medicaid

Waiver

Advisory

Committee

begins

meeting

2016 2017

Page 13: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

12

DRAFT - Confidential and Proprietary

Agenda for today’s discussion

Objectives of Waiver Advisory Committee

Introduction to Integrated Health Home model

Path forward

Care delivery model topics for input today

12Proprietary and Confidential

15 minutes

20 minutes

60 minutes

10 minutes

Context of the Illinois HHS Transformation 15 minutes

Page 14: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

13

DRAFT - Confidential and Proprietary

Discussions across topics will focus on the

insights from your experience

and potential implications of design

decisions under considerations

The Waiver Advisory Committee will be instrumental to

shaping the transformation across several topics

PRELIMINARY

Focus for the next two meetings

Respite Care

Home Visiting PilotIntegrated Health

Homes

Justice-involved

SUD Recovery

Coaching

Workforce

Development

SUD Case

Management

Supported

Employment

Services

Withdrawal

Management

Supportive Housing

Working groups presenting material for input

Page 15: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

14

DRAFT - Confidential and Proprietary

Agenda for today’s discussion

Objectives of Waiver Advisory Committee

Introduction to Integrated Health Home model

Path forward

Care delivery model topics for input today

14Proprietary and Confidential

15 minutes

20 minutes

60 minutes

10 minutes

Context of the Illinois HHS Transformation 15 minutes

Page 16: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

15

DRAFT - Confidential and Proprietary

Integrated Health Homes topics for advisory committee consideration

Detailed model (Following meeting)

▪ Next set of detailed design

decisions including:

– Activity requirements

What forms of care coordination

should providers be capable of

offering members?

– Incentives for value-based care

How can we drive increases in

provider performance?

– Quality and efficiency

measures

How should we measure provider

performance?

– Scale-up approach

How should the program be rolled

out?

Care delivery model (January 19)

▪ Foundational decisions for an

Integrated Health Home’s role in

the ecosystem:

– Member inclusion

– Who should be included in the

model?

– Care delivery improvements

How can we best meet members’

needs?

– Provider standards and

support

– What requirements should be

expected of providers, and how

can we support them in reaching

these?

Focus for today

1

2

3

Page 17: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

16

DRAFT - Confidential and Proprietary

What an Integrated Health Home is and is not

Integrated Health Homes in Illinois are:Integrated Health Homes in Illinois

are NOT:

… and NOT on the provision of all services

▪ Provider of all services for members

▪ A gatekeeper restricting a member’s choice of

providers

▪ A physical place where all Integrated Health

Home activities occur

▪ A care coordination approach that is the

same for all members regardless of individual

needs

Primary focus is on coordination of care…

▪ Integrated, individualized care planning and

coordination resources, spanning physical,

behavioral and social care needs

▪ An opportunity to promote quality in the core

provision of physical and behavioral health care

▪ A way to encourage team-based care

delivered in a member-centric way

▪ A way of aligning financial incentives around

evidence-informed practices, wellness

promotion, and health outcomes

For members with the highest needs:

▪ A means of facilitating high intensity,

wraparound care coordination

▪ An opportunity to obtain enhanced match for

care coordination needs

▪ Identifying enhanced support to help these

members and their families manage complex

needs (e.g., housing, justice system)

Anything else you would add to these lists?

Page 18: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

17

DRAFT - Confidential and Proprietary

Principles for Integrated Health Homes in Illinois

Develop a person- and family-centered care delivery model for the

whole Medicaid population, regardless of match status, that

encourages member and family engagement

Craft a flexible care delivery approach that reflects the diverse needs of

members in Illinois and recognizes that member needs change over

time

Evolve toward full clinical integration of behavioral, physical, and

social healthcare

Acknowledge and accommodate geographical variation in provider

capabilities, readiness, and priorities

Strike an appropriate balance between provider flexibility and

accountability to enable capabilities and readiness

Prioritize economic sustainability of care delivery model at both the

systemic and provider levels

Goal is to begin launch of model by July 2017

Page 19: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

18

DRAFT - Confidential and Proprietary

SOURCE: Open Minds; CMS database of approved Medicaid Health Home State Plan Amendments, as of December 2016

NY3

ME3

AR

MO3

IA3

RI3

SD

AL

MD

OHNJ3

VT

WV

OK3

KS1

ID1

WA

MI3 CT

NHMA

PA

VA

NC

SC

FL

GAMS

TN

KY

INIL

WI

MN

ND

NE

TX

NMAZ

UT

CO

WY

MT

OR1

NV

CA2

LA

DC

AK

Hawaii

1 Oregon, Idaho, and Kansas have opted not to continue their programs

2 California will launch its Health Home model in July 2017

3 State has initiated multiple health home models

The Illinois model will break

new ground by offering all

Medicaid members a fully-

integrated model of care

coordination

To date, 33 Health Home models have been developed throughout the

United StatesOnly focused on members with behavioral health conditions

Broader population, including members with behavioral health conditions

Inclusion criteria:

Full population

Only focused on members with physical health conditions

Page 20: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

19

DRAFT - Confidential and Proprietary

Profiles of ACA Health Homes launched to date

Illinois would be first fully integrated Health Home

Largest Medicaid Health Home programs developed to date

60

69

220

230

251

251

521

540 26%

26%

3%

19%

4%

3%

Number of enrollees, thousands

Many states also employ PCMH programs to coordinate the physical health needs of their

members separately, but Illinois model would coordinate both physical and behavioral

health care for all ~3.1m Medicaid members

Conditions

addressed

▪ Chronic

▪ Chronic/SMI

▪ Chronic/SMI

▪ SMI

▪ Chronic

▪ SMI/SED

% of Medicaid

population

1 Only includes members who are part of the state’s largest Health Home program

4%

4%

▪ SMI/SED

▪ Chronic

Includes members with SMI/SEDs

SOURCE: CMS Health Home Information Resource Center

Page 21: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

20

DRAFT - Confidential and Proprietary

Illinois’ model would address the needs of a broad range of member

archetypes

Living situationBehavioral health

conditionArchetype Age

Jenn Rural home AnxietyYoung Adult

Stephen Experiencing homelessness Actively psychotic/ opioid abuseAdult

Jane Youth in care ADHD/ODDChild

Brice Urban home Major depressionTeenager

Mike Juvenile institutionBipolar disorder/ alcohol and

marijuana abuseTeenager

Tom Friend’s couch Alcohol and heroin abuseAdult

Greg Correctional facility SchizophreniaYoung Adult

Darnell Experiencing homelessness Post-traumatic stressAdult

Cynthia Skilled nursing facility Moderate anxiety and depressionAged

Ashley Permanent supportive housing SchizophreniaAdult

Rural home Alcohol abuseAdultWilliam

Rural home Opioid abuseTeenagerMia

Connor Teenager Transferring to congregate care Severe aggression

In at-risk home At-riskToddlerJerry

Page 22: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

21

DRAFT - Confidential and Proprietary

Agenda for today’s discussion

Objectives of Waiver Advisory Committee

Introduction to Integrated Health Home model

Path forward

Care delivery model topics for input today

21Proprietary and Confidential

15 minutes

20 minutes

60 minutes

10 minutes

Context of the Illinois HHS Transformation 15 minutes

Page 23: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

22

DRAFT - Confidential and Proprietary

Approach for reviewing care delivery model design decisions

▪ The items that follow comprise the working group’s initial

perspective on key care delivery model design decisions,

thanks to close collaboration between representatives from the

Department of Healthcare and Family Services, Division of

Mental Health, Department of Children and Family Services,

Division of Alcoholism & Substance Abuse, and the Illinois

Department of Public Health

▪ These ideas build on work done as part of the Healthy Illinois

2021 plan, supported by a State Health Assessment, SIM

grants, and a State Health Improvement Plan

▪ The working group seeks your input on these decisions,

both on the direct questions posed on the following pages, and

with regard to any other queries or modifications you might

suggest as we discuss the decisions more broadly.

▪ Your responses today will help refine and improve these

decisions, and will be reflected wherever possible

Page 24: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

23

DRAFT - Confidential and Proprietary

Integrated Health Homes working team

Team lead

Teresa Hursey

Team members

DMHDiana Knaebe

DCFSPaula Jaudes

AgencyName

DMHLee Ann Reinert

DASAMaria Bruni

DASAJayne Antonacci

Juliana Harms DCFS

HFSMary Doran

HFSKristine Herman

HFSAmy Harris-Roberts IDPHShannon Lightner

HFSCatina Latham

HFSDavid Kuriniec

AgencyName

Page 25: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

24

DRAFT - Confidential and Proprietary

Member inclusion and engagement: Introduction to

suggested approach

Level of physical health needs

Level of

behav-

ioral

health

needs

Low

High

High Low

High behavioral health needs,

Low physical health needs

High-

est

needs

Low

behavioral

health needs,

high physical

health needs

Low needs

members

Moderate

needs

members

ILLUSTRATIVE

Are there

demographic

characteristics you

feel ought to qualify

a member for entry

into the highest tiers

of need (e.g.,

children in DCFS

care)

Are there any

members of the

Medicaid population

that should be

excluded from

Integrated Health

Home membership

(e.g., those already

receiving

wraparound support

from other

programs?)

1

Approach to tiering adopted to ensure members with similar needs receive

comparable care coordination support, and to focus resources on those

members who need greatest support

Page 26: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

25

DRAFT - Confidential and Proprietary

Integrated Health Homes will deliver improvements in care delivery

across a range of areas

Managed Care Organizations

Payment streams, in response to Integrated Health Homes meeting requirements and improving outcomes

Higher-intensity

Integrated Health

Homes

Lower intensity

Integrated Health

Homes

Integrated Health Homes

Higher-needs population1 Lower-needs population1

1 Actual tiering of intensity of care coordination may not be binary

JaneBrice Mike Mia Stephen DarnellAshley Tom William JennGreg CynthiaConnorJerry

Population

health

management

Member

engagement

and education

Physical/

maternal

health

provider

engagement

Behavioral

health provider

engagement

Integrated care

planning and

monitoring

Supportive

service

coordination

Reporting of quality and efficiency of care (i.e., member outcomes)

Enhanced access, screening, and assessment

2

Page 27: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

26

DRAFT - Confidential and Proprietary

IHHs achieve 6 main goals for members and families

Integrated

care planning

and

monitoring

Physical /

maternal health

provider

engagement

Behavioral

health provider

engagement

Supportive

service

coordination

Member

engagement &

education

Population

health

management

Support for treatment and medication adherence

(e.g. Ritalin, MAT)

Enhanced social skills education, self-care, and

engagement with supports (e.g., child & family teams)

Improved dialogue among providers on quality

outcomes across panel

Continuous stratification of panel and use of

standardized assessment processes to identify

highest-needs members

Access to and collaboration with community

supports is prioritized (e.g., supported housing,

employment, and services offered by agency partners)

Member needs are communicated to community

partners

Improved access to providers for routine

appointments and time-sensitive support (e.g., MCR)

Integrated experience with seamless connections

and communication across providers

Improved access to providers for routine

appointments and time-sensitive support

Integrated experience with seamless connections

and communication across providers

Providers take holistic view of health, supplying full

set of services appropriate to members’ needs

Comprehensive care plans developed with member

and caregivers, supported by ongoing communication

with behavioral and physical healthcare providers

Infrequent follow-ups and outreach to members and

their caregivers (including foster families)

Reactive treatment programs, with little emphasis on

self-care, education, and social skill development

Providers take a case-by-case view of population

health

Member focus determined based on episodes

Providers make limited use of screening tools (e.g.,

CANS, ANSA)

Limited provider engagement with community

supports in the care and recovery process (e.g.,

schools, Big Brothers/Sisters, AA)

Frequent barriers to attendance to behavioral health

appointments

Little continuity in care delivery across providers

Frequent barriers to attendance to medical

appointments

Little continuity in care delivery across providers

Infrequent data sharing and communication

between providers

Siloed care planning

Barriers to integrated care Integrated care facilitated by IHH care coordination

2

What should be added to these goals?

Page 28: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

27

DRAFT - Confidential and Proprietary

Meet Brice, a teenager with depression and multiple

suicide attempts

ILLUSTRATIVE

▪ Brice is 16 years old,

lives at home, and is

Medicaid-eligible

▪ Brice has major

depressive disorder and

has had multiple suicide

attempts

▪ Value

– Brice’s physician does not adhere to a preferred drug list and

prescribes expensive, non-generic anti-depressants

– Brice’s utilization of inpatient treatment is not optimal; he is

often admitted unnecessarily or not admitted when it is

necessary. When he is admitted, his length of stay is sometimes

longer or shorter than necessary

▪ Quality

– Brice is prescribed anti-depressants, but does not receive

evidence-based psychotherapy services for his depression

– His psychiatrist is not aware that Bryce uses alcohol and

marijuana on weekends due to difficulty coordinating lab testing

▪ Continuity

– Brice’s inpatient psychiatrists do not effectively communicate

with his CMHC to optimize his care during his inpatient stays

– Data is siloed, so the prescribing CMHC physician is blind to

other prescribers who may be providing care to Brice

– Brice’s school and church notice when he is more depressed,

but are not linked with his CMHC to inform them of the change

▪ Access

– When Brice turns 19 he loses his Medicaid eligibility and does

not sign up for health insurance

▪ Brice is linked in to a community mental

health center who manages his behavioral

health treatment and coordinates his care

with his school psychologist and his primary

care physician

▪ When Brice is actively suicidal he receives

crisis stabilization services from his

CMHC and, when necessary, they admit

him for inpatient psychiatric care

▪ When Brice gets older, the agencies and

providers involved in his care help him

transition into the adult system

How the system is set up for Brice today Health care pain points

2

Page 29: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

28

DRAFT - Confidential and Proprietary

For consideration: How should Brice’s IHH deploy resources to help

manage his changing level of need over time?

Level of need

Brice is admitted to

an ED after

expressing a strong

desire to harm

himself.

The hospital alerts his

MCO and IHH via

ADT feeds. Brice, his

IHH, and the

hospital create a

discharge plan

together

1

On discharge, the IHH

updates Brice’s care plan

(including his medication

regimen), with input from him

and clinical specialists. The

IHH involves his Child and

Family Team in finding

him a psychotherapist to

help manage his

depression, with extended

hours to reduce Brice’s

reliance on EDs

2

The IHH secures Brice’s

parents’ consent to share

and gather medical data

from his social supports, like

his pastor. Soon after, his

pastor alerts the IHH that

Brice may be experiencing a

spike in his suicidal ideation.

Brice’s IHH immediately

connects him with crisis

stabilization services

3

Brice’s IHH ensures he is

regularly screened for

substance use. On testing

positive for marijuana, his

nurse care coordinator

provides education on

substance abuse. As Brice

approaches adulthood, the

IHH begins working with

his family and social

worker to make sure he

retains Medicaid eligibility

and is able to continue his

membership at the IHH

4

▪ Brice is a 16 year

old from Chicago

with major

depression and

suicidal ideation

▪ Before joining an

IHH, Brice’s

conditions were

not managed

effectively or

holistically

▪ Since joining an

IHH with the right

capabilities to

meet his changing

needs, his care

has been better

integrated,

leading to

improved

outcomes for him

Day 1 Week 1 Month 1 Month 6

Which other clinical or supportive services should Brice’s IHH prioritize connecting him with?

Brice’s IHH is alerted

that he has broken

his leg. It begins

preparation for a

new discharge

plan, and seeks out

physical therapists

to help Brice

recover from his

injury

5

Month 9

2

Page 30: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

29

DRAFT - Confidential and Proprietary

Meet Tom, an adult with alcohol and opioid use disorders

and spent time in the correctional system

ILLUSTRATIVE

▪ Tom is 36 years old, newly

Medicaid eligible, and lives in a

friend’s home

▪ Tom has alcoholism and opioid

use disorder as well as early

signs of diabetes

▪ Tom receives level II substance

use disorder treatment from a

local outpatient substance use

disorder provider

▪ Value

– Tom is at risk for losing his housing (his friend has given him one week to get off

the couch); living on the street will likely exacerbate Tom’s addictions eventually

leading to need for high intensity care

– Tom’s alcoholism puts him at risk for serious medical illnesses, but he does

not see his PCP so is not provided counseling or screening for these diseases;

when they finally manifest they are severe and expensive

– There is a shortage of withdrawal management programs for opiate addiction so

Tom must engage in withdrawal management in the expensive ED/acute

care hospital

▪ Quality

– When Tom is drunk on the street and brought to the ED the providers discharge

him when he is sober without offering him any substance use disorder recovery

services

– Tom requires but does not receive testing for diabetes and education on the

disease and its treatment

▪ Continuity

– Tom finally does go to an inpatient substance use disorder treatment facility, but

is discharged without a holistic array of recovery services like case

management and job training, leading to a quick relapse

▪ Access

– Tom’s addictions lead him to avoid doctors and so he does not seek medical

treatment for his feet which he notices are slowly becoming numb; an early sign

of diabetes

– Tom sometimes stays in homeless shelters; but he does not receive substance

use disorder referrals while there

– Tom does not have access to transportation, causing him to frequently miss

appointments

– There is a shortage of withdrawal management programs for opiate

addiction and Tom has trouble finding a place to stabilize so that he can become

eligible for Level III.5 services

▪ Tom gets primary care services from his local PCP;

the clinic regularly screens him for diseases common in

alcoholics and coordinates his care with his

substance use disorder provider

▪ If Tom suffers an opioid overdose, EMS brings him to

the emergency room where he is stabilized and

discharged to a withdrawal management treatment

center

▪ Tom’s outpatient substance use disorder provider (level

II) works with Tom’s residential treatment providers to

plan for a safe discharge and transition

▪ Tom may be eligible for Medication Assisted Treatment

and may be evaluated by a trained

physician/methadone provider

▪ Tom may be eligible for Level III.5 care if he has

difficulty staying sober; however he must sufficiently

engage in withdrawal management before he will be

allowed admission

▪ Tom has access to a variety of services to support him

including recovery homes and alcoholics

anonymous

How the system is set up for Tom today Behavioral health pain points

Page 31: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

30

DRAFT - Confidential and Proprietary

For consideration: After joining, Tom’s IHH uses screenings to identify

his unmet needs and engages social supports extensivelyLevel of need

Tom is brought to an

ED after being

apprehended by the

police for public

intoxication and is

admitted for inpatient

withdrawal management.

The hospital and an

MCO recognize his

eligibility for Medicaid

and connect him with

an Integrated Health

Home that is capable of

serving his needs

1

Tom’s Integrated Health Home

immediately connects him to a

provider specializing in substance

use disorders. Additionally, his

care coordinator orders a series of

appropriate screenings for Tom,

and tests for physical conditions

commonly observed in alcoholics

and opioid addicts, resulting in a

diagnosis of diabetes for which he

is referred to an endocrinologist

2

Tom’s friend will no longer allow him

to sleep on his couch. Tom has no

other friends to turn to and is

suddenly homeless. Feeling

helpless, he considers turning to

drugs. He calls his substance use

disorder provider, who asks Tom

to visit and relays his housing

difficulties to his care coordinator.

His care coordinator finds a

homeless shelter for Tom to spend

the night in, and puts him in touch

with supportive housing services

3

Tom continues seeing his

substance use provider and

begins to stabilize. He

expresses his desire to

return to the workforce, and

his care coordinator puts him

in touch with employment

training and placement

services

4

▪ Tom is a 36 year

old with opioid

use disorder,

alcoholism, and

early signs of

diabetes who is

currently staying

on his friend’s

couch

▪ He has

intermittent

relationships with

several providers

and was not

previously

recognized as

Medicaid eligible

▪ He has been

admitted to an ED

before for

substance use but

has continued to

use and no one

has followed-up

Day 1 Week 1 Month 1 Month 6

Tom begins to notice

signs of

hyperglycemia.

Rather than heading

directly to the ED, he

contacts his care

coordinator, who is

able to schedule him

to see his PCP for

immediate treatment.

He is then scheduled

for a follow-up

appointment with

his endocrinologist

and is given

coaching on how to

avoid future

episodes

5

Month 9

2

Page 32: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

31

DRAFT - Confidential and Proprietary

Include provider types already capable of providing fully-

integrated physical and behavioral health care

Ensure other provider types can demonstrate capability

to collaborate effectively with other providers whose

abilities complement their own

Select provider types whose institutional character ensures

ability to maintain long-term relationship with members

Avoid excluding provider types where significant numbers

of members have shown preference for establishing

therapeutic and/or coordination relationships

Exclude provider types catering exclusively to specific age-

groups, in order to ensure providers will be able to

coordinate care for whole families

Guiding principles for determining eligibility of provider types3

What other principles should be considered?

Page 33: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

32

DRAFT - Confidential and Proprietary

States may choose from among a set of provider types in the Health

Home SPA, and may add additional provider types beyond this set

SOURCE: CMS SPA guidelines; State Health Home SPAs

Physical Health Providers

Primary care physicians

Clinical practices or

clinical group practices

Rural health clinics

Community health centers

Case management

agencies

Home health agencies

Federally Qualified Health

Centers

Physicians/physician

groups employed by

hospitals (e.g., Missouri)

Tribal health centers (e.g.,

Michigan)

Behavioral Health Providers

▪ Community mental health

centers

▪ Community/behavioral

health agencies

▪ Substance abuse providers

(e.g., Vermont)

▪ Mental health providers

employed by hospitals

▪ Psychiatric rehabilitation

programs

▪ Mobile treatment service

providers (e.g., Maryland)

Provider

types

offered by

default in

Health

Home SPA

Select

provider

types

observed in

other Health

Homes

1 Also permissible to use teams of select healthcare specialist types (with one designated as lead entity) and entities with state-specific

accreditation (e.g., Maine’s Enhanced Primary Care Practice)

3

Page 34: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

33

DRAFT - Confidential and Proprietary

Members with high behavioral health needsMembers with low or moderate

behavioral health needs

Scenario 1: Behavioral health

provider is lead entity1

Scenario 2: Physical health

provider is lead entity1

▪ Community mental health

centers

▪ Other eligible specialty

behavioral health provider

types as approved by the

State2

▪ Any physical health provider

type in accordance with the

Health Home SPA default list

▪ Any other State-approved

physical health provider type2

▪ The same set of physical

health providers eligible to

serve as IHHs for members

with low or moderate

behavioral health needs

Eligible

behav-

ioral

health

provider

types

Eligible

physical

health

provider

types

▪ Community mental health

centers

▪ Other eligible specialty

behavioral health provider

types as approved by the

State2

Physical health provider is

lead entity (“PCP on steroids”)

▪ Primary care physicians

▪ Clinical practices or clinical group

practices

▪ Rural health clinics

▪ Physicians and physician groups

employed by hospitals

▪ Community health centers

▪ Federally qualified Health centers

▪ Any behavioral health provider

type in accordance with the

Health Home SPA default list

(e.g., community/behavioral

health agencies)

▪ Any other provider type capable

of serving members with

moderate behavioral health needs

(e.g., clinic within hospital)2

1 With collaborative agreement in place with corresponding entity 2 Excludes e.g., psychiatric rehabilitation programs

Provider types under consideration for inclusion in the program vary

depending on member need

Are there additional provider types that should be explicitly included or excluded from consideration here?

3

Page 35: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

34

DRAFT - Confidential and Proprietary

Staffing and technical requirements suggested to deliver effective care

coordination and to reflect current provider capabilities

IHHs also

serving

members

with high

behavioral

health

needs

IHHs

serving

members

with low or

moderate

behavioral

health

needs

Software requirements

Collaborative

agreements

▪ Collaborative agreement

with:

– A PCP if the lead

entity is a specialist

behavioral health

provider

– A behavioral health

provider capable of

treating members with

high behavioral health

needs if the lead entity

is a PCP

▪ Collaborative

agreement with a

provider capable of

providing for moderate

behavioral health needs

▪ State-mandated screening

tools and functional

assessments, with use of

Admission, Discharge,

Transfer feeds as rolled

out, and progression

toward Electronic Health

Record use encouraged

▪ Same requirements

as for providers

serving members

with low and

moderate needs

▪ Health coordinators: As

above, with expectation of

training to ensure compliance

with High Fidelity Wraparound

approach and comparable

approaches for adults

▪ Clinical experts: As above,

with substance use disorder

specialist & psychologist

▪ Social supports: Social worker;

recovery support specialist

▪ Health coordinators: Lead

nurse care manager; nurse

care manager; clinical care

coordinator

▪ Clinical experts: Physician

and psychiatrist or similar

behavioral health specialist

Staffing

requirements

▪ What challenges might there be in different parts of Illinois to meet these requirements?

▪ How can collaborative agreements be written to ensure true collaboration among providers?

▪ At what point should EHR usage become mandatory for providers?

3

Page 36: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

35

DRAFT - Confidential and Proprietary

Approach Description

▪ Support grant applications to enhance provider infrastructure or capabilities

(e.g., workflow or member data analysis software, telemedicine systems)Grant

support

▪ Entity that supports regular discussions, exchanges of best practice,

conversations on working effectively with Medicaid/MCOs, and

networking/mentoring among IHH providers

Learning

collab-

orative

▪ Training and technical support on workforce development, care coordination/

integration, and other topics central to IHH performanceCoaching

▪ Disease-specific integration pilots to build a foundation for behavioral and

physical health collaboration among relevant providers (e.g., diabetes and

depression; non-opioid collaborative therapy etc.)

Pilots

▪ Development of an IHH readiness assessment tool to evaluate processes that

providers have in place and ability to perform integrated activities, permitting

providers to baseline their capabilities and learn from best practice

Readiness

assessment

Potential approaches to providing support

▪ Efforts spanning initial attempts to alert providers to existence of program and

its benefits, through to targeted support and guidance through application

process, e.g., through supplying draft text of collaborative agreement

Outreach,

support, &

technical

guidance

What other forms of support should be offered to providers – and when?

What capabilities will providers require greatest help in developing?

Ca

pa

bil

ity

bu

ild

ing

Pro

gra

m

eli

gib

ilit

y s

up

po

rt

Infr

a-

Str

uc

-

ture

Type

3

Page 37: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

36

DRAFT - Confidential and Proprietary

Agenda for today’s discussion

Objectives of Waiver Advisory Committee

Introduction to Integrated Health Home model

Path forward

Care delivery model topics for input today

36Proprietary and Confidential

15 minutes

20 minutes

60 minutes

10 minutes

Context of the Illinois HHS Transformation 15 minutes

Page 38: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

37

DRAFT - Confidential and Proprietary

Integrated Health Homes – agenda for our next discussion

Detailed model (Following meeting)

▪ Next set of detailed design

decisions including:

– Activity requirements

What forms of care coordination

should providers be capable of

offering members?

– Incentives for value-based care

How can we drive increases in

provider performance?

– Quality and efficiency

measures

How should we measure provider

performance?

– Scale-up approach

How should the program be rolled

out?

Page 39: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

38

DRAFT - Confidential and Proprietary

Appendix

Page 40: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

39

DRAFT - Confidential and Proprietary

Glossary of acronyms (1/2)

Acronym Meaning

Child and Adolescent Needs and Strengths assessmentCANS

Adult Needs and Strengths AssessmentANSA

Community Mental Health CenterCMHC

Integrated Health HomeIHH

Admission, discharge, transfer messagingADT

Emergency medical servicesEMS

Emergency departmentED

Alcoholics AnonymousAA

Institution for mental diseaseIMD

Implementation Advanced Planning DocumentIAPD

Medication Assisted TreatmentMAT

Page 41: Health and Human Services Transformation › hfs › SiteCollection... · 1 DRAFT - Confidential and Proprietary Medicaid Waiver Advisory Committee members (1/2) Meeting Chair Howard

40

DRAFT - Confidential and Proprietary

Glossary of acronyms (2/2)

Primary care physicianPCP

Screening, brief intervention, and referral to treatmentSBIRT

Managed care organizationMCO

Mobile crisis responseMCR

Oppositional defiant disorderODD

Serious emotional disorderSED

Substance use disorderSUD

Severe mental illnessSMI

Acronym Meaning

Planning Advanced Planning DocumentPAPD

Operations Advanced Planning DocumentOAPD

State Plan AmendmentSPA


Recommended