SmartPlan ChoiceProvider OrientationOverview and Timeline

Agenda

Introduction and Opening Remarks

Chicago Market and Projections Health Plan and Contract

Selection SmartPlan Choice Distinction

Introductions and Opening Remarks Overview of SmartPlan Choice

Who is SmartPlan Choice?

• Joint venture of Presence Health Partners & Independent Physician Alliance of Illinois, plus several other providers/clinics.

• An Accountable Care Entity (ACE), the category for a provider-sponsored and governed organization, managing quality, cost and care of IL Medicaid enrollees

• Serves women/caregivers, children and newly eligible Medicaid enrollees resulting from ACA.

Who is SmartPlan Choice?

• A health plan created by and governed by providers like you.

• A managed care organization with a collaborative culture and one where you can have input into policies.

• Joint venture of providers/clinics driven by a mission of helping the underserved.

• A team of providers with shared values working with and in the community to improve health for all.

• A group with a strategy to embrace innovation and change the delivery of health care.

Aug 11, 2014SmartPlan Choice Enrollment Begins

Oct 11, 2014Auto-enrollment

Begins

Jan – Dec 2015Shared Savings Measurement

Period

Jan 2016 - June 2017

MCO On-Site Readiness Review

Jul 1, 2017 MCO Effective

date/ Capitation Full Risk

Enrollment scheduled to begin in Central, IL and move North. Cook

County enrolls by zip codes & begins: Sept 8, 15, 29, Oct 6, Jan 12

SmartPlan Choice Timeline

60 days after enrollment, any Medicaid recipient who did not choose a PCP or medical home will have one assigned to them. A PCP must be enrolled in Illinois Health Connect (IHC) to have patients assigned to them.

State Requirements for Providers participating in SmartPlan Choice?

• Enroll with State of IL Health and Family Services (HFS)

– Enables you to send claims and receive payment

• Register with IL Health Connect (IHC) – Agreement to terms of medical

home

– Responsibility of primary care provider (PCP)

– Registry for providers and office sites

– Database for patient panels and patient allocationHFS audits the network and processes of SmartPlan Choice to ensure compliance to regulations. We may need verification from you.

Strategic Direction: State of Illinois

- SB 26 - Medicaid Expansion bill passes - projecting approximately 600,000 new enrollees

Care Coordination Expansion (July 24, 2013)

Source: Illinois Department of Healthcare and Family Services

SmartPlan Choice Counties of operations:1. Champaign2. Ford3. Vermilion4. Kankakee5. Kane6. Will7. Cook

SmartPlan Choice Service Area and Enroll Dates

County

1. Champaign ------------------------

2. Ford -------------------------------

3. Vermilion --------------------------

4. Kankakee ------------------------

5. Kane -------------------------------

6. Will ---------------------------------

7. Cook (by Zip Code) ------------

8. Iroquois (voluntary enroll) ----

• Enroll Start: 8 wks to choose

1. Aug 11 – Aug 16

2. Aug 11 – Aug 16

3. Aug 11 – Aug 16

4. Aug 18 – Aug 23

5. Aug 25 – Aug 30

6. Sep 29 – Oct 4

7. Sept 8, Sep 15, Sep 29, Oct 6 (ACA), Jan 12 (ACA)

8. Not mandatory – no date

State of IL

All enrollment marketing material and activity must be prior approved by the State of IL Health and Family Services (HFS). Including:• Community Health Fairs & Events• Public Announcements• Physician Office Materials

Enrollment Do’s & Don’ts

CAN SAY CANNOT SAY

Thank patients for privilege of serving them and to consider you when

selecting a provider for future health needs and when enrolling in a health

plan.

Choose SmartPlan Choice or any specific Health Plan.

Visit www.smartplanchoice.org to see letter of preference for SmartPlan Choice

approved by HFS Aug 20,2014

I am/this medical practice is part of SmartPlan Choice (must include any and all other Medicaid health plans

office contracted)

Choose SmartPlan Choice or any specific Health Plan.

Visit www.smartplanchoice.org to see letter of preference for SmartPlan Choice

approved by HFS Aug 20,2014

Enrollment Do’s and Don’ts

CAN DO CANNOT DO

Provide telephone for patients to contact Client Enrollment Services (1-877-912-

8880) directly to enroll

Cannot provide ONLINE enrollment at any provider setting, health fair, or other

gathering

Provide information on ALL health plans offered in the service area - - must use

State supplied/approved material.Persuade enrollment in a specific Health

Plan

Mail Outreach using materials supplied by State of IL (found on

www.SmartPlanChoice.org )Face to Face Outreach (door-to-door, telephone or other cold-call activity)

Pathway to Working Together

HFS Guidelines here

Provider Manual found here

Care Management Manual here

HFS approved letter for IPA

HFS approved letter for PHP

Dept. of IL Approved

Letter preferring SmartPlan

Choice (PHP)

Dept. of IL Approved

Letter preferring SmartPlan

Choice (IPA)

Chicago Market and Projections

ACEs within SmartPlan Choice Service Areas

Cook Kane Will Champaign Ford Vermilion Kankakee

Presence Health Partners/ Independent Physicians Assoc

SmartPlan Choice X X X X X X X

The Carle Foundation Illinois Partnership for Health X X X X X X

Advocate Physician Partners Advocate Accountable Care X X X

Loyola University Health Systems

Loyola Family Care X X

North Shore University Health System

Community Health Partners X

Access Community Healt Network

HealthCura X

Swedish Covenant, Norwegian American & Mercy

MyCare Chicago X

St Bernard Hospital Better Health Network X

University of IL Hosp & Health System

UI Health Plus X

Partners Health Plan Name

Cook County Projections from the State of IL - based on 2012 participation

Min ACE # ACEFchild FAdult FAdult Fsenior Grand Target Enrollmt in 0t18 19t64NoD 19t64Dis 65up Partial Total Total capacity Region

Cook 817,642 276,745 135,440 99,495 42,037 1,371,358 1,136,424 40,000 960% 20% 10% 7% 3% 100% 83%

F = Full Benefit = Populations served by ACEsPartial = Partial BenefitNoD = No Disability SmartPlan Choice currently servesDis = Disability 11% of target market

Before enrollment

Populations served by SmartPlan Choice

Managed Care Organizations by Populations Served in Illinois

Which Health Plan to contract?

Types of Managed Care Organizations

• Corporate owned. Full risk

• Provider owned. Full Risk

• Provider Organized. Network only

• Provider owned. 3 yr to Full risk- become MCO or MCCN

MCO

MCCN

CCE

ACE

SmartPlan Choice vs MCO?

• A health plan comprised of and governed by your peers.

• Opportunity to earn your fee for service over next 18 months plus incentives for quality performance

• Contribute to MCO policy vs mandated by MCO policy

• Have input into regional care coordination and management of high risk patients vs mandated by policy derived distantly

SmartPlan Choice ACE offers:

• Fee-for-service for first one and half years. Providers bill and are reimbursed by the State of Illinois for the first 18 months.

• Partial risk after 18 months; full risk after three years (An ACE is expected to become a MCCN or MCO).

• Patient Member Per Month (PMPM) payment for each covered member to manage the care coordination for physicians and help with future ACE infrastructure and growth

• Opportunity for performance incentive year one and shared savings after 18 months

Who should I contract?

• Do you want a fully developed, predefined structure with fixed policies and procedures?

• Do you want a developing organization having input into policies and procedures? – SmartPlan Choice!

• Which organization shares your values and understands your perspective? –SmartPlan Choice!

• More contracts = more policies and procedures = greater administrative burden. SmartPlan Choice! One community and one goal - improving health for all.

Why SmartPlan Choice?

Why SmartPlan Choice

• Mission Driven - Serving the Medicaid population is driven by the Mission of key partner of SmartPlan Choice.

• Local Management - Community is better managed by an active participant in the local community

• Stakeholder alignment – Local governance by peers who will protect your interests

• Culture – Transparency, Collaboration, Innovation and Accountability

SmartPlan Choice Contacts

For Providers

• Care Coordination 1.844.254.CARE (2273)

• Questions, Info, Other Jennifer.Atilano@presencehealth.org

Mary.Hervey@presencehealth.org

• Tools to assist offices info@smartplanchoice.org

For Members

• SmartPlanChoice.org Contact us

• Member Services 1.844.254.CARE (2273)

• Member Services TTY 1.844.852.1371