Health And Human Services Transformation - Illinois
Health and HumanServices TransformationIllinois HHS Medicaid Waiver AdvisoryCommittee DiscussionDiscussion documentJanuary 19, 2017
DRAFT - Confidential and ProprietaryMedicaid Waiver Advisory Committee members (1/2)Meeting Chair Howard A. Peters (Vice-Chairman, Medicaid Advisory Committee)Committee membersNameRole and location Jennifer Craig COO, Centerstones Illinois (Alton, Marion, Carbondale) Regina Crider Youth and Family Peer Support Alliance (Champaign County) Victor Dickson Safer Foundation (Chicago) Kathy Donahue SVP, Catholic Charities (Chicago) Dennis Duke President, Robert Young Center/Unity Point Health (Quad Cities) Philip Eaton President/CEO, Rosecrance Health Network (Rockford) Doug Elwell EVP, Cook County Health and Hospital System (Chicago) Raul Garza President/CEO, Aunt Martha’s (Chicago Heights) Phyllis Glink Executive Director, Irving Harris Foundation (Chicago) Angie Hampton CEO, Egyptian Health Department (Eldorado, Harrisburg, Carmi) Arlene Happach EVP/COO, Children’s Home and Aid (Chicago) Cathy Harvey Board President, Association of Managed Health Plans (Chicago) Cindy Hoffman EVP, Children’s Home Association of Illinois (Peoria) Sara Howe CEO, IL Association of Behavioral Health (Springfield)1
DRAFT - Confidential and ProprietaryMedicaid Waiver Advisory Committee members (2/2)Committee membersNameRole and location Tom Hughes Executive Director, Illinois Public Health Association (Springfield) Thomas Huggett, MD Lawndale Christian Health Center (Chicago) Marvin Lindsey CEO, CBHA (Chicago) Mark Mroz Mado Management Kathryn Nelson DuPage Federation Gail Nourse VP, Illinois Policy, Ounce of Prevention Heather O’Donnell Thresholds (Chicago) Barb Otto CEO, Health and Disability Advocates (Chicago) Jim Runyon CEO, Easter Seals (Peoria) President/CEO, IARF (Springfield) Janet Stover Mark Stutrud AJ Wilhemi President/CEO, Lutheran Social Services of Illinois (Chicago) CEO, Illinois Hospital Association (Naperville) Kari Wolf, MD Associate Professor, Chairperson of Psychiatry, SIU (Springfield) Daniel Yohanna, MD TBD Illinois State Psychiatric Society TBD Illinois Mental Health Partnership Illinois State Medical Society2
DRAFT - Confidential and ProprietaryAgenda for today’s discussionContext of the Illinois HHS Transformation15 minutesObjectives of Waiver Advisory Committee15 minutesIntroduction to Integrated Health Home model20 minutesCare delivery model topics for input today60 minutesPath forward10 minutesProprietary and Confidential33
DRAFT - Confidential and ProprietaryIntroduction4
DRAFT - Confidential and ProprietaryThe HHS transformation has been enabled by an historic level ofcollaborationThirteen agencies / departments / offices areparticipating in HHS transformation 1. Governor’s Office2. Department of Healthcare and Family Services (DHFS) and focusing on fivepillars3. Department of Children and Family Services (DCFS)1. Prevention and4. Department of Human Services (DHS)population health5. Department of Juvenile Justice (DJJ)2. Pay for value, quality and6. Department of Corrections (DOC)7. Department of Aging (DOA)outcomes3. Moving from institutionalto community care8. 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)4. Education and selfsufficiency5. Data integration andpredictive analytics12. Illinois State Board of Education (ISBE)13. Illinois Criminal Justice Information Authority (ICJIA)5
DRAFT - Confidential and ProprietaryAs a pressing issue that transcends agencies and populations acrossIllinois, behavioral health is a lynchpin in the transformation effortGovernor’s Office and12 Illinois agencies withshared sense of missionGroundwork laid inHealthy Illinois 2021plan, supported by StateHealth Assessment, SIMgrants, and State HealthImprovement PlanDisproportionate level ofspend on members withbehavioral health needs,i.e., mental health andsubstance use issuesRapid increase inopioid-related deathsLarge undiagnosed oruntreatedsubpopulationsUnderutilization ofcommunity services andoverutilization ofintensive institutionalcare6
DRAFT - Confidential and ProprietaryMedicaid individuals with diagnosed behavioral health needs make up 25% of the population, but 56% of the total spendFY2015 members and spendAnnualized members (millions), dollars (billions)100% Individuals with diagnosedbehavioral health needsIndividuals with no diagnosedbehavioral health needsIndividuals with only carecoordination fee spendIndividuals with no claims3.1Behavioral health core spend48%Medical spend44%Spend for non-behavioralhealth membersSpend for members with onlycare coordination fee spend25%62%6%7%MembersSOURCE: FY15 State of Illinois DHFS claims data10.58%0%Spend7
DRAFT - Confidential and ProprietaryObjectives of the Illinois HHS Transformation to address thesechallenges3Core digitizedmember ication,screening &access6109Best practicevendor andcontractmanagement5Workforceand systemcapacityThe nation’sleadingmember-centricbehavioralhealth strategyStructure,budgeting,and policysupport48High intensityassessment,care planning,and care7coordination /Low-intensity integrationassessment,care planning,and carecoordination /integrationData interoperabilityandtransparency8
DRAFT - Confidential and ProprietaryThe 1115 waiver will allow Illinois to realize a set of high-priority benefits,alongside initiatives that will maximize their effectivenessDemonstration waiver benefits#Benefit1Supportive housing services2Supported employment services3Services to ensure successful transitions forIDOC- and Cook County Jail (CCJ)incarcerated individualsDemonstration waiver initiatives#Initiative4.1 Services for individuals with substance usedisorder in short-term stays in IMDs1Behavioral and physical health integrationinitiatives4.2 SUD case management2Infant/Early childhood mental healthinterventions4.3 Withdrawal management3Workforce-strengthening initiatives4.4 Recovery coaching for SUD4First episode psychosis (FEP) programs5.1 Services for individuals with mental healthissues in short-term stays in IMDs5.2 Crisis beds6Respite care9
DRAFT - Confidential and ProprietaryThe State will also pursue initiatives outside the waiver to advance itsbehavioral health strategyNon-waiver initiatives covered hereOther initiativesState nds State Plan Amendments (SPAs),including, but not limited to:– Integrated physical andbehavioral health homes– Crisis stabilization and mobilecrisis response– Medication-assisted treatment(MAT)– Uniform Child and AdolescentNeeds and Strengths (CANS)and Adult Needs andStrengths Assessment (ANSA) Advance Planning Documents(APDs)– Data interoperability through360-degree view of behavioralhealth member10
DRAFT - Confidential and ProprietaryOverview of transformation journey to date20161115 waiverpubliccommentperiodSubmit 1115waiver andrelatedSPAs toCMSInitialfeedbackfrom CMSTransformation journeyJanFebState of thestate addressinitiates thecall for HHStransformationMarAprMayTown hallmeetings –Chicago andSpringfieldJunJulAugSepStakeholderworking groupsessions Consumeradvocates Providers Communityservices MCOsOctNovDecRegular crossagency Transformationworking groupmeetings2017InitialIntegratedHealthHome SPAsubmissionto ingOngoing 1:1 and small group engagement11
DRAFT - Confidential and ProprietaryAgenda for today’s discussionContext of the Illinois HHS Transformation15 minutesObjectives of Waiver Advisory Committee15 minutesIntroduction to Integrated Health Home model20 minutesCare delivery model topics for input today60 minutesPath forward10 minutesProprietary and Confidential1212
DRAFT - Confidential and ProprietaryThe Waiver Advisory Committee will be instrumental toshaping the transformation across several topicsPRELIMINARYFocus for the next two meetingsWorking groups presenting material for inputIntegrated HealthHomesHome Visiting PilotSupportive icesJustice-involvedRespite CareSUD CaseManagementWithdrawalManagementSUD RecoveryCoachingDiscussions across topics will focus on theinsights from your experienceand potential implications of designdecisions under considerations13
DRAFT - Confidential and ProprietaryAgenda for today’s discussionContext of the Illinois HHS Transformation15 minutesObjectives of Waiver Advisory Committee15 minutesIntroduction to Integrated Health Home model20 minutesCare delivery model topics for input today60 minutesPath forward10 minutesProprietary and Confidential1414
DRAFT - Confidential and ProprietaryIntegrated Health Homes topics for advisory committee considerationFocus for todayCare delivery model (January 19)Detailed model (Following meeting) Foundational decisions for anIntegrated Health Home’s role inthe ecosystem:–1 Member inclusion– Who should be included in themodel?–2 Care delivery improvementsHow can we best meet members’needs?–3 Provider standards andsupport– What requirements should beexpected of providers, and howcan we support them in reachingthese?Next set of detailed designdecisions including:– Activity requirementsWhat forms of care coordinationshould providers be capable ofoffering members?– Incentives for value-based careHow can we drive increases inprovider performance?– Quality and efficiencymeasuresHow should we measure providerperformance?– Scale-up approachHow should the program be rolledout?15
DRAFT - Confidential and ProprietaryWhat an Integrated Health Home is and is notIntegrated Health Homes in Illinois are:Primary focus is on coordination of care Integrated, individualized care planning andcoordination resources, spanning physical,behavioral and social care needs An opportunity to promote quality in the coreprovision of physical and behavioral health care A way to encourage team-based caredelivered in a member-centric way A way of aligning financial incentives aroundevidence-informed practices, wellnesspromotion, and health outcomesFor members with the highest needs: A means of facilitating high intensity,wraparound care coordination An opportunity to obtain enhanced match forcare coordination needs Identifying enhanced support to help thesemembers and their families manage complexneeds (e.g., housing, justice system)Integrated Health Homes in Illinoisare NOT: and NOT on the provision of all services Provider of all services for members A gatekeeper restricting a member’s choice ofproviders A physical place where all Integrated HealthHome activities occur A care coordination approach that is thesame for all members regardless of individualneedsAnything else you would add to these lists?16
DRAFT - Confidential and ProprietaryPrinciples for Integrated Health Homes in IllinoisDevelop a person- and family-centered care delivery model for thewhole Medicaid population, regardless of match status, thatencourages member and family engagementEvolve toward full clinical integration of behavioral, physical, andsocial healthcareCraft a flexible care delivery approach that reflects the diverse needs ofmembers in Illinois and recognizes that member needs change overtimeAcknowledge and accommodate geographical variation in providercapabilities, readiness, and prioritiesStrike an appropriate balance between provider flexibility andaccountability to enable capabilities and readinessPrioritize economic sustainability of care delivery model at both thesystemic and provider levelsGoal is to begin launch of model by July 201717
DRAFT - Confidential and ProprietaryTo date, 33 Health Home models have been developed throughout theInclusion criteria:United StatesOnly focused on members with behavioral health conditionsBroader population, including members with behavioral health conditionsOnly focused on members with physical health conditionsFull NWVCOCA2KS1MACT RI3IA3NENVNY3WIVAMO3DCMDKYNCAZAKNMOK3TNThe Illinois modelARwill breaknew ground by offering allMSALMedicaid members a fullyTXLAof careintegratedmodelcoordinationSCGAFLHawaii1 Oregon, Idaho, and Kansas have opted not to continue their programs2 California will launch its Health Home model in July 20173 State has initiated multiple health home modelsSOURCE: Open Minds; CMS database of approved Medicaid Health Home State Plan Amendments, as of December 201618
DRAFT - Confidential and ProprietaryProfiles of ACA Health Homes launched to dateIllinois would be first fully integrated Health HomeLargest Medicaid Health Home programs developed to dateNumber of enrollees, thousandsIncludes members with SMI/SEDs% of Medicaid Conditionspopulationaddressed26% Chronic26% Chronic/SMI3% Chronic/SMI4% Chronic604% SMI52119% Chronic540230220692514% SMI/SED2513% SMI/SEDMany states also employ PCMH programs to coordinate the physical health needs of theirmembers separately, but Illinois model would coordinate both physical and behavioralhealth care for all 3.1m Medicaid members1 Only includes members who are part of the state’s largest Health Home programSOURCE: CMS Health Home Information Resource Center19
DRAFT - Confidential and ProprietaryIllinois’ model would address the needs of a broad range of memberarchetypesAgeLiving situationBehavioral healthconditionJerryToddlerIn at-risk homeAt-riskJaneChildYouth in careADHD/ODDConnorTeenagerTransferring to congregate careSevere aggressionBriceTeenagerUrban homeMajor depressionMikeTeenagerJuvenile institutionBipolar disorder/ alcohol andmarijuana abuseMiaTeenagerRural homeOpioid abuseJennYoung AdultRural homeAnxietyGregYoung AdultCorrectional facilitySchizophreniaStephenAdultExperiencing homelessnessActively psychotic/ opioid abuseDarnellAdultExperiencing homelessnessPost-traumatic stressAshleyAdultPermanent supportive housingSchizophreniaTomAdultFriend’s couchAlcohol and heroin abuseWilliamAdultRural homeAlcohol abuseCynthiaAgedSkilled nursing facilityModerate anxiety and depressionArchetype20
DRAFT - Confidential and ProprietaryAgenda for today’s discussionContext of the Illinois HHS Transformation15 minutesObjectives of Waiver Advisory Committee15 minutesIntroduction to Integrated Health Home model20 minutesCare delivery model topics for input today60 minutesPath forward10 minutesProprietary and Confidential2121
DRAFT - Confidential and ProprietaryApproach for reviewing care delivery model design decisions The items that follow comprise the working group’s initialperspective on key care delivery model design decisions,thanks to close collaboration between representatives from theDepartment of Healthcare and Family Services, Division ofMental Health, Department of Children and Family Services,Division of Alcoholism & Substance Abuse, and the IllinoisDepartment of Public Health These ideas build on work done as part of the Healthy Illinois2021 plan, supported by a State Health Assessment, SIMgrants, 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, andwith regard to any other queries or modifications you mightsuggest as we discuss the decisions more broadly. Your responses today will help refine and improve thesedecisions, and will be reflected wherever possible22
DRAFT - Confidential and ProprietaryIntegrated Health Homes working teamTeam leadTeresa HurseyTeam membersNameAgencyNameAgencyJayne AntonacciDASAPaula JaudesDCFSMaria BruniDASADiana KnaebeDMHMary DoranHFSDavid KuriniecHFSJuliana HarmsDCFSCatina LathamHFSAmy Harris-RobertsHFSShannon LightnerIDPHKristine HermanHFSLee Ann ReinertDMH23
DRAFT - Confidential and ProprietaryILLUSTRATIVE1 Member inclusion and engagement: Introduction tosuggested approachHighHigh behavioral health needs,Low physical health needsLevel ofbehavioralhealthneeds Highestneeds ModerateneedsmembersLowbehavioralhealth needs,high physicalhealth needsLow needsmembersLowLowAre theredemographiccharacteristics youfeel ought to qualifya member for entryinto the highest tiersof need (e.g.,children in DCFScare)Are there anymembers of theMedicaid populationthat should beexcluded fromIntegrated HealthHome membership(e.g., those alreadyreceivingwraparound supportfrom otherprograms?)HighLevel of physical health needsApproach to tiering adopted to ensure members with similar needs receivecomparable care coordination support, and to focus resources on thosemembers who need greatest support24
DRAFT - Confidential and Proprietary2 Integrated Health Homes will deliver improvements in care deliveryacross a range of orDarnellJennWilliamCynthiaManaged Care OrganizationsEnhanced access, screening, and assessmentHigher-needs population1Lower-needs population1Integrated Health HomesIntegrated careplanning andmonitoringHigher-intensityIntegrated rnalhealthproviderengagementMemberengagementand educationBehavioralhealth providerengagementLower intensityIntegrated HealthHomesSupportiveservicecoordinationReporting of quality and efficiency of care (i.e., member outcomes)Payment streams, in response to Integrated Health Homes meeting requirements and improving outcomes1 Actual tiering of intensity of care coordination may not be binary25
DRAFT - Confidential and Proprietary2 IHHs achieve 6 main goals for members and familiesBarriers to integrated careInfrequent data sharing and communicationbetween providersSiloed care planningFrequent barriers to attendance to medicalappointmentsLittle continuity in care delivery across providersFrequent barriers to attendance to behavioral healthappointmentsLittle continuity in care delivery across providersLimited provider engagement with communitysupports in the care and recovery process (e.g.,schools, Big Brothers/Sisters, AA)Infrequent follow-ups and outreach to members andtheir caregivers (including foster families)Reactive treatment programs, with little emphasis onself-care, education, and social skill developmentProviders take a case-by-case view of populationhealthMember focus determined based on episodesIntegrated care facilitated by IHH care coordinationIntegratedcare planningandmonitoringPhysical /maternal healthproviderengagementBehavioralhealth berengagement &educationPopulationhealthmanagementProviders take holistic view of health, supplying fullset of services appropriate to members’ needsComprehensive care plans developed with memberand caregivers, supported by ongoing communicationwith behavioral and physical healthcare providersImproved access to providers for routineappointments and time-sensitive supportIntegrated experience with seamless connectionsand communication across providersImproved access to providers for routineappointments and time-sensitive support (e.g., MCR)Integrated experience with seamless connectionsand communication across providersAccess to and collaboration with communitysupports is prioritized (e.g., supported housing,employment, and services offered by agency partners)Member needs are communicated to communitypartnersSupport for treatment and medication adherence(e.g. Ritalin, MAT)Enhanced social skills education, self-care, andengagement with supports (e.g., child & family teams)Improved dialogue among providers on qualityoutcomes across panelContinuous stratification of panel and use ofstandardized assessment processes to identifyhighest-needs membersProviders make limited use of screening tools (e.g.,CANS, ANSA)What should be added to these goals?26
DRAFT - Confidential and Propriet
Jan 18, 2017 · 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-
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