Chairman Junge called the meeting to order. Present: Chairman Emilie N. Junge and Director Sidney A. Thomas, MSW (2) Director Ada Mary Gugenheim

Transcription

1 Minutes of the meeting of the Managed Care Committee of the Board of Directors of the Cook County Health and Hospitals System held Monday, February 26, 2018 at the hour of 10:30 A.M. at 1900 W. Polk Street, in the Second Floor Conference Room, Chicago, Illinois. I. Attendance/Call to Order Chairman Junge called the meeting to order. Present: Chairman Emilie N. Junge and Director Sidney A. Thomas, MSW (2) Director Ada Mary Gugenheim Absent: Director Virginia Bishop, MD, MPH (1) Additional attendees and/or presenters were: Debra Carey Deputy Chief Executive Officer, Operations Douglas Elwell Deputy Chief Executive Officer, Finance and Strategy James Kiamos Executive Director of Communications Jeff McCutchan General Counsel Deborah Santana Secretary to the Board The next meeting of the Committee will be held on Wednesday, April 18, 2018 at 10:30 A.M. II. Public Speakers Chairman Junge asked the Secretary to call upon the registered public speakers. The Secretary responded that there were none present. III. Report on CountyCare Health Plan (Attachment #1) James Kiamos, Executive Director of Managed Care, provided an overview of the Report on the CountyCare Health Plan. The Committee reviewed and discussed the information. The Report included information on the following subjects: Acquisition Update Membership Why Attrition Immediate Activities Current Marketing Campaign October 2017 through March 2018 Introducing CountyCare Rewards Program Additional Tactics Strategic Provider Partnerships Creativity with Physicians / Hospitals Our Network Now Where Our Members Reside Legislative Future Metrics Data Charts Quality, Risk Management, Utilization and Membership Metrics

2 Minutes of the Meeting of the Managed Care Committee Monday, February 26, 2018 Page 2 III. Report on CountyCare Health Plan (continued) During the discussion of the information, a question arose regarding the CountyCare organizational chart. Mr. Kiamos indicated that staff are currently working on it; once revisions are finalized, a copy will be provided to the Committee. Director Thomas inquired whether information can be provided that reflects the percentage of CountyCare members who have chosen their primary care provider from within CCHHS. Additionally, Chairman Junge inquired whether the administration can track data on members who fill their prescriptions at CCHHS versus filling them at outside pharmacies. Mr. Kiamos responded that this information will be provided. Director Thomas noted that the Medicaid Managed Long Term Services and Supports (MLTSS) and Waiver population is growing; it would be good to get that information also. Mr. Kiamos stated that that type of information would typically be included in the periodic report from Mary Sajdak, Senior Director of Integrated Care; he will coordinate with Ms. Sajdak to relay that request. Mr. Elwell provided information on two (2) other plans that will be reported on in the future. CCHHS is now at risk for HMOI; 3,700 members came in on January 1 st. Another plan that CCHHS has had for a while but is getting a bit more organized each day is the CareLink plan, which has 27,000 members. For that plan, CCHHS will probably be adding some partner organizations in the near future. Both of those plans will start being reported to the Committee at the next meeting. IV. Action Items A. Minutes of the Managed Care Committee Meeting, December 7, 2017 Director Thomas, seconded by Chairman Junge, moved to accept the minutes of the Managed Care Committee Meeting of December 7, THE MOTION CARRIED UNANIMOUSLY. B. Any items listed under Section IV V. Adjourn As the agenda was exhausted, Chairman Junge declared the meeting ADJOURNED. Respectfully submitted, Managed Care Committee of the Board of Directors of the Cook County Health and Hospitals System XXXXXXXXXXXXXXXXXXXXXXXXXX Emilie N. Junge, Chairman

3 Minutes of the Meeting of the Managed Care Committee Monday, February 26, 2018 Page 3 Attest: XXXXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary Requests/Follow-up: Request: Request: Request: Request: Request for a copy of the CountyCare organizational chart, following revision and finalization. Page 2 Request for information that reflects the percentage of CountyCare members who have chosen their primary care provider from within CCHHS. Page 2 Request for information on the CountyCare members who fill their prescriptions at CCHHS versus filling them at outside pharmacies. Page 2 Request for information to be provided on the MLTSS and Waiver populations in the next report on Integrated Care to the Committee. Page 2

4 Cook County Health and Hospitals System Minutes of the Managed Care Committee Meeting February 26, 2018 ATTACHMENT #1

5 CountyCare Update Prepared for: CCHHS Managed Care Committee of the Board of Directors February 26, 2018 James Kiamos Executive Director, Managed Care

6 Acquisition Update Operations stabilized from surge New provider partners contracted Attrition of non-legacy membership 2

7 Membership ( ) Monthly membership at 350,218 as of 2/1/18 ACA = 79,407 FHP = 239,364 ICP = 31,447 Choice through 3/31/18 3

8 Why Attrition Historical experience 20% is standard Consumer confusion that CountyCare limited to CCHHS clinics and hospitals Transactional relationship with providers added through acquisition 4

9 Immediate Activities Message broad provider participation to our members Aggressive provider outreach such as FQHC breakfast and office visits Ensuring that CountyCare member extra benefits are leveraged and executed Ongoing redetermination efforts and events 5

10 Current Marketing Campaign October 2017 March

11 Current Marketing Campaign October 2017 March

12 Introducing CountyCare Rewards Program New CountyCare Rewards Program Annual Health Risk Screening - $15 reward Healthy Moms Program - $10/$25 reward Well-Child Visits - $25/$10 reward Immunizations for Babies - $10 reward Breast Cancer Screening - $25 reward Blood Pressure Control - $25 reward Diabetic Annual PCP Visit and Screening - $25 reward Diabetic Eye Exam - $25 reward Care Management - $25 reward Aftercare/Follow-up Visits - $20/$10 reward Additional CountyCare Benefits Free Sleep Safe Kit for Mothers Who Complete All Prenatal Visits Free Car Seat for Enrolled Children Book Club for Kids Ages 3 Through 16 Free Home Pregnancy Tests Free Weight Watchers Membership Vouchers Free Cell Phone Minutes for Health-Related Calls to CountyCare 8

13 Additional Tactics Member Newsletter Website Updates Provider Materials Call Center Materials and Hold Messages 9

14 Strategic Provider Partnerships Migrating from a transactional relationship to a business partner relationship with non-mhn high volume providers Partnerships that reward efficiencies in care, quality and incents growth with CountyCare 10

15 Creativity with Physicians/Hospitals Where appropriate, push activities closer to providers allowing them to influence outcomes while offering an additional revenue stream Leverage membership growth with PCPs while addressing chronic Medicaid specialty access challenges through CCHHS specialists 11

16 Our Network Now 53 Hospitals 26 FQHC Partners 4,690 PCPs (Primary Care Providers) 14,639 Specialists 12

17 13 Where Our Members Reside

18 Legislative Changes in hospital assessment funding More of a focus on MCOs Mandatory facility contracting Illinois Association of Medicaid Health Plans Board representation Unique within the association 14

19 Future Metrics Group Performance Membership Quality Risk Pools (Medical, Hospital, Pharmacy) CCHHS volume Network Management Provider engagement Contract performance 15

20 Future Metrics Plan Finance (high level) Revenue Medical Expense Ratio Streamline existing operational metrics Dashboard approach Highlight trends 16

21 Data Charts Provided for Informational Purposes Only

22 Quality Metrics Provided for Informational Purposes Only % Change to Month Prior FYTD'18 Budget or Goal Key Measures Oct'17 Nov'17 Dec'17 Trend 1) QUALITY - HY'17 P4P Measures (FHP/ACA only reported) 1.1) Ambulatory Access Outcome Measure HY18 Goal Adult Access to Prevention: Total CC (AAP) 66.0% 66.1% 72.7% 10.0% 88% 1.2) All Other HEDIS Pay-For-Performance Measures Breast Cancer Screening (BCS) 50.8% 51.5% 55.1% 7.0% 66% Cervical Cancer Screening (CCS) 42.4% 42.5% 48.3% 13.6% 64% Comprehensive Diabetes Care: Eye Exam (CDC) 26.6% 26.4% 28.6% 8.3% 62% Comprehensive Diabetes Care: HbA1c Testing (CDC) 68.9% 70.1% 80.1% 14.3% 90% Comprehensive Diabetes Care: Nephropathy Testing (CDC) 81.2% 87.9% 85.5% -2.7% 92% Follow-up After Hospitalization for Mental Illness: 30d (FUH) 20.4% 18.9% 18.1% -4.2% 73% Alcohol & Other Drug Dependence Treatment: Ages 13+ Engagement (IET) 9.1% 9.3% 9.0% -3.2% 14% Alcohol & Other Drug Dependence Treatment: Ages 13+ Initiation (IET) 32.0% 33.4% 32.8% -1.8% 47% Postpartum Care (PPC) 44.2% 40.8% 49.2% 20.6% 74% Timeliness of Prenatal Care (PPC) 48.8% 47.0% 56.5% 20.2% 83% Weight Assessment & Counseling: Nutrition, Total (WCC) 11.8% 12.3% 13.4% 8.9% 71% Weight Assessment & Counseling: Phys Activity, Total (WCC) 3.1% 3.1% 6.8% 119.4% 64% Well-Child Visits in the First 15 Months of Life: 6 Visits (W15) 16.2% 17.0% 26.7% 57.1% 68% Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life (W34) 33.1% 33.8% 44.7% 32.2% 78% 18

23 Risk Management Metrics Provided for Informational Purposes Only Key Measures Oct'17 Nov'17 Dec'17 % Change to Month Prior Trend FYTD'18 Budget or Goal Key: % of Budget/ Goal 2) RISK MANAGEMENT 2.1) Completed HRS/HRA (all populations, cum) Overall 58.4% 30.2% 32.4% 7.1% 100% 32.4% MHN ACO 94.9% 67.6% 71.9% 6.4% 100% 71.9% La Rabida Care Coordination (CSNs only) 90.1% 78.5% 83.2% 6.0% 100% 83.2% CCHHS CCC 21.0% 8.4% 9.0% 7.0% 100% 9.0% 2.2) High-Risk Stratification (all populations, cum) Overall 5.4% 1.6% 1.7% 6.2% 3.0% -45.0% MHN ACO 3.2% 2.2% 2.3% 4.5% 3.0% -24.0% La Rabida Care Coordination (CSNs only) 31.0% 34.2% 36.3% 6.2% 3.0% % CCHHS CCC 14.9% 1.0% 1.0% 6.8% 3.0% -65.3% 2.3) Completed Care Plans on High Risk Members ACA/FHP 52.4% 48.3% 47.9% -0.4% 75.0% 63.9% ICP 33.0% 30.7% 28.0% -2.7% 75.0% or Within 5% > 5% From Better of Goal Goal Than Goal 19

24 Utilization Metrics Provided for Informational Purposes Only Key Measures Oct'17 Nov'17 Dec'17 3) UTILIZATION % Change to Month Prior Trend FYTD'18 Budget or Goal % of Budget/ Goal 3.1) CountyCare Reimbursement to CCHHS (FYTD) $89,883,588.1 $112,867,192 $10,671,427 $18,833, % 3.2) CCHHS ER Utilization/1,000 member months (per month) Change from Rolling 12-Mo Current to Jul'17 Aug'17 Sep'17 Prior Month Trend Average Baseline ACA % % FHP % % ICP % % 3.3) CCHHS Admits/1,000 member months (per month) ACA % % FHP % % ICP % % 3.4) ER Utilization/1,000 member months (per month) ACA % % FHP % % ICP 1,323 1,273 1, % 1, % 3.5) Inpt Utilization/1,000 member months (per month) ACA % % FHP % % ICP % % 3.6) Total Readmission Rates (same diagnosis within 30 days) ACA % % FHP % % ICP % % 3.7) BH Readmission Rates (same diagnosis within 30 days) ACA % % FHP % % ICP % % or Within 5% > 5% From Better of Goal Goal Than Goal 20

25 Membership Metrics Provided for Informational Purposes Only Key Measures Oct'17 Nov'17 Dec'17 % Change to Month Prior Trend FYTD'18 Budget or Goal Key: % of Budget/ Goal 4) MEMBERSHIP 4.1) Monthly Membership 138, , , % 225, % ACA 51,330 67,569 64, % 75, % FHP 80, , , % 135, % SPD 6,190 12,036 11, % 15, % Home/Community Waiver (incl DD) 850 1,628 1, % LTC % 4.2) FYTD Member Months 1,554,962 1,852, , , % ACA 603, ,986 64,786 75, % FHP 890,422 1,108, , , % SPD 61,123 73,159 11,907 15, % 4.3) Mbrs by Delegated Care Management Group CCHHS CCC (ACHN, LTSS, non-mhn ACO) 69, , , % MHN ACO 67, , , % La Rabida Care Coordination (CSNs only) 1,126 1,325 or Within 5% > 5% From Better of Goal Goal Than Goal 21

26 Operations Metrics Provided for Informational Purposes Only Key Measures Oct'17 Nov'17 Dec'17 % Change to Month Prior Trend FYTD'18 Budget or Goal Key: % of Budget/ Goal 5) OPERATIONS 5.1) Claims Payment Turnaround Time: % Paid < 30 days 49.3% 29.6% 28.1% -5.1% 90% 31.2% 5.2) Member & Provider Services Call Center Goal Goal Met Abandonment Rate 2.17% 11.02% 6.73% -38.9% < 5% N Hold Time % < 0:01:00 N % Calls Answered < 30 seconds 80.00% 44.84% 62.57% 39.5% > 80% N 5.3) Claims/Encounters Acceptance Rate (Quarterly) 90.10% 91.30% 91.30% 0.0% 95% or Within 5% > 5% From Better of Goal Goal Than Goal 22