1 Alliance for Health Steering Commitee January 7, 2015
2 AGENDA Presentation of the Work Group Recommendations Final Report Regional Health Improvement Summits report State Innovation Model- Model Design Award Opportunities for limited model testing Federal feedback on Model Test application Next Steps Priorities Potential Partnerships, including CMMI funded projects in Illinois Continued Stakeholder Engagement
3 WORK GROUP REPORT The report is provided in three sections: Report Detailed recommendations Additional Material Appendices Link to report: http://www2.illinois.gov/gov/healthcarereform/ Pages/GOHIT.aspx
INTEGRATED DELIVERY SYSTEM REFORM 4
IDSR Statistics 18 work group and subcommittee meetings 25.5 meeting hours 3 surveys Engaged 265 stakeholders from more than 150 organizations 5
IDSR Themes - Critical Issues discussed by stakeholders Address the evolving role of community providers in the managed care and IDS context. Major changes in Medicaid-funded human service delivery require new platforms for care coordination Address access and affordability barriers for undocumented individuals Develop working definition of integrated delivery system Identify quality metrics for broad and narrow populations that can be adopted by all payers. 6
IDSR Process Leadership This work group was led by Michael Gelder, Governor s Office of Health Innovation and Transformation director and Derek Robinson, MD, director of the Illinois Hospital Association Quality Care Institute. Subject matter expertise was provided by Art Jones, MD, Health Management Associates. Administrative, research, and coordination support was driven by Health & Medicine Policy Research Group and GOHIT. 7
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9 CHILDREN S SERVICES SUBCOMMITTEE 48 associated recommendations accompany these primary recommendations.
CHILDREN S SERVICES STATISTICS Engaged 205 stakeholders from 84 organizations 38 Breakthrough Group meetings Membership Advocates, parents and families of consumers Service providers including: behavioral health, social services, home & community-based services State staff including: Departments of Healthcare and Family Services, Human Services, Children & Family Services, Juvenile Justice, State Board of Education 10
THEMES - Critical Issues discussed by stakeholders Create and implement a statewide governance structure to support the transition to System of Care Framework for the Children s Behavioral Health Service Delivery System. Promote early intervention and prevention through global screening and universal assessment. Expand the Medicaid service array to include additional community-based services. Establish and fund statewide, university-based Center of Excellence to support a Children s Behavioral Health Service Delivery System based on a System of Care framework. Pursue statewide coverage for youth seeking publicly funded behavioral health services through a Care Managed Entity, consistent with Systems of Care. Important considerations for the immediate and midterm future Need for an established governance structure that has legitimacy, authority and accountability. Need to engage families and youth in any system and program design. 11
Process Leadership Dr. Lorrie Rickman Jones (GOHIT) and Grace Hou (Woods Fund) chaired the Services & Supports Work Group. Deb McCarrel (HFS) and Colette Leuck (Children s Mental Health Partnership) chaired the Children s Services Subcommittee. Sheila Pires and Shannon Van Deman provided subject-matter expertise. Illinois Health and Medicine Policy Research Group provided work group coordination. 12
13 LONG-TERM SERVICES & SUPPORTS SUBCOMMITTEE 53 associated recommendations accompany these primary recommendations.
LTSS SUBCOMMITTEE STATISTICS Engaged 464 stakeholders from over 180 organizations 1,780 total stakeholder volunteer hours 16 Subcommittee and Breakthrough Group meetings 8 surveys with 545 responses Membership Consumers of waiver services Advocates, parents and families of consumers Service providers including: behavioral health, social services, aging, developmental disabilities, home & community-based services State staff including: Department of Healthcare and Family Services, Department of Human 14
THEMES - Critical Issues discussed by stakeholders Unbundle services and broaden service definitions to allow for consumer choice, control and flexibility Address need for new services, rule-making and rates-development as part of implementation, and continue to involve consumers in the decision making processes Identify gaps and training needs and create training infrastructure and communications plan for all stakeholders Ensure standardization and accountability across managed care entities, plans, payers and providers for compliance with Person-centered Planning, BIP and HCBS regulations Ensure sufficient resources and community supports to implement and maintain a system-wide Person-centered Planning model Important considerations for the immediate and mid-term future BIP requirements regarding CFCM Federal CMS Home & Community Based Services (HCBS) regulations regarding Conflict of Interest and Person-centered Planning. The proposed service integration, service definitions and provider qualifications would inform 1115 waiver implementation. 15
Process Leadership Dr. Lorrie Rickman Jones (GOHIT) and Grace Hou (Woods Fund) chaired the Services & Supports Work Group. Lora McCurdy (HFS) chaired the LTSS Subcommittee and two Breakthrough Groups. Steve Lutzky (HCBS Strategies) and Gwyn Volk (Navigant) provided subject-matter expertise. Illinois Public Health Institute provided work group coordination. 16
POPULATION HEALTH INTEGRATION 17
Membership 93 social/advocates, 21 health care system organizations, 45 state staff and 5 managed care providers Work Group statistics (including subcommittees) 295 stakeholders 2155 organizations 222 meetings; 33 hours 268 responses to 1st Stakeholders Survey 232 responses to 2nd Stakeholder s Survey 18
IMPORTANT CONSIDERATIONS FOR THE IMMEDIATE AND MID-TERM FUTURE In recognizing that additional public health resources and improved integration are necessary to catalyze the efforts of isolated health systems and local communities, the Population Health Integration Work Group identified the following important considerations for the future: Managed care plans should be engaged further in discussions regarding the creation of a bonus pool for health plans. The members of the Expanding Maternal Child Home Visits Subcommittee should be utilized as resources, many of whom are also members of the Sustainability Workgroup of the Home Visiting Task Force, and remain committed to moving this effort forward. Each RHIC entity will likely have resources that can be leveraged towards the common work of the Collaboratives. The State can facilitate this by requiring or encouraging meaningful participation in RHICs. Resources such as pay for success funding is something that might be very effective for pilots that wish to engage in Asset Based Community Development and receive funding based on the results that their programs can demonstrate. 19
20 ISSUES UNDER DISCUSSION BY STAKEHOLDERS Asset Based Community Development Issues discussed were focused on: social determinants of health; the communities we wish to serve; building networks within the communities; addressing various geographic areas; and community based capacity in Illinois. Creation of Bonus Pool for Health Plans Subcommittee Providing incentives for population health interventions. Bonus pool dollars should be structured in a way that does not duplicate payment for services that are already reimbursable through Medicaid fee-for-service payments. Medicaid managed care plans must be at the table in these discussions. Expanding Maternal Child Home Visits Subcommittee A number of programs have been providing services that improve health outcomes and should coordinate with existing providers. The State needs to develop a strategy through which the State could allow home visitors to bill Medicaid for providing home visiting services. Regional Health Improvement Collaboratives Subcommittee Foundational principles included elements of: multi-sectoral representation that was not dominated by any specific discipline, active participation, and accountability.
PROCESS LEADERSHIP In partnership with the Illinois Department of Public Health, the Health & Medicine Policy Research Group has driven the development of content and supported the Chairs in the development and execution of strategy for the Population Health Integration Work Group. Health & Medicine has also worked closely with the Chairs of the Subcommittees as well to coordinate internal Work Group efforts with other Subcommittees and share information. 21
WORKFORCE 22
MEMBERSHIP 57 social/advocates, 15 health care system organizations, 15 state staff and 6 managed care providers WORK GROUP STATISTICS (INCLUDING SUB-COMMITTEES) 208 Stakeholders 117 Organizations 22 Meetings Held 44 hours of meetings 29 Responses to Stakeholder s Survey 23
Important considerations for the immediate and mid-term future In response to changing population and patient needs, federal and state health care reforms, and innovations in delivery models, professional practices, and technology, the work group recognizes the need to use professional and paraprofessional health care workers in new roles with different skill requirements. To that end, the following are important considerations for the future: Provide public funding critical to the innovation and sustainability of any pipelines and pathways strategy. Matching public resources to private resources that are aligned with meeting health workforce needs in high need areas to provide financial incentives. Capitalize on new federal funding streams for telehealth projects. Leverage colleges that currently and/or will train Community Health Workers, as well as community based organizations, community health centers, hospitals and other facilities that will employ CHWs. Leverage scope of practice resources including trade associations that represent the health professionals, health care system employers, and other industry commissions that evaluation. quality measures for health professionals. 24
ISSUES UNDER DISCUSSION BY STAKEHOLDERS Financial Incentives Subcommittee All recommendations are meant to help Illinois grow the health workforce to meet residents needs, ensure efficient health workforce planning, and better understand where there are provider shortages across different geographies. Health Workforce Expansion Subcommittee Health care reform is focused on outreach and prevention. Community Health Workers can provide an entry route for low-skilled workers to health professions. Workplace shortages create increasing pressure to have health professionals practice at the top of their license. Pipelines and Pathways Subcommittee Employers need to be included as partners in training and investment in pipeline and pathways programs. There are a number of barriers for health care professions to licensing, employment, and eligibility requirements for pipelines and pathways programs. Telehealth Subcommittee There is a need for a neutral platform to bring stakeholders together to learn from each other, to better understand telehealth obstacles, to explore ways to eliminate those obstacles and to coordinate their future telehealth plans. 25
PROCESS LEADERSHIP Health & Medicine Policy Research Group has driven the development of content and supported the Chairs in the development and execution of strategy for the Workforce Work Group. Health & Medicine has also worked closely with the Chairs of the Subcommittees as well to coordinate internal Work Group efforts with other Subcommittees and share information. 26
DATA AND TECHNOLOGY 27
WORK GROUP STATISTICS 21 work group and subcommittee meetings Engaged 162 stakeholders from over 130 organizations Membership Medical providers, health plans, behavioral health providers, community health centers, epidemiologists, information managers, data stewards, state staff, including Departments of Public Health and Healthcare and Family Services 28
29 THEMES - Critical Issues discussed by stakeholders Care coordination needs to include social and behavioral consumer goals Major changes in Medicaid-funded human service delivery require new platforms for care coordination Health care and human service providers are overwhelmed by the demands made on them to automate and integrate service and care delivery Ensure stakeholders involved, engagement continues Leverage existing assets claims data from payers, Health Care Cost Institute (HCCI) partnership Upload more State data, with a structured timeline for updates Utilize metadata standards and best practices across agencies Publish more data related to socio/economic factors of health Important considerations for the immediate and mid-term future Innovation must be balanced with cost and degree of difficulty to implement Integrated delivery system criteria should be expressed as goals for desired functionality, not as technical systems requirements Determine if APCD is a voluntary or compulsory activity; create stakeholder engagement process to support legislation Pursue a potential collaboration with HCCI Task proposed Executive Steering Committee with adopting uniform data standards and a governance plan to be utilized by all agencies
PROCESS LEADERSHIP Mary McGinnis (GOHIT) and Pat Merryweather (Telligen) co-chaired the Data and Technology Work Group. Joseph West (NextLevel Health) chaired the Care Coordination Subcommittee, Mark Chudzinski (Marketplace) chaired the APCD Subcommittee and Stephen Konya (IDPH) chaired the Open Data Subcommittee. Illinois Public Health Institute provided work group coordination. 30
31 Regional Health Improvement Summits Joint effort of DPH, GOHIT and the State Health Improvement Plan Implementation Council Held eight Regional Summits More than 1500 participants Opportunity for stakeholders to discuss how they can align their efforts with health improvement initiatives around the state
32 Round 2 - State Innovation Model (SIM) Design Grant Award $3 million to be awarded February 1, 2015 Opportunities for limited model testing Pilot site testing of innovations Regional Health Improvement Collaboratives Federal Feedback on Illinois application Stakeholder engagement Support from private insurance carriers, business and state group health Data and technology
33 Next Steps Stakeholder Feedback Priorities Potential Partnerships Continued Stakeholder Engagement
34 More Information GOHIT: http://www2.illinois.gov/gov/healthcarereform/pag es/gohit.aspx