Greetings from HFS Director Julie Hamos
Welcome to another periodic edition of HFS e-news to keep you updated on program changes. To register for future editions, please visit HFS E-News Online Registration or download for others who might be interested by visiting: hfs.illinois.gov/enews. If you are a Medicaid client, this newsletter is not the official notification of any changes that may impact you, and you do not have to respond in any way. This is general information for the public. Thank you,
Alliance for Health Seeking Your Input
The State of Illinois received a federal planning grant to develop a State Health Care Innovation Plan, which will focus on models to enhance quality, improve health status and reduce overall costs. It is a collaboration among health plans, providers, and payers to reform payment and healthcare delivery systems. The Innovation Plan will incorporate new initiatives, as well as build upon the delivery and payment system reforms already underway in Medicaid and the private sector.
This planning process is organized through the new “Provider-Plan-Payer Alliance for Health” or the “Alliance.” The Alliance has a website where all materials are being posted.
The Alliance is asking for input from healthcare consumers, using as a guide a series of Town Hall Questions that are found on the website. Please share your recommendations to improve the health of you and your community, your health care, and ways to reduce costs to make health care more affordable. These questions can be answered online:
Improve Personal and Community Health
- What are the greatest health challenges for your community? What would make these better?
- What is the best way to support healthy living in schools, work places, and the community?
- What is the best way to help people eat healthy foods and get regular exercise?
- What is the best way to get reliable information about health problems and healthy living?
Improve Health Care Delivery
- What are the three most important changes that would make your health care better?
- Do you have a doctor, clinic, or nurse where you go regularly for health care? If no, why not? If yes, how can your doctor, clinic, nurse, or community health worker help you coordinate health care for you and your family?
- What information do you need in order to choose a good health care provider like a doctor, clinic, or hospital? What is the best way to get this information?
- What help do you need to coordinate health care for you or your family?
- Health care can be expensive. What is the best way to make health care more affordable?
- Are you aware of any waste that could be eliminated?
- Have there been times when one doctor didn’t know what another doctor had done and repeated tests, procedures or prescriptions?
- What is the best way for consumers to be involved in improving the health care system in their communities?
New Accountable Care Entities Created by Legislation
You should know about an exciting new development in Illinois Medicaid, created under SB 26, legislation that also includes Medicaid expansion under the Affordable Care Act.
An Accountable Care Entity (ACE) is a new model of an integrated delivery system created under that legislation. This will now be the fourth model providing “care coordination services” for Medicaid clients, which now includes Managed Care Organization (MCO), Managed Care Community Network (MCCN) and Care Coordination Entity (CCE). The ACE will have these elements:
- Will be organized by providers and will coordinate a network of Medicaid services
- Will initially enroll children and their family members, with an option to enroll the newly eligible Medicaid adults under SB 26 and the Affordable Care Act
- Will each be large enough to have impact for a population: at least 40,000 clients in Cook County, 20,000 in collar counties, and 10,000 downstate
- Will include at a minimum the following types of providers: primary care, specialty care, hospitals, and behavioral healthcare; will have a governance structure that includes each type of provider
- Will build an infrastructure to support care management functions among the providers in the network, such as health information technology, risk assessment tools, data analytics, communication with Medicaid members, etc.
- Will be on a 3-year path to a new payment structure different from the current fee-for-service: shared savings within first 18 months, partial risk after 18 months, and full risk after three years, which means capitated payments with financial incentives for the providers within the network
This is an opportunity for the hospital community and other providers (not traditional MCOs) to develop integrated delivery systems in Illinois and to coordinate care for our Medicaid populations. Under SB 26, we will post a solicitation by August 1, and give five months to new entities to organize and apply. We will create a website page for all information on ACEs, after the bill is signed into law.
Please feel free to ask questions or share comments by e-mailing: email@example.com