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Transforming Illinois Health Care
State’s Vision to Achieve Triple Aim Transform Illinois’ Medicaid program and health care
delivery system
Transition from fee for service system to an integrated,
patient-centered delivery model
Strengthen community based & primary care infrastructure
Empower providers to manage care and incentivize quality
and improved patient outcomes
Transforming Illinois Health Care
Illinois hospitals have the infrastructure to bring together a
wide range of providers
Accountable Care Entities
Unique to Illinois
Established by IL law in 2013
Provider owned and operated
A group of doctors and hospitals; not an insurance company
Doctors and hospitals within an ACE are connected to easily share information
Responsible for all care provided
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What is a Medicaid 1115 Waiver?
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Allows states to apply for program flexibility from the Centers for Medicare & Medicaid Services to test new approaches to financing & delivering Medicaid
Provides incentives to providers to develop new models of care Lasts five years, but can be renewed/amended Must be budget neutral, leading to overall savings
Our State’s Waiver Application
Called the Path to Transformation Waiver
Four Pathways to Transformation
State
Waiver
Application
6Pathway 4Pathway 1 Pathway 2 Pathway 3
Goals:
Better Health Outcomes Lower Costs
Delivery System
Transformation
Population Health
Workforce
Home- & Community-
Based Supports
1st Pathway: Delivery System TransformationWaiver promotes care coordination & integrated delivery system development
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Hospital performance & integration pool
Institution transition pool
Access Assurance Pool
Innovation and transformation resource center
Public hospital pool
Delivery System
Transformation
2nd Pathway: Population Health
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Fund regional public health collaboratives
Expansion of maternal-child home visitation program
Population Health
3rd Pathway: Workforce
Strengthen the state’s health care workforce Provide incentives for training
physicians
Funding for loan repayment programs
Safety Net and Critical Access Hospital loan program
Establish training and certify community health workers
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Workforce
4th Pathway: Home & Community-Based Supports
Consolidation of nine existing home- & community-support waivers
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Home- & Community-
Based Supports
Increase funding & uniformity in benefits
Increase capacity of care provided in the community
Behavioral health expansion & integration
Challenges
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Many needs Limited fundingNegotiatons with CMS will determine final funding allocations.
Incentive pools, workforce, behavioral health home, transformation resource center, and public health integration provisions are critical for hospitals and continued transformation.
Waiver often has general descriptions of proposals. Will need provider input when finalizing details.
Incentive funding provisions need to have realistic expectations.
How is a Waiver Financed?
Costs Not Otherwise Matchable (CNOM) One of the most powerful provisions in Section
1115 allows CMS to grant approval of Costs Not Otherwise Matchable or CNOM
Includes services not normally qualifying as Medicaid expenditures
Must be budget neutral
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Waiver Examples Aligned With Hospital Transformation Efforts
1115 Waiver Payments and Initiatives
Integration & Incentive Pool
Institution Transition Pool
GME funding
Loan forgiveness
Community-Based Training and certification
Behavioral health homes
Integration with public health
Enhanced home and community supports
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What does Waiver Mean for Providers?
Financial & Technical Assistance to transform care models
Incentives for quality improvement, transformation and integration activities
Increased capacity for behavioral health referrals
Funding to recruit, train and retain qualified health care workforce
Better crisis, referral and discharge services
Model Test Grant- CMMI
$100 million- four years
Six integrated delivery systems
Public and private payer participation
Align quality metrics across plans
Linkages with community supports via public health
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How is state receiving input?
Alliance for Health Alliance Steering Committee
• All major stakeholders
Five workgroups
• Integrated Delivery System Reform
• Public Health Integration
• Workforce
• Data and Technology
• Services and Supports
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Conclusion
Waiver and Model Test are consistent with IHA goals
Key hospital provisions are critical to achieving waiver goals
Funding needs to reach providers
State can set criteria and standards
Rural health and health literacy needs can be enhanced
Waiver provides up-front investment for transformation
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