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SmartPlan Choice Provider Orientation Overview and Timeline.

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Presentation on theme: "SmartPlan Choice Provider Orientation Overview and Timeline."— Presentation transcript:

1 SmartPlan Choice Provider Orientation Overview and Timeline

2 Agenda  Introduction and Opening Remarks  Chicago Market and Projections  Health Plan and Contract Selection  SmartPlan Choice Distinction

3 Introductions and Opening Remarks Overview of SmartPlan Choice

4 Who is SmartPlan Choice? Joint venture of Presence Health Partners & Independent Physician Alliance of Illinois, plus several other providers/clinics. An Accountable Care Entity (ACE), the category for a provider-sponsored and governed organization, managing quality, cost and care of IL Medicaid enrollees Serves women/caregivers, children and newly eligible Medicaid enrollees resulting from ACA.

5 Who is SmartPlan Choice? A health plan created by and governed by providers like you. A managed care organization with a collaborative culture and one where you can have input into policies. Joint venture of providers/clinics driven by a mission of helping the underserved. A team of providers with shared values working with and in the community to improve health for all. A group with a strategy to embrace innovation and change the delivery of health care.

6 Aug 11, 2014 SmartPlan Choice Enrollment Begins Oct 11, 2014 Auto-enrollment Begins Jan – Dec 2015 Shared Savings Measurement Period Jan June 2017 MCO On-Site Readiness Review Jul 1, 2017 MCO Effective date/ Capitation Full Risk Enrollment scheduled to begin in Central, IL and move North. Cook County enrolls by zip codes & begins: Sept 8, 15, 29, Oct 6, Jan 12 SmartPlan Choice Timeline 60 days after enrollment, any Medicaid recipient who did not choose a PCP or medical home will have one assigned to them. A PCP must be enrolled in Illinois Health Connect (IHC) to have patients assigned to them.

7 State Requirements for Providers participating in SmartPlan Choice? Enroll with State of IL Health and Family Services (HFS) – Enables you to send claims and receive payment Register with IL Health Connect (IHC) – Agreement to terms of medical home – Responsibility of primary care provider (PCP) – Registry for providers and office sites – Database for patient panels and patient allocation HFS audits the network and processes of SmartPlan Choice to ensure compliance to regulations. We may need verification from you.

8 Strategic Direction: State of Illinois - SB 26 - Medicaid Expansion bill passes - projecting approximately 600,000 new enrollees Care Coordination Expansion (July 24, 2013 ) Source: Illinois Department of Healthcare and Family Services SmartPlan Choice Counties of operations: 1. Champaign 2. Ford 3. Vermilion 4. Kankakee 5. Kane 6. Will 7. Cook

9 SmartPlan Choice Service Area and Enroll Dates County 1.Champaign Ford Vermilion Kankakee Kane Will Cook (by Zip Code) Iroquois (voluntary enroll) ---- Enroll Start: 8 wks to choose 1.Aug 11 – Aug 16 2.Aug 11 – Aug 16 3.Aug 11 – Aug 16 4.Aug 18 – Aug 23 5.Aug 25 – Aug 30 6.Sep 29 – Oct 4 7.Sept 8, Sep 15, Sep 29, Oct 6 (ACA), Jan 12 (ACA) 8.Not mandatory – no date

10 State of IL All enrollment marketing material and activity must be prior approved by the State of IL Health and Family Services (HFS). Including: Community Health Fairs & Events Public Announcements Physician Office Materials

11 Enrollment Do’s & Don’ts CAN SAYCANNOT SAY Thank patients for privilege of serving them and to consider you when selecting a provider for future health needs and when enrolling in a health plan. Choose SmartPlan Choice or any specific Health Plan. Visit to see letter of preference for SmartPlan Choice approved by HFS Aug 20, I am/this medical practice is part of SmartPlan Choice (must include any and all other Medicaid health plans office contracted) Choose SmartPlan Choice or any specific Health Plan. Visit to see letter of preference for SmartPlan Choice approved by HFS Aug 20,

12 Enrollment Do’s and Don’ts CAN DOCANNOT DO Provide telephone for patients to contact Client Enrollment Services ( ) directly to enroll Cannot provide ONLINE enrollment at any provider setting, health fair, or other gathering Provide information on ALL health plans offered in the service area - - must use State supplied/approved material. Persuade enrollment in a specific Health Plan Mail Outreach using materials supplied by State of IL (found on ) Face to Face Outreach (door-to-door, telephone or other cold-call activity)

13 Pathway to Working Together HFS Guidelines here Provider Manual found here Care Management Manual here HFS approved letter for IPA HFS approved letter for PHP

14 Dept. of IL Approved Letter preferring SmartPlan Choice (PHP)

15 Dept. of IL Approved Letter preferring SmartPlan Choice (IPA)

16 Chicago Market and Projections

17 ACEs within SmartPlan Choice Service Areas Partners Health Plan Name

18 Cook County Projections from the State of IL - based on 2012 participation Before enrollment Populations served by SmartPlan Choice

19 Managed Care Organizations by Populations Served in Illinois

20 Which Health Plan to contract?

21 Types of Managed Care Organizations Corporate owned. Full risk Provider owned. Full Risk Provider Organized. Network only Provider owned. 3 yr to Full risk- become MCO or MCCN MCO MCCN CCE ACE

22 SmartPlan Choice vs MCO? A health plan comprised of and governed by your peers. Opportunity to earn your fee for service over next 18 months plus incentives for quality performance Contribute to MCO policy vs mandated by MCO policy Have input into regional care coordination and management of high risk patients vs mandated by policy derived distantly

23 SmartPlan Choice ACE offers: Fee-for-service for first one and half years. Providers bill and are reimbursed by the State of Illinois for the first 18 months. Partial risk after 18 months; full risk after three years (An ACE is expected to become a MCCN or MCO). Patient Member Per Month (PMPM) payment for each covered member to manage the care coordination for physicians and help with future ACE infrastructure and growth Opportunity for performance incentive year one and shared savings after 18 months

24 Who should I contract? Do you want a fully developed, predefined structure with fixed policies and procedures? Do you want a developing organization having input into policies and procedures? – SmartPlan Choice! Which organization shares your values and understands your perspective? –SmartPlan Choice! More contracts = more policies and procedures = greater administrative burden. SmartPlan Choice! One community and one goal - improving health for all.

25 Why SmartPlan Choice?

26 Why SmartPlan Choice Mission Driven - Serving the Medicaid population is driven by the Mission of key partner of SmartPlan Choice. Local Management - Community is better managed by an active participant in the local community Stakeholder alignment – Local governance by peers who will protect your interests Culture – Transparency, Collaboration, Innovation and Accountability

27 SmartPlan Choice Contacts For Providers Care Coordination CARE (2273) Questions, Info, Other Tools to assist For Members SmartPlanChoice.orgContact us Member Services CARE (2273) Member Services TTY


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