Transforming Illinois Health Care Illinois Medicaid 1115 Waiver

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 4

What is a Medicaid 1115 Waiver? 5  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  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 ApplicationOur State’s Waiver Application  Called the Path to Transformation Waiver

Four Pathways to Transformation State Waiver Application 6 Pathway 4 Pathway 1Pathway 2 Pathway 3 Goals: Better Health Outcomes Lower Costs Delivery System Transformation Population Health Workforce Home- & Community- Based Supports

1st Pathway: Delivery System Transformation Waiver promotes care coordination & integrated delivery system development 7  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 8  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 9 Workforce

4th Pathway: Home & Community-Based Supports Consolidation of nine existing home- & community-support waivers 10 Home- & Community- Based Supports  Increase funding & uniformity in benefits  Increase capacity of care provided in the community  Behavioral health expansion & integration

Challenges 11  Many needs  Limited funding  Negotiatons 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.  Many needs  Limited funding  Negotiatons 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 12

Budget Neutrality Under 1115 Waiver 13 CNOM counts toward budget neutrality gap

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 14

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 16

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 17

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 18