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. SmartPlan Choice Timeline
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
Aug 11, 2014
SmartPlan Choice Enrollment Begins
Oct 11, 2014
Auto-enrollment Begins
Jan – Dec 2015
Shared Savings Measurement Period
Jan June MCO On-Site Readiness Review
Jul 1, 2017
MCO Effective date/ Capitation Full Risk
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
SmartPlan Choice Counties of operations:
1. Champaign
2. Ford
3. Vermilion
4. Kankakee
5. Kane
6. Will
7. Cook
Care Coordination Expansion (July 24, 2013)
Source: Illinois Department of Healthcare and Family Services

9. SmartPlan Choice Service Area and Enroll Dates
County
Champaign
Ford
Vermilion
Kankakee
Kane
Will
Cook (by Zip Code)
Iroquois (voluntary enroll) ----
Enroll Start: 8 wks to choose
Aug 11 – Aug 16
Aug 18 – Aug 23
Aug 25 – Aug 30
Sep 29 – Oct 4
Sept 8, Sep 15, Sep 29, Oct 6 (ACA), Jan 12 (ACA)
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 SAY
CANNOT 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 20,2014
I am/this medical practice is part of SmartPlan Choice (must include any and all other Medicaid health plans office contracted)

12. Enrollment Do’s and Don’ts
CAN DO
CANNOT 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
HFS approved letter for IPA
Provider Manual found here
Care Management Manual here
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
Populations served by SmartPlan Choice
Before enrollment

19. Managed Care Organizations by Populations Served in Illinois

20. Which Health Plan to contract?

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

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
Because of the ACE providers have tools and resources to support the tenants of the Medical home which they would otherwise not have.
** From Network Review Criteria
#18 Medical Homes –
 The ACE’s Affiliated Provider network shall include Providers that act as Medical Homes, with a focus on FQHCs, CMHCs and multi-specialty PCP-centered medical groups and private practice PCP offices.
  Desk review: Information not found- not provided as part of pre-on-site documentation submission request.
Q: How many of your PCPs are medical homes? What services and technical assistance are you providing to help those clinics and PCP practices who are interested in becoming medical homes?
Currently, [# ] of our PCPs are medical homes. In addition, SmartPlan Choice will be providing supports for many of the key components of medical homes, including: strong information technology supports, analytic resources (such as frequent ED utilizers), and embedded care coordination. Our care coordination model includes the support of a care coordinator/care manager based on medium/high risk.
#19 Patient-Centered
 Medical Homes shall be patient-centered medical homes that provide and coordinate:
High quality, planned, family-centered health promotion;
Wellness Programs; acute illness care; and
Chronic Health Condition management.
Medical Homes shall provide all PCP services and be supported by Integrated Care Teams and Health Information Technology. Contractor will support Medical Homes and the integration of behavioral and physical health care by providing embedded Care Coordinators, as appropriate, onsite at FQHCs, CMHCs and high volume Providers that agree to this approach.
Desk review: Information not found- not provided as part of pre-on-site documentation submission request.
#20 Support for Medical Homes
 Medical Homes shall provide all PCP services and be supported by Integrated Care Teams and Health Information Technology.
Q: What support and services as the ACE will you provide to medical home providers that are part of your integrated delivery network?
Currently, [# ] of our PCPs are medical homes.  In addition, SmartPlan Choice will be providing supports for many of the key components of medical homes, including: strong information technology supports, analytic resources (such as frequent ED utilizers), and embedded care coordination. Our care coordination model includes the support of a care coordinator/care manager based on medium/high risk.
 This will be too difficult to gather? Or is there a way to estimate?
#21 Embedded Care Coordinators
 The ACE will support Medical Homes and the integration of behavioral and physical health care by providing embedded Care Coordinators, as appropriate, onsite at FQHCs, CMHCs and high volume Providers that agree to this approach.
 Desk review: Information not found- not provided as part of pre-on-site documentation submission request.
Q: What are your plans to support medical home and the integration of physical and behavioral health services?
We know that some of this work has already begun with our FQHC partners. In addition, we’ve begun discussions with our behavioral health partners to provide this type of integration. We’ve recently added this to our implementation plan.

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