Learning and Advocacy for Behavioral Health Primary Care - - PowerPoint PPT Presentation

SLIDE 1

Health and Human Services Transformation

Learning and Advocacy for Behavioral Health – Primary Care Integration

Integrated Health Homes June 25, 2018

SLIDE 2

DRAFT Confidential – Proprietary and Pre-decisional

INTEGRATED HEALTH HOMES

2

SLIDE 3

DRAFT Confidential – Proprietary and Pre-decisional

Integrated Health Homes in Illinois are NOT: … and NOT on the provision of all services

Provider of all services for members A gatekeeper restricting a member’s choice of

providers

A physical place where all Integrated Health

Home activities occur

A care coordination approach that is the

same for all members regardless of individual needs Integrated Health Homes in Illinois are: Primary focus is on coordination of care…

Integrated, individualized care planning and

coordination resources, spanning physical, behavioral and social care needs

An opportunity to promote quality in the core

provision of physical and behavioral health care

A way to encourage team-based care

delivered in a member-centric way

A way of aligning financial incentives around

evidence-informed practices, wellness promotion, and health outcomes For members with the highest needs:

A means of facilitating high intensity,

wraparound care coordination

An opportunity to obtain enhanced match for

care coordination needs

Identifying enhanced support to help these

members and their families manage complex needs (e.g., housing, justice system)

What an Integrated Health Home is and is not

3

SLIDE 4

4

Profiles of ACA Health Homes launched to date Illinois would be the first fully integrated Health Home

Largest Medicaid Health Home programs developed as of February 2017 60 69 220 230 252 252 522 540 26% 26% 3% 19% 4% 3% Number of enrollees, thousands Many states also employ Patient-Centered Medical Home programs to coordinate the physical

Chronic Chronic/SMI Chronic/SMI SMI Chronic SMI/SED

% of Medicaid Conditions population addressed

M

D

e n

R

t a l

A F T

I l l n e s

C

s

• n

; S E D

f i d e

=

n

S

t i

e r

a

i

l

• u

–

s

P

E

r

m

• t

p

i

r

• n

i e t

a l

a r

D

y

i s t

a n

u r b

d

a n

P

c

r

e

e

• d

e c i s i

• n

a l

4% 4%

SMI/SED Chronic

Includes members withSMI/SEDs1

health needs of their members separately, but Illinois model would coordinate both physical and behavioral health care for all ~3.1m Medicaid members

1 Only includes members who are part of the state’s largest Health Home program 2 SMI = Serious

SOURCE: CMS Health HomeIRC

SLIDE 5

DRAFT Confidential – Proprietary and Pre-decisional

Principles for developing care delivery model

Develop a person- and family-centered care delivery model for the whole Medicaid population, regardless of match status, that encourages member and family engagement Evolve toward full clinical integration of behavioral, physical, and social healthcare Craft a flexible care delivery approach that reflects the diverse needs of members in Illinois and recognizes that member needs change over time Acknowledge and accommodate geographical variation in provider capabilities, readiness, and priorities Strike an appropriate balance between provider flexibility and accountability to enable capabilities and readiness Prioritize economic sustainability of care delivery model at both the systemic and provider levels

5

SLIDE 6

DRAFT Confidential – Proprietary and Pre-decisional

Level of physical health needs Level of behav- ioral health needs High Low High High behavioral health needs, Low physical health needs High- est needs Low behavioral health needs, high physical health needs Low needs members Low Moderate needs members ILLUSTRATIVE Full Medicaid population will be included in the model, with exception of those receiving duplicative care coordination, in LTC facilities after 90 days, or with MMAI dual, partial eligibile, or TPL status Approach to tiering adopted to ensure members with similar needs receive comparable care coordination support, and to focus resources on those members who need greatest support

A Overview of potential approach to IHH member stratification

6

SLIDE 7

DRAFT Confidential – Proprietary and Pre-decisional

Integrated Health Home Implementation and Next Steps

Reimbursed through a per-member, per-month (PMPM) case management fee Model includes outcomes-based payment model rewarding measurable, positive outcomes associated with integrated care Developed in consultation with input and feedback from the HFS Medicaid Waiver Advisory Committee and sister state agencies HFS will continue collaboration with interested parties through learning collaboratives, provider forums and in-person meetings Anticipated Effective Date for Integrated Health Homes is October 1, 2018 Questions?

7