i. · 3/15/2019 · 2018 operations metrics: call center & encounter rate 5 performance key...

Minutes of the meeting of the Managed Care Committee of the Board of Directors of the Cook County

Health and Hospitals System held Friday, March 15, 2019 at the hour of 10:30 A.M. at 1950 W. Polk Street,

in Conference Room 5301, Chicago, Illinois.

I. Attendance/Call to Order

Chair Thomas called the meeting to order.

Present: Chair Sidney A. Thomas, MSW and Director Mike Koetting (2)

Director Ada Mary Gugenheim

Telephonically

Present: Director David Ernesto Munar (1) and Board Chair M. Hill Hammock

Absent: None (0)

Director Koetting, seconded by Chair Thomas, moved to allow Director Munar to

telephonically participate in the meeting as a voting member. THE MOTION

CARRIED UNANIMOUSLY.

Additional attendees and/or presenters were:

Debra Carey – Deputy Chief Executive Officer of

Operations

James Kiamos – Chief Executive Officer, CountyCare

Jeff McCutchan –General Counsel

Mary Sajdak – Chief Operating Officer, Integrated Care

Deborah Santana – Secretary to the Board

John Jay Shannon, MD – Chief Executive Officer

The next meeting of the Committee will be held on Thursday, June 20, 2019 at 10:30 A.M.

II. Public Speakers

Chair Thomas asked the Secretary to call upon the registered public speakers.

The Secretary responded that there were none present.

III. Report on CountyCare Health Plan (Attachment #1)

James Kiamos, Chief Executive Officer of CountyCare, provided an overview of the Report on the

CountyCare Health Plan. The Committee reviewed and discussed the information.

The Report included information on the following subjects:

Metrics:

- Current Membership

- Managed Medicaid Market

- Call Center and Encounter Rate

- Claims Payment

- Overall Care Management Performance Care Management

- Overall Member Age Distribution

- Affordable Care Act (ACA) Member Age Distribution

1 of 76

Minutes of the Meeting of the Managed Care Committee

Friday, March 15, 2019

III. Report on CountyCare Health Plan (continued)

Open Enrollment:

- 2019 Open Enrollment Trends

- Open Enrollment: 2018 vs. 2019

- Cook County Fee For Service (FFS) vs. Managed Care Organization (MCO) Enrollment 2018

- Illinois Medicaid Enrollment: 2018 Q4

- Cook County Enrollment Attrition

Repatriation

- Context of Repatriation Effort

- Analyzing Primary Car Physician Visit Patterns by Cohort

- Cohort Overview in Detail

- Actions Taken For Repatriation

- Byproducts of this Effort

State Legislation

- 2019 Spring Session

IV. Recommendations, Discussion / Information Items

A. Strategic planning discussion:

Integrated Care

Mary Sajdak, Chief Operating Officer of Integrated Care, provided an overview of the presentation on

Integrated Care, which included information on the following subjects:

Integrated Care Management – Department Organization

Impact 2020 Recap – Status and Results

FY2020-2022 – The Future: Environmental Scan of Market, Best Practices and Trends

Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis

FY2020-2022 – Integrated Care Strategic Planning Recommendations

Medicaid Managed Care / Managed Populations

Mr. Kiamos provided an overview of the presentation on Medicaid Managed Care / Managed Populations,

which included information on the following subjects:

CountyCare Health Plan – Overview of Department

Impact 2020 Recap – Status and Results

FY2020-2022 – The Future: Environmental Scan of Market, Best Practices and Trends

Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis

FY2020-2022 – CountyCare Health Plan Strategic Planning Recommendations

2 of 76

Minutes of the Meeting of the Managed Care Committee


V. Action Items

A. Minutes of the Managed Care Committee Meeting, December 13, 2018

Chair Thomas, seconded by Director Koetting, moved to accept the minutes of the

Managed Care Committee Meeting of December 13, 2018. THE MOTION

CARRIED UNANIMOUSLY.

B. Any items listed under Section V

VI. Adjourn

As the agenda was exhausted, Chair Thomas declared the meeting ADJOURNED.

Respectfully submitted,

Managed Care Committee of the

Board of Directors of the

Cook County Health and Hospitals System

XXXXXXXXXXXXXXXXXXXXXXXXXX

Sidney A. Thomas, MSW, Chair

Attest:

XXXXXXXXXXXXXXXXXXXXXX

Deborah Santana, Secretary

Requests/Follow-up:

There were no requests for follow-up made at the meeting.

3 of 76

Cook County Health and Hospitals System Managed Care Committee Meeting


ATTACHMENT #1

4 of 76

Coun

tyCa

re Upd

ate

Prep

ared

for: CC

H Man

aged

Care Co

mmittee

James Kiamos

CEO, C

ountyC

are

March 15, 201

9

5 of 76

2

Met

rics

6 of 76

Curren

t Mem

bership

Catego

ryTotal M

embe

rsAC

HN M

embe

rs% ACH

N

FHP

213,77

122

,645

10.6%

ACA

72,016

14,700

20.4%

ICP

29,673

6,53

922

.0%

MLTSS

5,53

40

N/A

Total

320,99

443

,884

13.7%

3

Mon

thly

mem

bers

hip

as o

f Feb

ruar

y 7,

201

9

ACA:

Affo

rdab

le C

are

Act

FHP:

Fam

ily H

ealth

Pla

nIC

P: In

tegr

ated

Car

e Pr

ogra

mM

LTSS

: Med

icai

d Lo

ng-T

erm

Ser

vice

and

Sup

port

7 of 76

Man

aged

Med

icaid Market

4Illin

ois

Dep

artm

ent o

f Hea

lthca

re a

nd F

amily

Ser

vice

s Ja

nuar

y 20

19 D

ata

* Onl

y O

pera

ting

in C

ook

Cou

nty

Man

aged

Care Organ

izatio

nCo

ok Cou

nty

Enrollm

ent

Cook

Cou

nty

Market S

hare

*Cou

ntyC

are

325,55

631

.5%

Meridian (a W

ellCare Co

.)24

5,42

223

.8%

Blue

Cross Blue Sh

ield

238,73

223

.1%

IlliniCare

109,16

610

.6%

Molina

68,166

6.6%

*Next L

evel

45,230

4.4%

Total

1,03

2,27

210

0.0%

8 of 76

2018

Ope

ratio

ns M

etric

s: Call C

enter &

En

coun

ter R

ate

5

Performan

ce

Key Metric

sState Goa

lOct

Nov

Dec

Mem

ber &

Provide

r Services C

all C

enter M

etric

s

Aban

donm

ent R

ate

< 5%

0.79

%0.39

%0.79

%

Hold Tim

e (m

inutes)

1:00

0:06

0:05

0:11

% Calls An

swered

< 30 second

s> 80

%95

.39%

95.22%

91.42%

Qua

rterly

Claims/En

coun

ters Accep

tance Ra

te95

%96

.99%

9 of 76

2018

Ope

ratio

ns M

etric

s: Claim

s Paymen

t

6

Performan

ce

Key Metric

sState Goa

lOct

Nov

Dec

Claims P

aymen

t Turna

roun

d Time & Volum

es

% of C

lean

Claim

s Adjud

icated

< 30

days

90%

94.2%

95.6%

97.1%

% of C

laim

s Paid < 30

days

90%

35.2%

62.5%

65.7%

Total C

laim

s Adjud

icated

N/A

397,67

345

2,89

343

6,81

3

10 of 76

2018

Ope

ratio

ns M

etric

s:

Overall Ca

re M

anagem

ent P

erform

ance

7

Performan

ce

Key Metric

sMarket %

Oct

Nov

Dec

Completed

HRS

/HRA

(all po

pulatio

ns)

Overall Pe

rforman

ce40

%53

.4%

57.0%

57.4%

Completed

Care Plan

s on High

Risk Mem

bers

Overall Pe

rforman

ce65

%69

.7%

64.7%

67.4%

•C

ount

yCar

e’s

high

risk

per

cent

age

exce

eds

the

Stat

e’s

requ

irem

ent o

f 2%

for F

amily

Hea

lth P

lan

and

5% fo

r Int

egra

ted

Car

e Pr

ogra

m.

11 of 76

Overall Mem

ber A

ge Distrib

ution

Age Ca

tego

ryMem

bership

< 1

7,25

4

18,30

4

2‐5

33,966

6‐18

105,73

7

19‐39

84,403

40‐54

45,146

55‐64

39,980

65+

10,560

8

Aver

age

Age

= 27

.1 y

ears 2%

2%10

%

32%

25%

13%

12%

0%10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mem

bership Distrib

ution by Age Category

< 1

12‐5

6‐18

19‐39

40‐54

55‐64

65+

12 of 76

ACA Mem

ber A

ge Distrib

ution

Age Ca

tego

ryMem

bership

19‐39

34,284

40‐54

22,282

55‐64

23,225

65+

834

9

Aver

age

Age

= 42

.7 y

ears

ACA:

Affo

rdab

le C

are

Act

13 of 76

10

Ope

n En

rollm

ent

14 of 76

2019

Ope

n En

rollm

ent T

rend

s

11

•Overall MCO

enrollm

ent in Co

ok Cou

nty ha

s declin

ed during the op

en enrollm

ent

windo

w th

us fa

r•No MCO

has experienced

material o

rgan

ic enrollm

ent g

rowth

•We may se

e more flu

ctua

tions post o

pen en

rollm

ent

* Mer

idia

n an

d H

arm

ony

mem

bers

hip

is c

ombi

ned

due

to m

erge

r

Cook

Cou

nty: 201

9 Ope

n En

rollm

ent W

indo

w

MCO

Oct‐18

Jan‐19

Net Cha

nge

10/18 ‐1

/19

% Cha

nge

10/18 ‐1

/19

Coun

tyCa

re33

4,89

632

5,55

6‐9,340

‐3%

Meridian*

(a W

ellCare Co

.)24

9,55

324

5,42

2‐4,131

‐2%

Blue

Cross

Blue

Shield

248,42

223

8,73

2‐9,690

‐4%

IlliniCare

108,23

610

9,16

693

01%

Molina

70,040

68,166

‐1,874

‐3%

Next L

evel

53,574

45,230

‐8,344

‐16%

Total

1,06

4,72

11,03

2,27

2‐32,44

9‐3%

15 of 76

2019

Ope

n En

rollm

ent T

rend

s

12

•De

spite

Meridian/Ha

rmon

y merger, be

ing ou

tspe

nt by othe

r plans, auto‐

assig

nmen

t con

tract terms n

ot enforced; Cou

ntyC

are ha

s maintaine

d its strong

lead

in m

arket sha

re•Focused ou

trea

ch, p

rimary care physic

ian relatio

nships and

rede

term

ination

efforts a

t all mem

ber p

oints o

f con

tact are critical

* Mer

idia

n an

d H

arm

ony

mem

bers

hip

is c

ombi

ned

due

to th

eir m

erge

rCook

Cou

nty: M

arket S

hare

MCO

Oct‐18

Jan‐19

Chan

ge

Coun

tyCa

re31

.5%

31.5%

0.0%

Meridian*

(a W

ellCare Co

.)23

.4%

23.8%

0.4%

Blue

Cross Blue Sh

ield

23.3%

23.1%

‐0.2%

IlliniCare

10.2%

10.6%

0.4%

Molina

6.6%

6.6%

0.0%

Next L

evel

5.0%

4.4%

‐0.6%

Total

100.0%

100.0%

0.0%

16 of 76

334,89

6 33

3,48

8

330,01

3

325,55

6

310

,000

315

,000

320

,000

325

,000

330

,000

335

,000

340

,000

Oct‐18

Nov

‐18

Dec‐18

Jan‐19

137,57

6

129,38

1

123,47

0 12

1,85

1

110

,000

115

,000

120

,000

125

,000

130

,000

135

,000

140

,000

Jan‐18

Feb‐18

Mar‐18

Apr‐18

Ope

n En

rollm

ent: 201

8 vs 201

9

132018

Ope

n En

rollm

ent |

Legacy Co

untyCa

re Only

2019

Ope

n En

rollm

ent |

Full P

opulation

‐11.4%

‐2.8%

17 of 76

383,87

8

348,82

8

328,92

8 33

2,24

3

300

,000

310

,000

320

,000

330

,000

340

,000

350

,000

360

,000

370

,000

380

,000

390

,000

Jan‐18

Feb‐18

Mar‐18

Apr‐18

Ope

n En

rollm

ent: 201

8 vs 201

9

14

‐13.5%

2018

Ope

n En

rollm

ent |

Full P

opulation

2019

Ope

n En

rollm

ent |

Full P

opulation

334,89

6 33

3,48

8

330,01

3

325,55

6

310

,000

315

,000

320

,000

325

,000

330

,000

335

,000

340

,000

Oct‐18

Nov

‐18

Dec‐18

Jan‐19

‐2.8%

18 of 76

21%

24%

25%

21%

24%

24%

23%

24%

23%

23%

23%

22%

79%

76%

75%

79%

76%

76%

77%

76%

77%

77%

77%

78%

0

200,00

0

400,00

0

600,00

0

800,00

0

1,00

0,00

0

1,20

0,00

0

1,40

0,00

0

1,60

0,00

0

Jan‐18

Feb‐18

Mar‐18

Apr‐18

May‐18

Jun‐18

Jul‐1

8Au

g‐18

Sep‐18

Oct‐18

Nov‐18

Dec‐18

FFS

MCO

Cook

Cou

nty FFS vs M

CO Enrollm

ent 2

018

15•Overall Co

ok Cou

nty Med

icaid en

rollm

ent d

ecreased

8.6% (1

30K mem

bers) o

ver 2

018

•% of p

opulation en

rolled in M

anaged

Care flu

ctua

ted throug

hout th

e year, b

ut is back

to 78%

as o

f Decem

ber

Dat

a is

Jan

uary

201

8 th

roug

h D

ecem

ber 2

018

‐130

K mem

bers

(‐8.6%)

1,50

2,50

51,

466,

403

1,44

2,42

81,

409,

900

1,45

3,62

01,

437,

452

1,41

7,38

91,

4449

,653

1,43

4,20

11,

419,

087

1,39

8,01

41,

372,

952

19 of 76

Illinois M

edicaid En

rollm

ent: 20

18 Q4

16

3,03

6,40

6

2,99

6,86

2

2,94

7,26

3

2,90

0,00

0

2,92

0,00

0

2,94

0,00

0

2,96

0,00

0

2,98

0,00

0

3,00

0,00

0

3,02

0,00

0

3,04

0,00

0

3,06

0,00

0

Oct‐18

Nov‐18

Dec‐18

Total Illino

is

1,41

9,08

7

1,39

8,01

4

1,37

2,95

2

1,34

0,00

0

1,35

0,00

0

1,36

0,00

0

1,37

0,00

0

1,38

0,00

0

1,39

0,00

0

1,40

0,00

0

1,41

0,00

0

1,42

0,00

0

1,43

0,00

0

Oct‐18

Nov‐18

Dec‐18

Cook Cou

nty

1,61

7,31

9

1,59

8,84

8

1,57

4,31

1

1,55

0,00

0

1,56

0,00

0

1,57

0,00

0

1,58

0,00

0

1,59

0,00

0

1,60

0,00

0

1,61

0,00

0

1,62

0,00

0

1,63

0,00

0

Oct‐18

Nov‐18

Dec‐18

Non

‐Coo

k Co

unty

Tota

l Illin

ois

Enro

llmen

t: M

anag

ed C

are

and

Fee

For S

ervi

ce C

ombi

ned

2.9%

dec

reas

e 3.

3% d

ecre

ase

2.7%

dec

reas

e

20 of 76

Cook

Cou

nty En

rollm

ent A

ttrition

17

2018

Q4 | MCO

Enrollm

ent

2018

Q4 | FFSEn

rollm

ent

1,09

3,46

7

1,08

3,18

4

1,07

2,35

9

1,06

0,00

0

1,06

5,00

0

1,07

0,00

0

1,07

5,00

0

1,08

0,00

0

1,08

5,00

0

1,09

0,00

0

1,09

5,00

0

1,10

0,00

0

Oct‐18

Nov‐18

Dec‐18

MCO

325,62

0

314,83

0

300,59

3

285,00

0

290,00

0

295,00

0

300,00

0

305,00

0

310,00

0

315,00

0

320,00

0

325,00

0

330,00

0

Oct‐18

Nov‐18

Dec‐18

FFS

‐21,10

8(‐1

.9%)

‐25,02

7(‐7

.7%)

•Overall po

pulatio

n en

rolled in M

edicaid in Coo

k Co

unty has decreased

by 46

,135

mem

bers (‐3.3%

) in 20

18 Q4 alon

e

21 of 76

18

Rep

atria

tion

22 of 76

Context o

f Rep

atria

tion Effort

•Go

al is to

promote the Med

ical Hom

e mod

el•Mem

bers sh

ould be assig

ned to th

e PC

P they

actually visit

•Co

mpreh

ensiv

e plan

review

to und

erstan

d PC

P visit patterns v

ersus e

mpa

nelm

ent status

19

23 of 76

Analyzing PC

P Visit Patterns b

y Co

hort

Coho

rt Ana

lysis

Sum

mary ‐C

urrent M

embe

rs

Coho

rtMem

bers

Percen

t

(A) M

embe

rs with

only em

pane

led PC

P visits

132,09

0 47

%

(B)M

embe

rs with

no PC

P visits

98,079

35

%

(C) M

embe

r with

at lea

st 1no

n‐em

pane

led PC

P visit

53,314

18%

20

Notes: R

eflects m

embe

rs active in th

e plan

as o

f 2/15/19

. Coh

orts are m

utua

lly exclusiv

e.

DOS Jan –De

c 20

18 fo

r mem

bers with

at lea

st th

ree mon

ths o

f eligibility

•Mem

bers were segm

ented into coh

orts based

on PC

P visit patterns

•65

% of the

mem

bers in

Group

B have at least o

ne non

‐PCP

med

ical or

pharmacy claim. Mem

bers in

Group

B, h

ave lower th

an average utiliza

tion

rate and

lower per cap

ita cost.

24 of 76

Coho

rt Overview in Detail

Coho

rt Ana

lysis

Sum

mary ‐C

urrent M

embe

rs

Coho

rtMem

bers Pe

rcen

t

(A) M

embe

rs with

only em

pane

led PC

P visits

132,09

0 47

%

(B)M

embe

rs with

no PC

P visits

98,079

35%

(C1)

Mem

bers with

empa

neled an

d no

n‐em

pane

led PC

P visits

20,631

7%

(C2)

Mem

bers with

only 1 no

n‐em

pane

led PC

P visit

29,790

11

%

(C3)

Mem

bers with

more than

1 no

n‐em

pane

led PC

P visits

2,89

31%

21

Not

es: R

efle

cts

mem

bers

act

ive

in th

e pl

an a

s of

2/1

5/19

. Coh

orts

are

mut

ually

exc

lusi

ve.

DO

S Ja

n –

Dec

201

8 fo

r mem

bers

with

at l

east

thre

e m

onth

s of

elig

ibilit

y.

•M

embe

rs o

nly

visi

ting

one

PCP

(Gro

ups

A an

d C

2) a

re lo

wer

util

izer

s an

d in

cur l

ower

cos

ts th

an th

ose

visi

ting

mul

tiple

pro

vide

rs fo

r PC

oG

roup

s A

& C

2->

19 e

ncou

nter

s/m

embe

r and

$2,

966/

mem

ber

oG

roup

s C

1 &

C3

->41

enc

ount

ers/

mem

ber a

nd $

7,74

5/m

embe

r

25 of 76

Actio

ns Taken

For Rep

atria

tion

•De

tailed an

alysis of prim

ary care visit u

tiliza

tion

history

•Town ha

ll he

ld along

with

other m

essaging

to

commun

icate to prim

ary care partners

•Messaging

our m

embe

rs im

pacted

along

with

new

mem

bership cards reflecting PC

P whe

re th

ey get

their c

are

•En

forcing med

ical hom

e pa

ymen

t restrictio

ns with

ou

r PCP

s

22

26 of 76

Byprod

uct o

f this E

ffort

•Efficient and

coo

rdinated

care via the Med

ical Hom

e•

High

er HED

IS sc

ores and

other qua

lity ou

tcom

es•

Improved

effe

ctiven

ess o

f MHN

Con

nect to

redu

ce

unne

cessary ED

utiliza

tion

•More effective rede

term

ination efforts

•Be

tter ability for u

s to drive do

mestic

spen

d ay accurately

know

ing attributed

PCP

and

affiliated facility

•Overall redu

ction of costs to

plan allowing us to

better

invest in

coo

rdination of care, hou

sing/food

insecurity

and othe

r various hea

lth re

lated initiatives

23

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24

Stat

eLe

gisl

atio

n

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2019

Spring Session

•33

6bills

andresolutio

nson

CCH’stracking

listan

d12

2bills

relatedto

Med

icaidor

Med

icaidman

aged

care

•Provider‐spe

cific bills

•HB

315/SB

1604

(DME)

•HB

1638

, HB2

944, HB2

912, SB1

811 (ambu

lance)

•HB

2715

/SB1

697 (hospitals)

•HB

2814

/SB1

807, HB3

352/SB

1820

(safety‐ne

t ho

spita

ls)•

Audits and

add

ition

al re

porting by

MCO

s •

HB21

17/SB1

238, HB2

658/SB

1685

, HB2

690,

HB30

48/SB2

012

25

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2019

Spring Session

•En

ding

/limiting

partic

ipation in M

edicaid man

aged

care

•HB

1603

/SB4

3, HB3

245, HB3

267

•Placing ad

ditio

nal adm

inistrativ

e bu

rden

on Med

icaid

man

aged

care providers

•HB

2730

/SB1

703 (req

uire a new

adm

inistrativ

e ap

peals

process)

•Im

proving rede

term

ination an

d initial M

edicaid

application processes

•SB

2021

•

MCO

assessm

ent

•HB

272 (not th

e mod

el being

disc

ussed in th

e Go

vernor’s

office)

26

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ATTACHMENT #2

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Strategic Planning FY2020- 2022Integrated Care Management

Mary Sajdak

Chief Operating Officer, Integrated CareMarch 15, 2019

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Integrated Care Management Department Organization

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3

Chief Operating OfficerIntegrated Care

Assistant Administrator

Administrative Assistant V

Director, Managed Care Operations

Director, Inpatient Care Coordination

Manager, Inpatient Care Coordination



Manager, Prov. Sched and Transportation

Director, Patient Support Center

Manager, Patient Support Center

Manager, Referral Services

Manager, Behavioral Health Integration

Manager, Prior Authorization

Senior DirectorCare Coordination

Director, Special Programs

BHAL Staff (3)

Director, HousingDirector, CareLink

Manager, Logistics

Manager, ConciergeServices

Manager, Risk Contracts

Manager, Assisted Outpatient Treatment

Justice Staff (3)(Bond Court)

Manager, Quality

Total Positions: 359

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Department Primary Function UnitsManaged Care Contracting, contract compliance, managed care

education, Managed Care Organization (MCO) interface, Cook Medical Group

Contract administrationPrior authorizationCook Medical Group Administration

Patient SupportCenter

Home transportation, physician schedules, specialty referrals, appointments, care coordination logistical support, Concierge Services

4-Ride, Physician Schedules, Referral Support Center, Patient Appointments, Care Coordination logistics, patient navigation

Complex (Ambulatory) Care Coordination

Support high/moderate risk patients, link patients to community based services, provide transitions between health services, supports access to behavioral health services

Complex Care CoordinationLong Term Service and SupportDiabetes and Asthma Mgt.Behavioral Health AccessTransition of CareJustice related Care Coordination

Inpatient Care Coordination

Provide medical justification for acute care, Support patient-centered discharges

Nurse TeamSocial Worker TeamEmergency Department Team

Carelink Administer Carelink Program Matrixed

Housing Interface with housing agencies, develop housing models

TBD435 of 76

Manager, Hm/Comm Based Waiver Svcs



5

Director, Waiver Services


Manager, Extended Care Services

Director, Complex Care Coordination

Manager, Complex Care Coordination






Manager, CHWManager, Hm/Comm

Based Waiver Svcs


Educator

Manager, Transition of Care

Senior DirectorCare Coordination

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Care Coordination-Current Positions

CCC-High Risk

MLTSSLTSS

Waiver

Transition Of Care

BehavioralHealth

Access Line

Justice Related

Care CoordNurses 41 16 7 0 0

Social Workers 17 89 7 3 3

CHW* 12 4 0 0 1

Directors 1 1 0 0 0

Managers 6 8 1 0 0

Total 77 118 15 3 4

6

Number and Type of Staff

*Community Health Worker

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Impact 2020 UpdateStatus and Results• Deliver High Quality Care

• Grow to Serve and Compete

• Foster Fiscal Stewardship

• Invest in Resources

• Leverage Valuables Assets

• Impact Social Determinants

• Advocate for patients 38 of 76

Impact 2020

8

Progress and UpdatesFocus Area Name StatusDeliver High Quality Care

1.1 Screen patients using evidence-based management techniques. Screen at least 70% of the assigned CountyCare population, approximately 56,000. (2019 membership is 178,000)

Ongoing

resources added 1/19

1.3 Deploy or enhance care coordination throughout the System and CountyCare, including community health workers.

Completed

care coordination

patients (CCC/LTSS)

1.3 Conduct analysis of services and identify gaps in the continuum of care and add services.

Ongoing

1.6 Integrate services with correctional health. Complete

behavioral health and primary care needs

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Impact 2020

9

Progress and UpdatesFocus Area Name StatusFoster Fiscal Stewardship

3.1 Maximize reimbursements from Managed Care Organizations (MCOs) and private insurance and complete on value, grow membership and influence in MCO strategy

In Progress

increase likelihood of payment

Impact Social Determinants

6.3 Partner with other organizations to address population health; Screen for other social determinants of health including housing, exercise, clothing, drug and alcoholabuse, transportation and utilities.

Ongoing (Agreements in place)

Depository

Impact Social Determinants

6.4 Further develop care coordination services across the CCHHS continuum of care to address social determinants of health to improve population health.

Ongoing

coordination

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FY2020-2022The FutureEnvironmental Scan of Market, Best Practices and Trends

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Environmental Scan of Market, Best Practices and Trends

• Fully integrate the delivery of behavioral, physical, and social healthcare

• Scale intensity of service provision to needs of the population

• Collaborative agreements to support a full provision of care

• Coordinated with and paid by MCOs

• Fee for service, with Pay for Performance (P4P)

• Membership is tiered according to Clinical Risk Group Software based upon 18 months of in/out patient and pharmacy data

• Tier A-High behavioral, high physical

• Tier B-High behavioral

• Tier C-High physicial

• CCH, Complex Care Coordination Team has been accepted as an IHH

11

Integrated Health Homes

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Environmental Scan of Market, Best Practices and Trends

State• If Integrated Health Homes (IHH) is launched, significant change to structure, process, staffing patterns

and technology requirements

• External MCOs requesting CCH support their IHH initiatives. CCH is in discussions and has predicated payment changes upon IHH participation.

National• Recommendations for complex care coordination best practice from Institute for Health Care

Improvement, Center for Health Care Strategies, and National Center for Complex Health and Social Needs

Thought Leaders• Cross sector collaboration e.g. housing and health, justice and health

12

Themes

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SWOT AnalysisStrengths, Weaknesses, Opportunities and Threats

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SWOT Analysis

Item• Item

14

Strengths

transportation, Legal Aid Foundation

Weaknesses

care performance

coordination benefits

population served

Opportunities

creating a model that recognizes and responds to high-risk patients

to help Care Coordination leap forward-determine what works?

Threats

risky in light of bullet #1

experience, quality and safety is major consideration of health plans when developing provider network

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FY2020-2022

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Deliver High Quality Care

Care Coordination

outcomes for patient and provider

16

FY2020-2022 Strategic Planning Recommendations

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Grow to Serve and Compete-

Referral Center

for patients seen who have community based providers

17


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Foster Fiscal Stewardship

Item• Improve authorization process for inpatient/observation care by Inpatient Care Coordination team

• Reduce the number of denials for inpatient/observation care

• Evaluate ability of non-licensed, bachelor’s prepared staff to support increased care coordination activities

• Create ability of select Patient Support Center staff to appoint patients identified as a result of discharge, care coordination, or reporting illness

• Support and track out-of-network admissions who are returned to CCH services for continued care (Cook Medical Group, County Care)

18


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Invest in Resources

Advanced Analytics

and the intersection of the two

achievement

19


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Leverage Valuable Assets

CCDPH Partnerships

outcomes for the people and communities served

provided by CCH

20


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Impact Social Determinants/Advocate for Patients

21


for Serious Mental Illness (SMI)

funding expires e.g. recovery coaches, AOT Assisted Outpatient Treatment (AOT) program, etc.

for scalability and ease of referrals

needs

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Impact Social Determinants/Advocate for Patients FY 2020-2022 Strategic Planning Recommendations

Create a coordinating committee -- success will depend on cross-department collaboration and coordination

Identify working definitions for social determinants of health, which ones may be in the purview of CCH departments and strategies for others that may have significant impact

• Complete gap analysis and provide recommendations

• Document resource requirements, training etc.

• Enter into discussions to support collaboration

Review information from cataloging existing programs and determine next steps

Complete implementation of social service data base

22

Organizing for Impact and Sustainability

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Thank you.

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ATTACHMENT #3

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Strategic Planning FY 2020-2022CountyCare

James Kiamos, CEO, CountyCare Health Plan March 15, 2019

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Overview of DepartmentCountyCare Health Plan

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Overview of Department

CountyCare is a Medicaid Managed Care plan providing health benefits and care coordination to 320,000 Medicaid beneficiaries in Cook County

CountyCare Divisions:• Operations and Delegated

Vendor Oversight• Clinical Services and Care

Management • Pharmacy • Finance• Network Management• Project Management • Compliance

FY 2019 Budget: $1.817B

FY 2019 FTEs: 57

CountyCare Health Plan

3

CountyCare website

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Impact 2020 RecapStatus and Results

• Deliver High Quality Care• Grow to Serve and Compete• Foster Fiscal Stewardship• Invest in Resources• Leverage Valuables Assets• Impact Social Determinants/Advocate for Patients

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Impact 2020CountyCare Health Plan Progress and Updates

5

FocusArea

Name Status

Delivery High Quality Care

Maintain high-quality CountyCare network, including continuous improvement in quality measures year-over-year

Ongoing

Develop mechanisms to ensure communications occur in members’ preferred languages In progress

Expand use of MHNConnect real-time alerts platform for care coordination and continuity of care

Ongoing

Roll out an innovative quality program for providers to collaborate with CountyCare initiatives and provide better care to members at the provider-level

Complete

Implement provider performance scorecards and pay-for-performance programs Ongoing

Grow to Serve & Compete

Acquire members through marketplace changes, including Family Health Network and Aetna transitions

Complete

Leverage CountyCare data to provide value-added benefits, including a Member Incentive Program (e.g. diapers, prenatal vitamins, and LASIK program)

Complete

Implement retain & gain strategy, including robust redetermination plan Ongoing60 of 76

Impact 2020

6

FocusArea

Name Status

Grow to Serve & Compete(cont’d)

Exploring new lines of business to serve members as they age out of Medicare and seniors with chronic special needs

In progress

Foster FiscalStewardship

Develop high-performing CountyCare network, including opportunities to narrow network and implement risk- and value-based contracts

In progress

Establish emergency department utilization reduction plan In progress

Increase domestic spend through targeted initiatives, including utilization of eConsult resulting in appropriate direct referrals, establishing centers of excellence and emergency department transfers

In progress

Roll out medical cost action plans to include pharmacy cost saving initiatives Complete

Invest in resources

Recruit, hire, and retain the best employees who are committed to CountyCare and CCH mission

Ongoing

Impact SDOH

Implement programs that address the social determinants of health, such as Black Oaks LINK matching program and flexible housing pool

Complete

CountyCare Health Plan Progress and Updates

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FY2020-2022The FutureEnvironmental Scan of Market, Best Practices and Trends

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Oct. 2018 Nov. 2018 % Change Dec. 2018 % Change

Cook County 1,413,665 1,386,693 1.91% 1,353,809 2.37%

Other 1,617,146 1,591,627 1.58% 1,556,278 2.22%

Environmental Scan of Market, Best Practices, Trends

• Steady decreases in Medicaid membership due to loss of coverage across fee-for-service and managed care.

• Cook County Medicaid beneficiaries are losing coverage at a higher rate than those in other IL counties. Possible cause of loss of Medicaid coverage is current redetermination policy.

Reduction in Medicaid coverage across Illinois

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9

CountyCare Health Plan Market Share

Managed Care Organization Cook CountyEnrollment

Cook County Market Share

*CountyCare 325,556 31.5%

Meridian (a WellCare Co.) 245,422 23.8%

Blue Cross Blue Shield 238,732 23.1%

IlliniCare 109,166 10.6%

Molina 68,166 6.6%

*Next Level 45,230 4.4%

Total 1,032,272 100.0%Illinois Department of Healthcare and Family Services January 2019 Data

* Only Operating in Cook County

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• CountyCare retention rate: 73%

• State fee-for-service retention rate: 54%

• Best practice: implement a robust retention strategy at all touchpoints at the member-and provider-level including redetermination events, and robust targeted outreach

• Leverage all engagement points within CCH

• Partner with medical homes to improve retention and redetermination

• Successful redetermination has a direct positive impact on the health system’s payor mix

CountyCare Health Plan Member Retention Through Redetermination

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SWOT AnalysisStrengths, Weaknesses, Opportunities, and Threats

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SWOT Analysis

12

Strengths• Commitment to serving Cook County’s vulnerable and

underserved populations• Provider-led health plan and care management• Low administrative spend• Flexible, delegation-based model• Extensive provider network• Mission-oriented and culturally competent staff• Focus on social determinants of health (SDOH)

Weaknesses• Difficulty scaling staff with plan growth• Complexity associated with delegated model• Limited branding and marketing resources• Extensive provider network• Challenges with data integrity with multiple

vendors/partners• Managed care learning curve for CCH

Opportunities• Expanded product lines to serve new populations• Policy change for a streamlined and efficient

redetermination process with new administration • Innovative programs to integrate behavioral health with

medical• Increased member engagement in medical homes to

better quality outcomes and cost savings• Greater investment disease analytics and SDOH• Expanded retention efforts to preserve continuity of

coverage and care• Tighter relationship with CCH providers

Threats• Federal changes to Medicaid policy• State budget constraints • Shrinking Medicaid population in Cook County• Disruptive redetermination process• Rising pharmaceutical costs• Provider resistance to Managed Medicaid in Illinois• Population that is increasingly complex, both medically

and in terms of SDOH

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FY2020-2022CountyCare Health Plan

• Deliver High Quality Care• Grow to Serve and Compete• Foster Fiscal Stewardship• Invest in Resources• Leverage Valuables Assets• Impact Social Determinants/Advocate for Patients

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Improve Behavioral Health (BH) Quality and Integration

14

Deliver High Quality Care FY 2020-2022 Strategic Planning RecommendationsCountyCare Health Plan

Top Inpatient Medical Diagnoses (Adult)

Claims December 2017-November 2018

Diagnosis Description (3-Digit Primary) Admissions

Schizoaffective disorders 1,780Bipolar disorder 1,711Opioid related disorders 1,679Major depressive disorder, recurrent 1,359Schizophrenia 1,098Other sepsis 1,014Other chronic obstructive pulmonary disease 781Alcohol related disorders 638Essential (primary) hypertension 610Major depressive disorder, single episode 590Excludes diagnoses related to pregnancy, childbirth, and the puerperium

• From 2017-2018, 25% of admissions were related to behavioral health or substance use disorder diagnoses

• There are overall fewer BH admitting diagnoses and a wide range of medical diagnoses

• BH disease burden and comorbidity is significant within the CountyCare membership

• Goal: improve effective management of this population with integrated, comprehensive outpatient care

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Deliver High Quality Care FY 2020-2022 Strategic Planning Recommendations

• Improve Behavioral Health (BH) Quality and Integration• Implement Integrated Health Homes to coordinate care for members’ physical, behavioral, and

social needs• Ensure 100% of in-network hospitals are on MHNConnect real-time alerts platform• Launch Transitions of Care Program and co-locate care coordination in 5-10 high volume BH

hospitals• Increase utilization of medication assisted treatment (MAT) among members with opioid use

disorder

• Transition high volume providers to value-based contracts

• Limit network for certain categories of care

• Continue National Committee for Quality Assurance (NCQA) readiness for 2020 re-survey


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Grow to Serve and Compete FY 2020-2022 Strategic Planning Recommendations

Continue to implement a strong member retention and growth strategy to retain and gain membership through:

• Enhanced primary care engagement and repatriation efforts

• Rich value-based contracting efforts including enhanced reimbursement

• Development of a Newborn Program to increase mother and newborn retention

• Creation of a member retention team to focus on outbound calls to members to augment existing redetermination efforts

• Continued partnership with medical homes to increase Medicaid redetermination rates


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Grow to Serve and Compete FY 2020-2022 Strategic Planning Recommendations

• Explore participation in Medicare Advantage and other lines of business• Chronic Conditions Special Needs Plan (C-SNP) for persons with HIV• Institutional Special Needs Plan (I-SNP)• Institutional Equivalent Special Needs Plan (IE-SNP)• Medicare-Medicaid Alignment Initiative (MMAI)

• Advocate for Medicaid premium plans in Illinois for those with incomes that exceed Medicaid income eligibility guidelines

• Implement a CountyCare Rewards Program 2.0 for improved health outcomes and member retention

• Implement new rewards that align with membership growth strategy


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Foster Fiscal Stewardship FY 2020-2022 Strategic Planning Recommendations

• Continue implementation of Medical Cost Action Plan, including poly-pharmacy and high utilizer initiatives.

• Implement Presumptive Eligibility Program for Home and Community Based Services Wavier (HCBS) Services:

• Strategy to help members stay at home and reduce potentially unnecessary long term care utilization

• Increase membership in the Integrated Care Program (ICP) by assisting members with disabilities attain SSI/SSDI.

• Continued procurement and implementation to increase value and decrease costs for pharmacy, dental, vision, and transportation benefits.

• Seize opportunities to bring services to CCH in areas where we excel.

• Realignment of network to support the Quality Program

• Identification of Skilled Nursing Facility and Home Health Partners


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Invest in Resources/Leverage Valuable Assets FY 2020-2022 Strategic Planning Recommendations

• Continue to invest in employees that are committed to CountyCare and CCH mission

• Invest in programs and technology that improve team efficiency and effectiveness

• Strengthen CountyCare’s workforce including restructuring CountyCare’s organizational structure

• Facilitate and share resources across CCH and CountyCare to maximize workforce efficiencies and capacity

• Leverage all opportunities allotted to us as a health plan within a government health system to impact all aspects of public health and policy


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Impact Social Determinants/Advocate for Patients FY 2020-2022 Strategic Planning Recommendations

• Integrate health risk screening data on the social determinants of health (SDOH) into risk stratification methodology

• Increase connections between CountyCare care coordinators and CCH SDOH Initiatives

• Invest in SDOH Initiatives to serve members experiencing housing, food, and economic insecurity

• Improve access to housing for CountyCare members experiencing homelessness, e.g. Flexible Housing Pool

• Maximize Boulevard program by aligning quality and utilization goals with caseload outcomes

• CountyCare as an equal contributor to CCH SDOH initiatives from inception


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Thank you.

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i. · 3/15/2019 · 2018 operations metrics: call center & encounter rate 5 performance key...

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