Health and Human Services Transformation Integrated Health Homes: Overview of approach Kristine Herman, HFS-Bureau Chief Behavioral Health Diana Knaebe, Director, DHS- Division of Mental Health Discussion document May 2017
DRAFT - Confidential and Proprietary The HHS transformation has been enabled by an historic level of collaboration Thirteen agencies / departments / offices are participating in HHS transformation… 1. Governor’s Office 2. Department of Healthcare and Family Services (DHFS) …and focusing on five pillars 3. Department of Children and Family Services (DCFS) 1. Prevention and 4. Department of Human Services (DHS) population health 5. Department of Juvenile Justice (DJJ) 2. Pay for value, quality and outcomes 6. Department of Corrections (DOC) 3. Moving from institutional 7. Department of Aging (DOA) to community care 8. Department of Public Health (DPH) 4. Education and self 9. Department of Veteran’s Affairs (DVA) sufficiency 10. Illinois Housing Development Authority (IHDA) 5. Data integration and predictive analytics 11. Department of Innovation and Technology (DoIT) 12. Illinois State Board of Education (ISBE) 13. Illinois Criminal Justice Information Authority (ICJIA) 1
DRAFT - Confidential and Proprietary As a pressing issue that transcends agencies and populations across Illinois, behavioral health is a lynchpin in the transformation effort Groundwork laid in Healthy Illinois 2021 Governor’s Office and plan , supported by State 12 Illinois agencies with Health Assessment, SIM shared sense of mission grants, and State Health Improvement Plan Disproportionate level of spend on members with Rapid increase in behavioral health needs, opioid-related deaths i.e., mental health and substance use issues Underutilization of Large undiagnosed or community services and untreated overutilization of subpopulations intensive institutional care 2
DRAFT - Confidential and Proprietary Medicaid individuals with diagnosed behavioral health needs make up ~25% of the population, but ~56% of the total spend FY2015 members and spend Annualized members (millions), dollars (billions) 100% = 3.1 10.5 Behavioral health core spend 8% Individuals with diagnosed 25% behavioral health needs 48% Medical spend Individuals with no diagnosed 62% behavioral health needs Spend for non-behavioral Individuals with only care health members 44% coordination fee spend Spend for members with only 6% Individuals with no claims care coordination fee spend 7% 0% Members Spend SOURCE: FY15 State of Illinois DHFS claims data 3
DRAFT - Confidential and Proprietary Objectives of the Illinois HHS Transformation to address these challenges 3 Core and 2 preventive behavioral Integrated, health digitized 4 services member data 1 Behavioral health Enhanced support identification, services 5 screening & access Workforce and system capacity The nation’s leading member-centric behavioral 6 health strategy High intensity assessment, 10 care planning, and care 7 coordination / Structure, integration budgeting, Low-intensity and policy assessment, support care planning, 9 and care 8 coordination / Best practice integration vendor and Data inter- contract operability management and transparency 4
DRAFT - Confidential and Proprietary The 1115 waiver will allow Illinois to realize a set of high-priority benefits, alongside initiatives that will maximize their effectiveness Demonstration waiver benefits # Benefit 1 Supportive housing services 2 Supported employment services 3 Services to ensure successful transitions for Demonstration waiver initiatives IDOC- and Cook County Jail (CCJ)- incarcerated individuals # Initiative 1 Behavioral and physical health integration 4.1 Services for individuals with substance use initiatives disorder in short-term stays in IMDs 2 Infant/Early childhood mental health 4.2 SUD case management interventions 4.3 Withdrawal management 3 Workforce-strengthening initiatives 4.4 Recovery coaching for SUD 4 First episode psychosis (FEP) programs 5.1 Services for individuals with mental health issues in short-term stays in IMDs 5.2 Crisis beds 6 Respite care 5
DRAFT - Confidential and Proprietary The State will also pursue initiatives outside the waiver to advance its behavioral health strategy Non-waiver initiatives covered here Other initiatives ▪ State Plan Amendments (SPAs), including, but not limited to: – Integrated physical and Advance behavioral health homes State Plan Other – Crisis stabilization and mobile Planning Amendments waivers Documents crisis response – Medication-assisted treatment (MAT) – Uniform Child and Adolescent Needs and Strengths (CANS) Other General and Adult Needs and demon- 1115 revenue Strengths Assessment (ANSA) stration waiver funds ▪ Advance Planning Documents grants (APDs) – Data interoperability through 360-degree view of behavioral health member 6
DRAFT - Confidential and Proprietary The Waiver Advisory Committee will be instrumental to PRELIMINARY shaping the transformation across several topics Focus for the next two meetings Working groups presenting material for input Integrated Health Workforce Home Visiting Pilot Supportive Housing Development Homes Supported SUD Case Employment Justice-involved Respite Care Management Services Discussions across topics will focus on the Withdrawal SUD Recovery insights from your experience and potential implications of design Management Coaching decisions under considerations 7
DRAFT - Confidential and Proprietary What an Integrated Health Home is and is not Integrated Health Homes in Illinois Integrated Health Homes in Illinois are: are NOT: … and NOT on the provision of all services Primary focus is on coordination of care… ▪ Integrated, individualized care planning and ▪ Provider of all services for members coordination resources, spanning physical, ▪ A gatekeeper restricting a member’s choice of behavioral and social care needs providers ▪ An opportunity to promote quality in the core ▪ A physical place where all Integrated Health provision of physical and behavioral health care Home activities occur ▪ A way to encourage team-based care ▪ A care coordination approach that is the delivered in a member-centric way same for all members regardless of individual ▪ A way of aligning financial incentives around needs 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) Anything else you would add to these lists? 8
DRAFT - Confidential and Proprietary Principles for Integrated Health Homes in Illinois 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 Goal is to begin launch of model by July 2017 9
DRAFT - Confidential and Proprietary To date, 33 Health Home models have been developed throughout the United States Inclusion criteria: Only focused on members with behavioral health conditions Broader population, including members with behavioral health conditions Only focused on members with physical health conditions Full population WA MT ME 3 ND VT OR 1 MN ID 1 NH SD MA NY 3 WI WY MI 3 CT RI 3 PA IA 3 NE NV NJ 3 OH UT IL IN DC WV CO CA 2 MD VA KS 1 MO 3 KY NC TN AZ OK 3 The Illinois model will break NM AR SC new ground by offering all MS GA AL Medicaid members a fully- integrated model of care TX LA coordination AK FL Hawaii 1 Oregon, Idaho, and Kansas have opted not to continue their programs 2 California will launch its Health Home model in July 2017 3 State has initiated multiple health home models 10 SOURCE: Open Minds; CMS database of approved Medicaid Health Home State Plan Amendments, as of December 2016
DRAFT - Confidential and Proprietary Profiles of ACA Health Homes launched to date Illinois would be first fully integrated Health Home Includes members with SMI/SEDs Largest Medicaid Health Home programs developed to date Number of enrollees, thousands % of Medicaid Conditions population addressed ▪ Chronic 26% 540 ▪ Chronic/SMI 230 26% ▪ Chronic/SMI 220 3% ▪ Chronic 4% 69 ▪ SMI 4% 60 ▪ Chronic 52 1 19% ▪ SMI/SED 25 1 4% ▪ SMI/SED 25 1 3% Many states also employ PCMH programs to coordinate the physical 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 11 SOURCE: CMS Health Home Information Resource Center
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