Illinois Governor’s Office of Health Innovation and Transformation

1. Illinois Governor’s Office of Health Innovation and Transformation Integrated Delivery System Reform (IDSR) Work Group Initial Meeting Wednesday June 18, 2014

2. Implementation Work Groups

3. How the Work Groups Were Formed Alliance for Health Innovation Plan Path to Transformation 1115 Waiver Implementation Work Groups Create Comprehensive Integrated Delivery Systems with Payment Reforms Transform the Health Care Delivery System Integrated Delivery System Reform Ensure Supports and Services for People with Specific Needs LTSS Infrastructure, Choice and Coordination Services and Supports Enhance Public Health Efforts Build Capacity for Population Health Management Public Health Integration Ensure the Workforce has Appropriate Education, Training, and Compensation 21st Century Health Care Workforce Workforce Expand the State’s Leadership Role in Promoting Continuous Improvement Innovation and Transformation Resource Center Data and Technology

4. Implementation Work Group Process • All Implementation Work Groups will adhere to the following high level process as they work toward a common goal: the development of a Strategic Implementation Plan Strategic Implementation Plan • This plan represents the culmination of all Work Group planning activities, and will include actionable steps for implementing all strategic recommendations.

5. IDSR Leaders Chair: Michael Gelder – Executive Director, GOHIT Mr. Gelder advises the Governor on all matters pertaining to national health reform representing the Governor’s office with health care provider associations, advocates and other stakeholders. Prior to GOHIT, Mr. Gelder served as Deputy Director, Illinois Department on Aging assisting the elderly and disabled populations of Illinois. Co-Chair: Derek Robinson, MD, MBA, FACEP – Executive Director, IL Hospital Association (IHA) The Institute for Innovations in Care and Quality Dr. Robinson oversees the strategic initiatives of the Institute directed at accelerating health reform readiness and transforming Illinois’ health systems so that every patient receives the right care, at the right time, in the right setting, with the right patient outcomes.

6. IDSR Subject Matter Expert Art Jones, MD Principal, Health Management Associates Chicago, IL A pioneer in the accountable care organization movement, Dr. Arthur Jones has 27 years of "boots-on-the-ground" experience as the founding physician and CEO of Lawndale Christian Health Center — a large urban community health center on Chicago's west side. Dr. Jones helped establish Lawndale as a model managed care organization in the forefront of delivering Medicaid services under a near global capitation payment system.  During his tenure, the organization earned top ratings for financial performance and invested in innovations to improve the health of the uninsured.  Its redesigned delivery model capitalizes on the efficiencies of electronic medical records, and its care coordinators are creating fully integrated medical homes.

7. Work Group Organization Structure CMS Subcommittees Data and Technology Work Group COMMUNICATION COMMUNICATION GOHIT • DOC • DCFS • DOI • HFS • DPH • DHS • DOA • DCEO • CMS • IDFR Subcommittees Integrated Delivery System Reform Work Group GOHIT Executive Advisory Committee Subcommittees Public Health Integration Work Group Subcommittees Services and Supports Work Group Subcommittees Workforce Work Group

8. IDSR Work Group Participation Total Members: 174 Total Organizations: 132 Organizations represented include:

9. Work Group Ground Rules • Regular, active participation is essential to maintain progress and move recommendations forward • Participants who miss meetings will be kept informed through meeting minutes • Lend your expertise and share all relevant information • Everyone has a chance to speak without interruption • All ideas and opinions will be respected • No one should dominate the conversation or topic • Be open to new ideas • Make decisions based on what is best for our customers • Organizations that send more than one individual to a Work Group or Subcommittee should identify one person to act as the official spokesperson

10. IDSR Work Group Charter Purpose Illinois is committed to multi-payer payment and delivery system innovation that involves transforming from a fee-for-service system to an advanced system of care where patient outcomes and provider payments are aligned. Illinois is seeking substantial flexibility and additional federal investment in innovative strategies designed to increase access to care and incentivize the development of comprehensive, integrated delivery systems capable of taking responsibility for the health of a defined population.

11. IDSR Work Group Charter The IDSR Work Group shall develop recommendations to: Align Quality Metrics • For Medicaid and commercial plans so all patients receive consistently high quality care. Define Integrated Delivery Systems • Establish criteria for integrated delivery to transformthe health care practice into a financially viable, high performing system. Transition Fund • The fund is proposed in the 1115 Waiver to provide supports and incentives for institutional providers to reduce excess capacity or convert facilities to currently needed uses. Implement Health Homes under Section 2703 of the ACA • The health home program will meet the requirements under Section 2703 of the ACA and serve adults with multiple chronic conditions (e.g., SMI), including those with co-occurring chronic health conditions. Create the Hospital Access Assurance Pool • Creating a payment methodology that transitions historical Medicaid UPL supplemental hospital payments to access assurance payments and, ultimately, a methodology that is based on uncompensated care costs. Maximize Federal Funding (e.g., Community First Choice) • Identify the best option to maximize federal reimbursement based on the recommended service delivery, payment reforms, and quality criteria.

12. IDSR Subcommittees The IDSR Work Group Charter will help to inform the development of subcommittees designed to address the topics of the IDSR Work Group.

13. Criteria for Integrated Delivery Systems A clearly defined, risk-stratified patient population A transparent performance management system for practitioners and facilities An information technology system that connects to the Illinois Health Information Exchange (ILHIE) and uses certified electronic health records, as well as common care management platforms and risk assessment tools Ability to contract with the state directly (e.g., Accountable Care Entities) and with multiple payers (e.g., MCOs, Cook County) A network of critical providers including primary care, specialists, hospitals, long-term, and behavioral health A well-defined, evidence-based model of care built around the needs of the populations they serve

14. Criteria for Integrated Delivery Systems A governance entity composed of critical providers that establishes policy and direction for the IDS and can contract, accept, and disburse payment on its behalf Ability to disburse savings among providers to incentivize practices that lead to fewer emergency room visits, fewer hospitalizations, and increased patient satisfaction Well-defined processes, resources, and tools to collect, aggregate, analyze, and report data Ability to implement care management at the practice level Ability to import and analyze disparate sources of data (including revenue, costs, quality, and utilization) to provide performance reports, feedback, and consultation to providers

15. Next Steps and Next Meeting • Define and staff subcommittees • Communicate list of subcommittees and associated topics to Work Group members • Work Group members register for subcommittees of interest • Schedule subcommittee meetings The next IDSR Work Group meeting will be scheduled for: Late July 2014 Exact date, time and location TBD

16. GOHIT Resources • Please submit all questions to: GOV.gohit@illinois.gov • Meeting materials will be posted here: http://www2.illinois.gov/gov/healthcarereform/Pages/GOHIT.aspx • Governor’s Office Health Reform www.healthcarereform.illinois.gov • 1115 Waiver http://www2.illinois.gov/gov/healthcarereform/Pages/1115Waiver.aspx