Family Health Network and Community Care Alliance of Illinois

Overview

Keith Kudla, CEO(KKudla@FHNChicago.com)

Presentation is incomplete without oral comments

a Managed Care Community Network (MCCN) contracted with the IL Department of Health and Family Services (HFS)

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• Sinai Health System is one of five Family Health Network Sponsors

• Family Health Network (FHN) provides access to cost effective quality health care for people who could not otherwise afford it through enrollment in our health plan and the support FHN provides Safety Net Providers.

• FHN is contracted with IL HFS to participate in the Voluntary Medicaid Managed Care Program. Founded in 1995, FHN is a not-for-profit corporation directed by “safety net” hospitals with all operations located in Illinois.

• Operational for 17 years, FHN is the only surviving Managed Care Community Network (MCCN) in Illinois. Approximately 15 MCCNs and HMOs have come and gone.

• FHN’s model has been successful because it aligns provider incentives and results in quality care for enrollees. Providers, including hospitals, are rewarded for efficiencies and quality outcomes.

• Low administrative expense. General and Administrative (excl. marketing) expenses less than 7%. Consistently one of the best performing plans in the country.

• FHN pays providers timely

• Provider/Member services unit ranked as one of the best in the country.

FHN Overview

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Growth enables Investment

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In 2010 Family Health Network embarked on a multi-year, multi-million dollar strategy to:

1. Expand access to care by increasing contracted provider network.

2. Enhance care coordination capabilities through implementation of the McKesson Clinical Care Management System and a more robust patient centered care coordination model.

3. Make FHN “scalable” and improve overall health plan performance through migration to the industry leading* information system platform and participating in the Metro Chicago Health Information Exchange.

*TriZetto’s QNXT system as rated by Gartner Group and Forrester Research

Planning & Positioning

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Model is designed to: Compensate providers fairly and reward excellence by allowing top performers to earn more

Offer direct and powerful incentives for providers to drive efficiency and better outcomes

Encourage medical providers to work in teams and take collective responsibility for a patient’s health

Provide a realistic framework to transform a fragmented and inefficient system into one that is integrated, accountable, and focused on creating healthy communities

Hospital Services Pool, 31.5%

OOA,Burns,Transplants, Reinsurance,

Solvency Contribution 11.5%

Outreach,Education,Enrollment, 5.0%

Medical Services Pool, 45.0%

Med. Mgt, PFQ*, Add'l Member Incentives,

Admin., 7.0%

*FHN PFQ program funded out of Admin Pool and HFS withhold/bonus

Financial Integration – align incentivesIllustrative: Hybrid Global Cap

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• Summer 2011- FHN established a partnership with Asthma CarePartners of the Sinai Urban Health Institute.

• 213 of FHN’s members with severe Asthma have been enrolled

• Results achieved:– ED Visits have declined 76%– Hospitalizations have declined 82%– Hospital Days have declined 96%– School/work absenteeism is down 78%– Quality of Life scores up 26%

• FHN’s Financial Model rewards Health Systems for successful population health management

Sinai Partnership with FHN

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State of Illinois Goal

A redesigned health care delivery system that is more patient-centered, with a focus on improved health outcomes, enhanced patient access, and patient safety.

Our Response

FHN, in partnership with Access Living of Chicago, Health and Medicine Policy Research Group, and Sinai Health System; formed the not-for-profit Community Care Alliance of Illinois (CCAI) to serve Illinois’ most complex Medicaid and Medicare populations. CCAI has built an organization of local experts to form a local entity designed for the population. Few entities have experience in this field so we have sought guidance from national experts.

The Health & Medicine Mission is to promote social justice and challenge inequities in health and health care. We are a 30-year old independent policy center that conducts research, educates and collaborates with other groups to advocate policies and impact health systems to improve the health status of all people.

Chicago’s Center for Independent Living, fostering an inclusive society and programs that empower people with disabilities to live independent and self-directed lives, including having consumer controlled and fully accessible health care options.

Sinai Health Systems and Schwab Rehabilitation Hospital

Located on the west side of Chicago, Sinai Health System is recognized as a national model for urban health care delivery.

A provider governed health plan that manages the full continuum of care and is accountable for the overall cost and quality of care for a defined Medicaid population and regulated by HFS. Illinois’ only Managed Care Community Network with a mission to support Safety Net Providers.

Salient features of clinical care model• Non-profit• Comprehensive care coordination across all levels of care

Stakeholder (incl. consumer) representation throughout• Integration of medical & long-term care services • Focus on prevention, health and wellness• Anchor Medical Homes - specialized primary care networks:

Disability accessible, knowledgeable– Sinai Anchor Medical Homes: Physical Disability (Schwab), Behavioral

Health, Sinai Medical Group• Interdisciplinary Care Team: Disability Competent, Specialized

Primary Care Team• Centers of Excellence: Specialty Services – Rush, RIC

11COMMUNITY CARE ALLIANCEHealth Programs for Independent Living

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Strategic Growth for FHN and CCAI:

1. CCAI - HFS Seniors and Persons with Disabilities Integrated Care Program (ICP)

• Cook, Collar Counties and Rockford• HFS Proposal submitted – Award Received!

2. CCAI – CMS Medicare Advantage (MA-PD) and Dual Eligible Special Needs Plan (D-SNP)

• Application in process

3. FHN - HFS TANF and ACA Expansion Population• Cook, Collar Counties and Rockford

4. FHN – Health Exchange Product designed to serve low income populations

• Deferred until year 2

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