Download - THE COMMUNITY CARE ALLIANCE OF ILLINOIS
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“Medicaid Care Coordination: Making it Work in
Illinois”
December 19, 2012
Greg Alexander
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THE COMMUNITY CARE ALLIANCE
OF ILLINOIS
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Agenda
I. Introduction
II. Mission, Vision & Model of Care
III. Anchor Medical Homes & Enhanced Care Sites, and
Centers of Excellence
VI. Questions/Discussion
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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I. INTRODUCTION
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Who we are• Non-Profit MCCN
• Wholly owned subsidiary of Family Health Network
• Modeled after Commonwealth Care Alliance of Massachusetts
Collaborators,
• Access Living
• Family Health Network
• Health and Medicine Policy Research Group
• Schwab Rehabilitation Hospital
• Sinai Health System
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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CCAI Board of Directors
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CCAI
Board of
Directors
Consumer Rep: Judy Panko Reis
Consumer Rep:
Sharon Lamp
FHN
Jose Sanchez
FHN
Keith Kudla
Jeff Miller Chair
Kristen Pavle
Kristi Kirschner
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RFP Update
Innovations: Seniors and People with Disabilities
• Awarded a contract with HFS as a MCCN
• Implementation date: 4/1/2013
• Voluntary enrollment in Year 1; membership on par with Integrated
Care Plans in Year 2 and beyond
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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CCAI Model of Care
• Person-centered.
• Wraparound “all-in” care, integrating medical,
psychosocial and long-term care.
• Focus on prevention, health and wellness.
• Disability-competent primary care services with integrated
care teams. Integral role for disability- trained primary
care nurse practitioners
• Flexible sites of services including more home care and
fully accessible sites of care (Anchors)
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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II. MISSION, VISION &
MODEL OF CARE
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Mission: The Community Care Alliance of Illinois is a health plan dedicated to consumer-directed, community-based innovative health services specializing in the care of
seniors and people with disabilities.
Vision:To be the leader in Choice, Access, and Quality of Health Services for people we serve.
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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Underlying Philosophy of CCAI
To achieve a higher quality of care, with
improved patient satisfaction and cost savings
• Secondary prevention of complications through care
coordination
• Empowering consumer voice and utilizing community
peer resources
• Incorporating long term services and support
• Decreasing ER visits
• Reducing hospitalization rates
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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CCAI Target Population
Adults and Seniors with Disabilities, Including:
• Multiple Chronic Illnesses
• Severe Mental Illness
• Deaf and Hard of Hearing
• Intellectual Developmental Disabilities
• Physical Disabilities
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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CCAI Clinical Model of Care: “Patient Centered”
CCAI Specialized Primary Care Team
CCAI Wrap-Around Services
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Consumer/
Patient/
Caregiver
COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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CCAI Model of Care
• Person-centered
• Wraparound “all-in” care, integrating medical,
psychosocial and long-term care
• Focus on prevention, health and wellness
• Disability-competent primary care services with integrated
care teams. Integral role for disability- trained primary
care nurse practitioners
• Flexible sites of services including more home care and
fully accessible sites of care (Anchors)
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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Interdisciplinary Care Team:
Disability Competent Primary Care
• PCP (MD/DO or NP - family medicine, internal medicine, pediatrics)
• Nurse care coordinators
• Long-Term Services and Supports Coordinator (social worker)
Specialty Care
• Rehab professionals
• Behavioral/mental health providers
• Specialists (orthopedics, neurosurgery, pulmonary, etc.)
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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Stineman MF, Streim JE. The Biopsycho-ecological paradigm: A
foundational theory for medicine. PM&R 2010; 2(11); 1035-45.
COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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Based upon HRA, Initial Health Risk and
Complexity Stratification
TIER 1 – HIGH RISK
TIER 2 – MEDIUM RISK
TIER 3 – LOW RISK
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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CCAI 6-Domain HRA, Individualized Care Plan
• Active/acute medical issues: Primary prevention of acute disease/ illness, Secondary prevention of disability complications, CDM, Health behaviors
medical
• Functional assessment; Mobility, ADLs, IADLs, communication, social skills, leisure and vocational pursuitsfunctionalfunctional
• Housing with appropriate accessibility both into home and within home; Community transportation and access to needed services. environmental
• Financial security- ability to meet basic needs (food, rent, medication co-pays, etc.)financial securityfinancial security
• Primary and backup social support
• Proxy for advance directive
• Respite services for caregivers
social supportssocial supports
• Mental/behavioral health history; Active issues, Level of stress, Substance Abuse and Coping skills
psychological/ behavioral healthpsychological/
behavioral health
COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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Model of Care Diagram
PCP No
Assigned to NP PCP
PCP Yes, member want
to continue current
relationship with PCP
Collaborating MD
Monthly meetings
Consultation
Specialists
DME
LTC
Rehabilitat
ive
Services
Mental
Health
Services
Pharmacy
PCP
working
with care
manager
LTSS
Specialists
DME
LTC
Rehabilitat
ive
Services
Mental
Health
Services
Pharmacy
PCP/NP
working
with care
manager
LTSS
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III. ANCHOR MEDICAL HOMES,
ENHANCED CARE SITES, AND
CENTERS OF EXCELLENCE
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Anchor Medical Homes: Gold Star Designation
Fully accessible and user-friendly environment for people with disabilities and complex needs, Anchor Medical Homes will provide the following:
• Physical access (parking, entrance, clinic space, bathrooms)
• Communication access including interpreting services
• Accessible medical equipment including exam tables, wheelchair accessible scales, transfer equipment and staff training
• Staff knowledgeable regarding disability care and accommodations
• 24/7 access
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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Anchor Medical Homes: Gold Star Designation
(continued)
• Commitment to incorporating health information technologies and enhancements
• Interdisciplinary Care Team meetings, case reviews, etc.
• Jointly-hired Nurse Practitioners as collaborative plan liaisons
• Commitment to adapted health, wellness and secondary prevention resources for all CCAI members
• Commitment to incorporating consumer input and peer support services
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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• Swedish Covenant Hospital
• Mercy Diagnostic and Treatment Center
• PrimeCare, Inc. (St. Mary/St. Elizabeth)
• Sinai for SMI
• Schwab Rehabilitation Hospital: Deaf and Hard of
Hearing and People with Disabilities
• St. Bernard Hospital
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Initial CCAI Anchor Medical Homes
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Health Programs for Independent Living
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Enhanced Care Sites
• Pre-existing PCP relationships that member desires to
preserve
• PCP/member can access all CCAI enhanced services
(Nurse Practitioner, Nurse Care Coordinators, Long-Term
Services and Supports Coordinators (LTSS) available to
them)
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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Centers of Excellence: Specialty Services
• Continuum of rehabilitation services
• Continuum of behavioral/ mental health services
(coordinated through PsycHealth)
• Pursuing specialty care clinics:
- Muscular dystrophy
- Adult spina bifida
- Dementia
- Intellectual/ Developmental disabilities
- Deaf and Hard of Hearing services
- Reproductive health
- Preventative dental
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COMMUNITY CARE ALLIANCE
Health Programs for Independent Living
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IV. QUESTIONS & DISCUSSION
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