Strategic Planning FY 2020-2022
CountyCare
James Kiamos, CEO, CountyCare Health Plan
March 15, 2019
Overview of Department
CountyCare Health Plan
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
Impact 2020 Recap
Status 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
Impact 2020
CountyCare Health Plan Progress and Updates
5
Focus
Area
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
Ongoing
Impact 2020
6
Focus
Area
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 Fiscal
Stewardship
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
FY2020-2022
The Future
Environmental Scan of Market, Best Practices and Trends
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
8
Environmental Scan of Market, Best Practices, Trends
9
CountyCare Health Plan Market Share
Managed Care Organization
Cook County
Enrollment
Cook County
Market Share
*CountyCare
31.5%
Meridian (a WellCare Co.)
23.8%
Blue Cross Blue Shield
23.1%
IlliniCare
10.6%
Molina
6.6%
*Next Level
4.4%
Total
100.0%
Illinois Department of Healthcare and Family Services January 2019 Data
* Only Operating in Cook County
Environmental Scan of Market, Best Practices, Trends
• 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
10
SWOT Analysis
Strengths, Weaknesses, Opportunities, and Threats
SWOT Analysis
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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
FY2020-2022
CountyCare 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
Improve Behavioral Health (BH) Quality and Integration
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Deliver High Quality Care
FY 2020-2022 Strategic Planning Recommendations
CountyCare Health Plan
Top
Inpatient Medical Diagnoses (Adult)
Claims
December 2017-November 2018
D
iagnosis Description (3-Digit Primary)
Admissions
Schizoaffective
disorders
1,780
Bipolar
disorder
1,711
Opioid
related disorders
1,679
Major
depressive disorder, recurrent
1,359
Schizophrenia
1,098
Other
sepsis
1,014
Other
chronic obstructive pulmonary disease
781
Alcohol
related disorders
638
Essential
(primary) hypertension
610
Major
depressive disorder, single episode
590
Excludes 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
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
CountyCare Health Plan
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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
CountyCare Health Plan
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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
CountyCare Health Plan
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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
CountyCare Health Plan
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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
CountyCare Health Plan
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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
CountyCare Health Plan
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Thank you.