SmartPlan Choice
Provider Orientation
Overview and Timeline
Agenda
 Introduction and Opening Remarks
 Chicago Market and Projections
 Health Plan and Contract Selection
 SmartPlan Choice Distinction
Introductions and
Opening Remarks
Overview of SmartPlan Choice
Who is SmartPlan Choice?
• Joint venture of Presence Health Partners &
Independent Physician Alliance of Illinois, plus several
other providers/clinics.
• An Accountable Care Entity (ACE), the category for a
provider-sponsored and governed organization,
managing quality, cost and care of IL Medicaid enrollees
• Serves women/caregivers, children and newly eligible
Medicaid enrollees resulting from ACA.
Who is SmartPlan Choice?
• A health plan created by and governed by providers like
you.
• A managed care organization with a collaborative culture
and one where you can have input into policies.
• Joint venture of providers/clinics driven by a mission of
helping the underserved.
• A team of providers with shared values working with and
in the community to improve health for all.
• A group with a strategy to embrace innovation and
change the delivery of health care.
SmartPlan Choice Timeline
Enrollment scheduled to begin in
Central, IL and move North. Cook
County enrolls by zip codes & begins:
Sept 8, 15, 29, Oct 6, Jan 12
Aug 11, 2014
Oct 11, 2014
SmartPlan Choice
Enrollment Begins
Auto-enrollment
Begins
Jan – Dec 2015
Shared Savings
Measurement
Period
60 days after enrollment, any Medicaid
recipient who did not choose a PCP or
medical home will have one assigned to
them. A PCP must be enrolled in Illinois
Health Connect (IHC) to have patients
assigned to them.
Jan 2016 - June
2017
MCO On-Site
Readiness Review
Jul 1, 2017
MCO Effective
date/ Capitation
Full Risk
State Requirements for Providers
participating in SmartPlan Choice?
• Enroll with State of IL Health and Family Services (HFS)
– Enables you to send claims and receive payment
• Register with IL Health Connect (IHC)
– Agreement to terms of medical home
– Responsibility of primary care provider (PCP)
– Registry for providers and office sites
– Database for patient panels and patient allocation
HFS audits the network and processes of SmartPlan Choice to ensure compliance
to regulations. We may need verification from you.
Strategic Direction:
State of Illinois
- SB 26 - Medicaid Expansion bill passes projecting approximately 600,000 new
enrollees
SmartPlan Choice
Counties of operations:
1. Champaign
2. Ford
3. Vermilion
4. Kankakee
5. Kane
6. Will
7. Cook
Care Coordination Expansion (July 24, 2013)
Source: Illinois Department of Healthcare and Family Services
SmartPlan Choice Service Area
and Enroll Dates
County
•
1.
Champaign ------------------------
1.
Aug 11 – Aug 16
2.
Ford -------------------------------
2.
Aug 11 – Aug 16
3.
Vermilion --------------------------
3.
Aug 11 – Aug 16
4.
Kankakee ------------------------
4.
Aug 18 – Aug 23
5.
Kane -------------------------------
5.
Aug 25 – Aug 30
6.
Will ---------------------------------
6.
Sep 29 – Oct 4
7.
Cook (by Zip Code) ------------
7.
Sept 8, Sep 15, Sep 29, Oct 6
(ACA), Jan 12 (ACA)
8.
Iroquois (voluntary enroll) ----
8.
Not mandatory – no date
Enroll Start: 8 wks to choose
State of IL
All enrollment marketing material and
activity must be prior approved by the State
of IL Health and Family Services (HFS).
Including:
•
Community Health Fairs & Events
•
Public Announcements
•
Physician Office Materials
Enrollment Do’s & Don’ts
CAN SAY
CANNOT SAY
Thank patients for privilege of serving
Choose SmartPlan Choice or any
them and to consider you when
specific Health Plan.
selecting a provider for future health Visit www.smartplanchoice.org to see
needs and when enrolling in a health letter of preference for SmartPlan Choice
approved by HFS Aug 20,2014
plan.
Choose SmartPlan Choice or any
specific Health Plan.
I am/this medical practice is part of
SmartPlan Choice (must include any Visit www.smartplanchoice.org to see
and all other Medicaid health plans letter of preference for SmartPlan Choice
approved by HFS Aug 20,2014
office contracted)
Enrollment Do’s and Don’ts
CAN DO
CANNOT DO
Provide telephone for patients to contact Cannot provide ONLINE enrollment at any
Client Enrollment Services (1-877-912provider setting, health fair, or other
8880) directly to enroll
gathering
Provide information on ALL health plans
offered in the service area - - must use
State supplied/approved material.
Persuade enrollment in a specific Health
Plan
Mail Outreach using materials supplied by
State of IL (found on
www.SmartPlanChoice.org )
Face to Face Outreach (door-to-door,
telephone or other cold-call activity)
Pathway to Working Together
HFS Guidelines here
HFS approved
letter for IPA
Provider Manual
found here
Care Management
Manual here
HFS approved
letter for PHP
Dept. of IL
Approved
Letter
preferring
SmartPlan
Choice (PHP)
Dept. of IL
Approved
Letter
preferring
SmartPlan
Choice (IPA)
Chicago Market and
Projections
ACEs within SmartPlan Choice Service
Areas
Partners
Health Plan Name
Presence Health Partners/
Independent Physicians Assoc
SmartPlan Choice
X
X
X
X
X
X
The Carle Foundation
Illinois Partnership for Health
X
X
X
X
X
X
Advocate Physician Partners
Advocate Accountable Care
X
X
X
Loyola Family Care
X
Community Health Partners
X
HealthCura
X
MyCare Chicago
X
Better Health Network
X
UI Health Plus
X
Loyola University Health
Systems
North Shore University Health
System
Access Community Healt
Network
Swedish Covenant, Norwegian
American & Mercy
St Bernard Hospital
University of IL Hosp & Health
System
Cook Kane Will Champaign Ford Vermilion Kankakee
X
X
Cook County Projections from the
State of IL - based on 2012 participation
Populations served by SmartPlan Choice
Cook
Min ACE # ACE
Fchild
FAdult FAdult Fsenior
Grand
Target
Enrollmt
in
0t18 19t64NoD 19t64Dis 65up Partial
Total
Total
capacity Region
817,642 276,745 135,440 99,495 42,037 1,371,358 1,136,424 40,000
9
60%
20%
10%
7%
3%
100%
83%
F = Full Benefit
Partial = Partial Benefit
NoD = No Disability
Dis = Disability
= Populations served by ACEs
SmartPlan Choice currently serves
11% of target market
Before enrollment
Managed Care Organizations by Populations Served in Illinois
Which Health Plan to
contract?
Types of Managed Care Organizations
MCO • Corporate owned. Full risk
MCCN • Provider owned. Full Risk
CCE • Provider Organized. Network
only
ACE • Provider owned. 3 yr to Full
risk- become MCO or MCCN
SmartPlan Choice vs MCO?
• A health plan comprised of and governed by your peers.
• Opportunity to earn your fee for service over next 18
months plus incentives for quality performance
• Contribute to MCO policy vs mandated by MCO policy
• Have input into regional care coordination and
management of high risk patients vs mandated by policy
derived distantly
SmartPlan Choice ACE offers:
• Fee-for-service for first one and half years. Providers bill and
are reimbursed by the State of Illinois for the first 18 months.
•
Partial risk after 18 months; full risk after three years (An ACE
is expected to become a MCCN or MCO).
• Patient Member Per Month (PMPM) payment for each
covered member to manage the care coordination for
physicians and help with future ACE infrastructure and growth
• Opportunity for performance incentive year one and shared
savings after 18 months
Who should I contract?
• Do you want a fully developed, predefined structure with
fixed policies and procedures?
• Do you want a developing organization having input into
policies and procedures? – SmartPlan Choice!
• Which organization shares your values and understands
your perspective? –SmartPlan Choice!
• More contracts = more policies and procedures = greater
administrative burden. SmartPlan Choice! One
community and one goal - improving health for all.
Why SmartPlan Choice?
Why SmartPlan Choice
• Mission Driven - Serving the Medicaid population is
driven by the Mission of key partner of SmartPlan
Choice.
• Local Management - Community is better managed by
an active participant in the local community
• Stakeholder alignment – Local governance by peers who
will protect your interests
• Culture – Transparency, Collaboration, Innovation and
Accountability
SmartPlan Choice Contacts
For Providers
• Care Coordination
• Questions, Info, Other
1.844.254.CARE (2273)
Jennifer.Atilano@presencehealth.org
Mary.Hervey@presencehealth.org
• Tools to assist offices
info@smartplanchoice.org
For Members
• SmartPlanChoice.org
• Member Services
• Member Services TTY
Contact us
1.844.254.CARE (2273)
1.844.852.1371