As new models of payment and healthcare delivery rapidly emerge, we must increasingly align efforts across the hospital, physician group, community health centers, and the 7 health sciences colleges to ensure that our patients receive comprehensive, coordinated care. We also must have a solid grasp on how the Affordable Care Act and changes to Medicare and Medicaid affect what we do every day and what we should be preparing to do in the future.
The Health Policy and Strategy section of the VCHA office was created to provide policy expertise, programmatic leadership, coordination, and support for initiatives that have two defining features: 1) they stem from policy changes and government activity at the state and federal levels, and 2) they involve multiple units of the UI Health enterprise that must work together to achieve goals.
Below are some highlights of what we do. Please don’t hesitate to reach out to one of us to discuss any of these projects further.
What We Do
Medicaid Policy at UI Health
The VCHA Health Policy and Strategy team follows, interprets, and communicates internally about Medicaid policy developments, and recommends appropriate actions for UI Health. We also serve as the primary liaisons to the Illinois Department of Healthcare and Family Services (HFS).
Major areas of Medicaid policy that we cover include:
- Reimbursement to governmental entities
- The rollout of Medicaid managed care in Illinois (see here for more information: http://www.illinois.gov/hfs/MedicalProviders/cc/Pages/default.aspx)
- Medicaid innovation in Illinois (e.g., the 1115 waiver)
- State budget process and its implications for UI Health
Office contact: Amy Lulich
Medicare Policy at UI Health
The VCHA Health Policy and Strategy team follows, interprets, and communicates internally about Medicare policy developments, and recommends appropriate actions for UI Health. We also prepare communications to federal agencies and congressional offices, and directly engage with key contacts, including our national associations.
Major areas of Medicare policy that we cover include:
- Analysis of new payment methodologies, including:
- Support efforts to preserve payments for hospital outpatient departments (HOPDs), including evaluation and management payments
- Support graduate medical education (GME) to help ensure access to care and training the next generation of physicians
- Support efforts to delay reductions to disproportionate share hospital (DSH) payments
- Medicare quality and value based penalties, such as the Hospital Readmissions Reduction Program (HRRP). We are particularly interested in risk-adjustment for socioeconomic status in calculating readmissions rates.
- We monitor funding proposals and reductions related to workforce training education, especially those that impact primary care providers and federally qualified health centers (FQHCs).
- Federal budget process and its implications for UI Health
- Although not part of Medicare, we also cover issues related to the 340B drug pricing program
Office contact: Amy Lulich
UI Health Plus
In response to the state’s shift of its Medicaid population to managed care, UI Health created an Accountable Care Entity (ACE) called UI Health Plus. ACEs were provider-led organizations that provided comprehensive care and care coordination for Medicaid clients across the state. The main goals for UI Health Plus included: 1) retaining the 12K patients that had already been assigned to UI Health primary care providers (PCPs) through the Illinois Health Connect program, 2) bringing new patients into UI Health, and 3) helping us build the infrastructure needed to make the transition from payments based on volume to payments that depended on outcomes.
When new leadership at the state level announced the elimination of the ACE model, UI Health leadership determined that teaming with Blue Cross Blue Shield of Illinois would provide the best opportunity to maintain our relationships with patients and preserve the new care coordination infrastructure we had built, while transferring the membership to an experienced managed care organization (MCO). This transition of UI Health Plus members to Blue Cross Community Family Health Plan occurred on January 1, 2016. As we look to the future, we will want to ensure that we do not lose the momentum of UI Health Plus, but rather use this partnership as an opportunity to continue to improve our ability to manage populations.
Office contact: Amy Lulich
The Affordable Care Act (ACA) at UI Health
The Affordable Care Act (ACA) is often described in relation to the Triple Aim: better care and better health outcomes at lower costs. Beyond the health insurance expansion provided by the ACA, the law also includes programs, funding and guidance on how we expect to transform how we deliver and pay for healthcare well into the future.
The VCHA Health Policy and Strategy team has provided internal expertise on provisions in the ACA and their impact on our providers and patients, and worked directly with our state and federal governments to influence policy decisions. In addition, we have led or co-led the following initiatives:
ACA Health Insurance Enrollment Initiative
The ACA created new health insurance options through the expansion of Medicaid and the creation of a Health Insurance Marketplace. As part of UI Health’s mission to promote health equity and improve the health of our communities, we are committed to helping the uninsured patients and community members in UI Health’s primary service area obtain healthcare coverage.
UI Health is an approved Certified Application Counselor (CAC) organization by the Centers for Medicare & Medicaid Services. This means that a group of our staff are trained and government certified to provide in-person assistance to applicants enrolling in health insurance coverage through the expanded Illinois Medicaid program and the Health Insurance Marketplace. Our Certified Application Counselors (CACs) can answer your questions over the phone, by email, or you can schedule an appointment to get help in-person.
Community Health Needs Assessment (CHNA)
UI Health is committed to serving our community and the people of Illinois, particularly in serving as a national model for our pursuit of the elimination of health disparities. By conducting a CHNA every three years, we have the opportunity to systematically evaluate the needs in our community and define an implementation plan for addressing the highest priority needs. We believe that our focused efforts can begin to reduce the disparities that exist and address many of our residents’ unmet needs.
UI Health’s 2016 Community Assessment of Health Needs (UI-CAN) is now available.
Office contact: Anna Wojcik
Innovation Grants and Contracts
The Affordable Care Act created the CMS Innovation Center, which funds programs that develop and test a series of new innovation models that are designed to change the way healthcare is delivered to improve care, improve outcomes, and lower costs. The health policy and strategy team has been deeply engaged in several Innovation Center programs, providing leadership, proposal development, and enterprise-level coordination for programs including:
Health Care Innovation Challenge (Rounds 1 and 2)
The VCHA office (including both the Population Health Sciences and the Health Policy and Strategy teams) led an effort to coordinate applications being submitted by UI Health for both rounds of the CMS Health Care Innovation Awards. The goal was to ensure that applications reflected the broader goals of the university and were feasible within the structure of our clinical delivery system.
In Round 1, VCHA offered financial support to help applicants prepare proposals, and provided substantial seed funding for one applicant to internally develop its innovation. This became the Emergency Patient Interdisciplinary Care Coordination (EPIC) program for frequent ER visitors.
In Round 2, VCHA worked closely with all applicants, with particular attention to the development of new payment and service delivery models to meet CMS requirements.
Coordination of Healthcare for Complex Kids (CHECK)
In September of 2014, the University of Illinois at Chicago, Department of Pediatrics was the only recipient in Illinois to be awarded one of the 39 Round 2 Health Care Innovation Awards. The CHECK program targets Medicaid and CHIP patients in Cook County who are from 0-25 years of age and have asthma, sickle cell disease, diabetes, prematurity, or multiple chronic diseases. Through the use of community health workers, innovative technology tools, and mental health interventions, the CHECK program aims to:
- Decrease Medicaid spending
- Decrease school absenteeism
- Increase patient engagement
The Health Strategy & Policy Team helps the CHECK program navigate relationships with the state Medicaid agency, Medicaid managed care plans, and the broader UI Health organization.
Great Lakes Practice Transformation Network
The Great Lakes Practice Transformation Network (GLPTN) is part of a nationwide effort funded by the Centers for Medicare & Medicaid Services to improve the quality of patient care while spending health care dollars more wisely. The goal of practice transformation is higher-quality care – more carefully coordinated and with fewer unnecessary tests and procedures – leading to better care, fewer hassles, and lower costs.
The GLPTN brings together 11,500 clinicians across the states of Illinois, Indiana, and Michigan in order to share, adapt, and further develop their comprehensive quality improvement strategies. To support this work, the network will train and deploy quality improvement advisors (QIAs) to coach clinicians through the five phases of patient-centric practice transformation and to provide direct technical assistance on local quality improvement efforts. At UIC, we will be focusing on improvement in our primary care clinics across the system, including family medicine, internal medicine, pediatrics, and Mile Square Health Centers. Together, GLPTN is working to improve the quality and reliability of care for a population of more than 10 million Americans in the region.
The Health Policy and Strategy team provides project management for the grant. We also help coordinate across the primary care departments that will be participating, and work to align this effort with other healthcare delivery transformations occurring within UI Health.
Office contact: Anna Wojcik
Serve as liaisons between the university’s Office of Government Relations and UI Health, including helping assess the likely impact of policy changes, identify positions on legislation, and communicate directly with elected officials in Chicago, Springfield, and Washington, DC to advance our healthcare priorities. Office contact: Amy Lulich.