From Innovation To Implementation: Work Group Report From The Office of Health Innovation and Transformation

From
InnovatIon
to
ImplementatIon:
Work Group Report from the
Office of Health Innovation and Transformation
December 31, 2014

State of Illinois
Office of the Governor
Springfield, Illinois 62706
Pat Quinn
GOVERNOR
December 31, 2014

Over the last two years, Illinois has accelerated efforts to improve the health of our 13 million
residents. Achieving the “triple aim” of helping Illinois residents improve their health, ensuring
access to affordable, high-quality health care, and containing costs has been a priority of my
administration since the signing of the Affordable Care Act in 2010. The current high-cost
system is financially unsustainable and leaves too many people without care, including those who
struggle with chronic disease or disability. And, far too often, these burdens fall on minorities and
people with low incomes.
Shortly after taking office in 2009, I initiated programs to serve more Medicaid clients in
integrated medical care delivery systems, beginning with older adults and people with disabilities.
In 2011, I signed bipartisan Medicaid reform legislation requiring that at least half of Medicaid
clients be served in risk-based, coordinated care systems by 2015, a goal we will meet.
In 2012, Illinois received a $2 million Model Design award from the Center for Medicare and
Medicaid Innovation to develop a statewide innovation plan. To undertake this comprehensive,
intensive planning effort, my office established the Alliance for Health. The Alliance is made up
of health policy makers, health care providers, insurers, payers, public health professionals, small
and large businesses, and community development advocates who have come together to develop
strategies and innovations to achieve the “triple aim”. They identified five essential areas in their
December 2013 Implementation Plan we need to address to achieve that aim.
In January 2014, I issued an executive order creating the Governor’s Office of Health Innovation
and Transformation to lead and manage Illinois’ health transformation efforts, broadly engaging
stakeholders to determine how to implement the Alliance for Health Innovation Plan.
The recommendations in this report reflect months of work by hundreds of stakeholders and
state staff to reach consensus around implementing health transformation in Illinois. I am
incredibly proud of the work of these groups and deeply appreciate their commitment to making
Illinois a healthier state.
Sincerely,
Pat Quinn
table of Contents
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Integrated Delivery System Reform Work Group Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Services and Supports Work Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Population Health Integration Work Group Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Workforce Work Group Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Data and Technology Work Group Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Related Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Next Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Work Group Report from the Office of Health Innovation and Transformation 1
From
InnovatIon
to
ImplementatIon
exeCutIve summary
ExECuTIVE SuMMARy
In June 2014, the Governor’s Office of Health Innovation and Transformation (GOHIT) initiated
an intensive stakeholder engagement process to recommend how Illinois should implement the
requested Section 1115 Medicaid waiver reforms and the broader health system transformation
innovations in the State Innovation Model Test grant application. The waiver request and grant
application were submitted in June and July, respectively, pursuant to recommendations in the
Alliance for Health Innovation Plan, completed in December 2013.
GOHIT established work groups as an opportunity for interested organizations and individuals to
discuss and recommend how the state would advance and implement the innovations. This process
enables stakeholders to play an active role in the implementation the Alliance’s innovations.
The work groups addressed the five health system transformation drivers identified in the
Innovation Plan and the corresponding pathways in the subsequent Medicaid Section 1115 waiver
application:
• Integrated Delivery System Reform
• Supports and Services for people with specific needs
• Public health integration
• Workforce expansion
• Data and technology, for continuous health system improvement.
Integrated Delivery System Reform

The Integrated Delivery System Work Group was formed to recommend ways to implement
integrated delivery systems in Illinois. This model brings together local physicians, hospitals, nursing
homes, and other essential community providers into a network connected with electronic health
records where all care is organized around the needs of the patient and their family in order to
achieve improvements in health and health care. Illinois committed to pilot several integrated
delivery systems in its SIM grant application and definitions and guidelines are needed. The
Integrated Delivery System Reform (IDSR) Work Group focused on five key areas necessary for the
development of integrated delivery systems. Subcommittees focused on: Integrated Delivery Systems,
Quality Metrics, Care for the undocumented, Community Based Capacity, and Health Homes.
Major recommendations cover:

Integrated Delivery Systems:
• Criteria for integrated delivery systems (IDS) in Illinois, including engagement with Regional
Public Health Improvement Collaboratives
• Selection criteria for potential IDS pilot sites
• Criteria for health plan participation with IDS
• Guidelines for funding and coordination with the public health system
• Role of Innovation and Transformation Resource Center
• utilization of new health care worker roles
Quality Metrics:
• Broad set of measures that apply to all populations, as well as a narrow set of measures for
specific populations.
• Value metrics should be standardized among plans and payers as much as possible, and
include a small and manageable subset that are tied to financial incentives.
• Quality parameters should be aligned among health plans and payers for similar populations
and should be measured in uniform fashion.
• Measures should address social determinants of health, including access and equity.
• Measures should address risk in order to focus on prevention and the availability of treatment
services post-diagnosis.
• Measures should be consistent with national standards, yet allow room for innovation and
needs specific to Illinois population.
• Measures should be actionable and relevant to a large portion of the enrollees.
Care for the Undocumented:

• Facilitate integrated health service delivery infrastructures in areas with high concentrations
of undocumented individuals
• Ensure continued funding to safety net providers
• Increase the availability of public and private coverage options.
• Establish a Health care Marketplace for undocumented individuals; Expand requirement for
employers to offer insurance
• Discourage private health insurance companies from requiring SSN for the purchase of
coverage.
Community Based Capacity:

• Survey community-based providers and that the state work to equip and prepare them to be
active, on-going providers of service.
• Work with community-based providers working with the Medicaid eligible population to
equip and prepare them to be providers of services within this new care coordination
environment.
• Place community organization participation metrics into Healthcare and Family Services
Managed Care Organization contracts.
• The state should work with Medicaid providers encouraging them to agree to utilize the state
community based provider infrastructure.
Health Homes:
Section 2703 of the ACA establishes a new state plan option for states that incentivizes, through a
higher federal matching rate (90% for eight calendar quarters), intense support services for
Medicaid clients with chronic conditions. HFS presented a Health Home plan for Illinois in late
November that was discussed and recommendations submitted to HFS to guide its State Plan
Amendment.
• Submission of a State Plan Amendment (SPA) to the federal Department of Health and
Human Services (HHS) to establish the Health Home program, and the use of the final
Health Homes Concept Paper written by the Department of Healthcare and Family Services
as a roadmap for implementation.
Services and Supports

This work group divided its work into two primary subcommittees: Children’s Services and Long
Term Supports and Services.
4 From InnovatIon to ImplementatIon:

The Children’s Services Subcommittee focused on developing recommendations around children
with complex behavioral health needs. The subcommittee recommended adopting a System of Care
Framework for the Children’s Behavioral Health Service Delivery System. The Subcommittee
focused on three main tasks: 1) developing implementation strategies that are consistent with
Systems of Care principles, 2) designing an enhanced delivery system and full continuum of care
for children with behavioral health needs, and 3) helping inform the NB vs Hamos settlement that
meets the requirements of Early Periodic Screening, Diagnosis, and Treatment (EPSDT). Five
“breakthrough” groups were established to complete the work for the Children’s Services
subcommittee: Governance, Service Coordination and Case Management, Service Provider
Contracting and Network, and Entry and Access.
Recommendations cover:
Governance:
• Establish a governance structure to sustain and implement a statewide Systems of Care
framework for the children’s behavioral health system.
Service Coordination & Case Management:

• Develop Care Management Entities, consistent with Systems of Care that interface with all
Medicaid platforms and private payers.
Service Array:
• Expand the Medicaid Service Array to include new services such as Care Coordination,
Intensive In-Home, Mobile Crisis Response and Psychiatric Residential Treatment Facilities.
Provider Contracting:
• Build a robust network of community-based providers should be a higher priority than
additional out-of-home alternatives.
Entry & Access

• universal Assessment by independent certified assessors utilizing the CANS tool to
determine level of behavioral health needs.
The Long Term Supports and Services Subcommittee focused on developing recommendations to
ensure ready access to the wide range of services and supports by individuals based on functional
need, and not solely based on disability. It established four breakthrough groups: Service
Definitions and Provider Qualifications, Conflict-free Case Management & Person-centered
Planning, Behavioral Health, and Developmental Disabilities.
Recommendations cover:
Service Integration:
• Integrate 96 services within 8 existing Home & Community-Based Services (HCBS) waiver
services into 23 proposed service groupings
• utilize 23 service definitions and provider qualifications approved by stakeholders
Conflict-free Case Management:
• Take a phased-approach with Conflict-free Case Management (CFCM) compliance:
o Step 1: develop a Balancing Incentives Program (BIP) CFCM protocol implementation
plan for September 2015

o Step 2: develop Conflict of Interest rules that reflect more stringent federal Centers for
Medicare & Medicaid (CMS) HCBS requirements
Consumer Bill of Rights:

• Implement Consumer Bill of Rights as proposed across all LTSS consumer populations
Person-Centered Planning:
• Implement the Statement of Intent across all LTSS consumer populations
• Take a phased approach to transforming to a Person-centered Thinking system:
o Step 1: Translate the Statement of Intent into actionable Vision Statement
o Step 2: Develop a compliance plan for HCBS Person-centered Planning regulations
o Step 3: Develop a comprehensive plan for building a Person-centered Thinking system
that will identify necessary infrastructure, business process, regulatory, training, and
consumer and family education changes Population Health Integration Work Group
The Population Health Integration Work Group

This work group sought to enhance the ability of the Illinois health care system to engage in
population health management by leveraging public health resources and encouraging linkages
between public health and health care delivery systems. The findings and policy recommendations
reflect the efforts of the four subcommittees: Creation of Bonus Pool for Health Plans, Expanding
Maternal-Child Home Visit, Asset Based Community Development and Regional Health
Improvement Collaboratives.
Recommendations include:
• The regional Health Improvement Collaboratives (rHIC) subcommittee recommends that
the State of Illinois require that RHICs engage in an integrated approach to community
health planning; explore requiring participation of key partners as part of state certification,
licensure, and contracting processes; sustain the infrastructure of the RHIC; create an
evaluation plan that helps determine which efforts are impacting outcomes; establish a
technical assistance center to support RHIC’s and other areas interested in collective impact
in community health improvement; and convene an RHIC Advisory Committee to support
statewide implementation efforts.
• The asset based Community Development (abCD) subcommittee recommends that the
State of Illinois pursue policies to ensure comprehensive, positive strength-based community
development; confirm one of Illinois state agencies initiate a pilot program-partnership with
one or more select communities; develop a new, separate work group formed to focus on
community based capacity; and develop guiding principles in partnering with communities
and pilot sites in developing intersectoral health care systems.
• The Creation of bonus pool for Health plans subcommittee recommends that the State of
Illinois pursue policies to establish a new source of funding that would be dedicated to
supporting population health interventions; ensure that a portion of bonus pool dollars funds
the work of RHIC; and create guidelines on how bonus pool dollars may or may not be spent.

• The expanding maternal Child Home visits subcommittee recommends that the State of
Illinois pursue policies to seek federal reimbursement for evidence-based home visiting
services; develop a certification system to allow home visitors who are engaged in family
support to become Medicaid-eligible providers; ensure that existing home visiting and care
coordination systems are fully integrated with Medicaid Managed Care programs; and
continue to safeguard existing funding for home visiting services and use additional dollars to
expand access.
Workforce Work Group

The Workforce Work Group assessed the state’s health care workforce needs to assure alignment
with the needs of the Medicaid program; address workforce shortages in high-need urban and
rural areas; and build a work force that is ready to practice in integrated, team-based settings in
geographies, populations, and disciplines that are in the greatest demand. Four subcommittees
undertook this work: Financial Incentives, Health Workforce Expansion, Pipeline and Pathways
(which was further separated into three breakthrough groups: Pathways, Veterans, and Inter-
professional), and Telehealth.
Recommendations include:
• The Financial Incentives Subcommittee recommends that the State of Illinois pursue
policies to improve licensure renewal data collecting; expand loan repayment programs to
include community based workers and all clinical careers; design and implement a Medicaid
Graduate Medical Education (GME) training program to help ensure access to services and
incentivize health care providers to create or increase investment in training through loan
repayment assistance and/ or bonus payment pool for safety net hospitals.
• The Health Workforce Expansion Subcommittee recommends that the State of Illinois
pursue policies related to Community Health Workers (CHW) to ensure that on-going
CHW data is collected and evaluations conducted; establish a CHW certification process,
core curriculum standards for CHW training, and CHW funding opportunities and
resources.
• Additionally, the Subcommittee recommends that the state form and convene a Scope of
Practice (SOP) Review Board; establishing a review process to evaluate the barriers that exist
for health professions; and encourage ways to use each profession “at the top of its license”.
• The Pipelines & Pathways Subcommittee recommends that the State of Illinois integrate
the concerns of adult learners and job seekers into a pipeline and pathways process in the
traditional educational and workforce pipeline;
• The Teleheath Subcommittee recommends that the State of Illinois evaluate and, where
appropriate, pursue policies to implement “The Illinois Telehealth Initiative”; conduct various
demonstration projects; and provide telehealth services to children, hospital Emergency
Departments, as well as urban jails and correctional facilities.
Data and Technology

The Data and Technology Work Group focused on recommendations to establish a framework for
leveraging existing systems, promoting standards and technology infrastructure, supporting
interoperable communication, and prioritizing elements of additional technical resources and
functionality needed to accelerate the Innovation Model. It worked through three subcommittees:
Care Coordination, Open Data, and All-payer Claims Database.
recommendations cover:
Care Coordination:
• Implement the Common Care Platform as described in the proposed framework.
• Implement the Portable Care Plan as described in the proposed design.
All Payer Claims Database (APCD):

• Continued exploration of the merits of creating an All-Payer Claims Database (APCD) for
the benefit of the residents of the State of Illinois
Open Data:
• Establish an Open Health Data Executive Steering Committee (with participation from all
Health and Human Services State Agencies)
• Address technology limitations of current site and backend legacy systems
• Publically release and update a comprehensive Illinois health data dictionary/catalog
• Develop multiple ongoing public engagement/feedback mechanisms
• Prioritize future uploads based on public demand/feedback and potential benefit to health
care transformation in Illinois

ACkNOWLEDGEMENTS
The Governor’s Office of Health Innovation and Transformation would like to acknowledge and
thank the chairs, co-chairs, subject matter experts and support staff for their hard work leading the
work group process. Health and Medicine Policy Research Group and the Illinois Public Health
Institute were instrumental in facilitating the work groups, driving consensus, and drafting
recommendations for consideration. The Illinois Framework Project, Woods Charitable Trust,
Chicago Community Trust, and the Michael Reese Health Trust deserve special recognition for
their generous contributions that helped support their work.
Several state agencies, including the Department of Healthcare and Family Services, the
Department of Human Services, the Department of Public Health, the Department on Aging, the
Department of Corrections, the Department of Children and Family Services, the Department of
Financial and Professional Regulation, the Department of Insurance, and the Illinois Health
Information Exchange provided the leadership and expertise required to make progress on our
ambitious goals of transforming the health care system in Illinois. Thank you to the stakeholders,
advocates, consumers and all other work group participants who spent countless hours contributing
to the ideas in this report and committing to move these recommendations forward.
From
InnovatIon
to
ImplementatIon
IntroDuCtIon
INTRODuCTION
This report reflects an unparalleled effort by leaders of public and private payers, health insurance plans
and providers, public health practitioners, health policy experts, community development advocates,
and other sectors to reach accord on the steps necessary for Illinois to achieve the triple aim:
• Improve the health of our population,

• Enhance the quality and effectiveness of health care services, and
• Lower health care costs.
Several forces have converged for the state and stakeholders to engage in this unique public-private
planning effort and reach the consensus recommendations included in this report.
One driving force is the crisis in state Medicaid costs that resulted in the passage and signing of
bipartisan legislation in 2011 (P.A. 96-1501) that required at least half of Illinois Medicaid clients
to be served in risk-based coordinated systems of care by 2015. This commitment focused attention
on how Illinois would dramatically expand its voluntary managed care program to enroll more than
1 million new clients in traditional insurer-based managed care and in newly created entities that
assume risk for the total cost to care for clients and carefully coordinate care to ensure positive
health outcomes.
Hospitals, community health centers, and other care providers routinely paid on a fee-for-service
basis are very concerned about what role they play in the managed care expansion. Advocates for
clients are concerned whether the state can hold managed care entities responsible for high quality
care and protect against excessive profits that could accrue if they provide inadequate care.
This effort to create more efficient and effective health care delivery systems also underscores the
need for an expanded and appropriately trained and compensated workforce, and the importance of
data and technology. Providers need access to health histories and other data immediately to
provide better care and avoid duplicative tests, procedures, and prescriptions. More efficient forms
of care, achieved by expanding the role of providers to practice to the full extent of their training
and education or by embracing effective new technologies are essential for achieving the triple aim.
Passed in 2010, the Affordable Care Act became a new force driving health care change. It reflects
the nation’s commitment to reduce the number of Americans without health insurance. It also
explicitly directs national attention to improve quality and control costs. With the expansion of the
Medicaid program to cover low-income adult wage-earners and vigorous outreach to the state’s
childless adult population to participate in the federal health insurance marketplace, more than
800,000 additional state residents are now covered under Medicaid or private insurance, at no
additional cost to the state. The ACA also provides funds to seed public and private sector models
to improve access and quality, and limit costs through the Center for Medicare and Medicaid
Innovations, within the Centers for Medicare and Medicaid Services at HHS. CMMI spearheads
the national effort to transform the delivery of health care. CMMI recognizes the urgent need for
more collaboration between Medicare and Medicaid, based on the large number of people who
qualify for both programs due to old age or expensive disabilities. CMMI also urges states to
encourage collaboration between their population health resources and health care providers.
Illinois’ two Model Design grants were made possible by the ACA funding.
A third force is the urgent need to address health care costs to prevent them from eclipsing other
public and private sector funding priorities. Costs will continue to increase unless the state’s
population can reach improved levels of overall health, reduced levels of disability, lower rates of
chronic illness, etc. And these factors are less influenced by access to medical care than they are by
social determinants of health, such as education, adequate nutrition and exercise, clean air and
water, and safe housing and communities.
Without significant health improvements, the need for ever-more expensive medical care will
continue to affect all payers, public and private. Studies increasingly reveal the impact of higher
medical costs on wages and benefits, with wages stagnating as increasingly costly health insurance
premiums are paid by individuals, employers, and employees. Achieving these improvements will also
alleviate the disproportionate costs borne by low-income individuals and racial and ethnic minorities,
who are less healthy and have higher disability levels than whites and those with higher income.
The effort to transform the state’s private and public health care systems is based on the premise
that better health is essential for improving Illinois’ economy and helping our state’s children,
families, communities, and businesses thrive without undue financial costs and social burdens of
disease and disability.
To address these forces, Illinois adopted the triple aim to guide transformation of its health and
health care systems. In 2012, Illinois successfully competed for a $2 million CMMI State
Innovation Model (SIM) planning grant to accelerate the managed care planning and
implementation process. This money was used to convene key stakeholders—health insurance
plans, health care providers, public and private sector payers, and public health practitioners—as
well as businesses, academic experts, advocates, and others engaged in health and health care
delivery to identify innovations that would help achieve the three aims. Intense, consultant-
moderated discussions led to development of the December 2013 Innovation Plan, which was
released in December 2013.
The Alliance identified five key system change drivers:

• Integrated delivery systems and related payment incentives
• Services and supports for people with specific needs
• Workforce expansion and enhancements
• Public health integration and collaboration with clinical care
• State leadership to achieve continuous quality improvement
The Alliance developed specific recommendations under each of these drivers. Some of these
focused on payment reforms needed from major payers such as Medicaid and commercial
insurance to ensure high quality care through comprehensive integrated delivery systems. Others
were directed to ensure older adults and people with disabilities have access to the services they
need to achieve their highest level of independent functioning in the most community-integrated
setting possible. Proposals to fill workforce gaps and shortages were identified, as were restrictions
on scope-of-practice laws that prevented professionals from working in Illinois to the full extent of
their training and education. With many more Medicaid and Medicare clients enrolled in
managed care plans, the Alliance recognized that their health could be improved by integrating
public health practices with health care delivery.

To lead the public-private partnership to implement the innovations, in January 2014, Governor
Pat Quinn established the Office of Health Innovation and Transformation (GOHIT). This office
organized the Alliance innovations into three categories: those that can be implemented without
federal approval or additional funds; those that would require significant changes to the state’s
Medicaid program for which federal approval and funds are necessary; and broader innovations
that require significant additional funding to test.
GOHIT addressed all three categories during 2014. It led a consensus-building process and
successfully sponsored legislation during the spring session to define community health workers and
facilitate electronic exchange of electronic health records containing sensitive mental health, genetic
counseling, and HIV/AIDS information. GOHIT also supported the application to federal CMS
for a Medicaid waiver under Section 1115 of the Social Security Act, which was submitted in June
2014, and developed the application for State Innovation Model Test grant funds, submitted in July.
The Medicaid-related innovations reflect Illinois’ legislative mandate to enroll at least half of
Medicaid clients in managed care by 2015. Medicaid has increased the number of managed care
plans and, based on legislation in spring 2013, also opened opportunities to newly defined
Accountable Care Entities, which can serve as a model for integrated delivery systems.
As anticipated in the Alliance Innovation Plan and with additional Medicaid changes
recommended by stakeholders, such as the Illinois Hospital Association, Illinois applied in June
2014 to the federal Department of Health and Human Services, Centers for Medicare and
Medicaid Services for a waiver under Section 1115 of the Social Security Act. The waiver would
enable Illinois to receive the substantial initial increase in federal funding necessary to implement
the Medicaid-related innovations. The waiver would enable the state to establish a standard set of
home- and community-based services for all older adults and people with disabilities and to
expand services for disability groups whose current state service package is limited. The 1115
waiver also seeks to allow the state to issue bonus payments to integrated delivery systems and
plans that participate in local public health efforts and succeed in helping clients achieve stable
housing with necessary support services. Illinois applied for an 1115 waiver in June 2014.
The Medicare and Medicaid Innovation Center funds states to implement innovations that impact
private sector payers, such as commercial insurers, self-insured corporations and Medicare. Larger
grants are available for states that enable 80 percent of their populations to access care through
integrated delivery systems. Illinois applied for these grant funds in July 2014.
Recognizing that substantial stakeholder consensus would be essential for these innovations to
succeed, the Governor’s Office of Health Innovation and Transformation organized stakeholder
work groups in June 2014 around each of the five key drivers and supported their efforts to flesh
out details and the steps necessary to implement them. The work groups, in turn, established
subcommittees to further explore implementation issues, based on dozens of topics from the waiver
and model test grant that warranted further stakeholder deliberations. Over six months more than
500 people participated in more than 150 meetings of the work groups, their subcommittees, and
break-through groups.
Each work group was led by a Chair and Co-chair, generally, one from GOHIT staff or a state
agency and the other from the private sector. Most had subject matter experts available to assist
them, as well. Subject matter experts and outside support staff to manage invitations, agendas,
minutes, and other meeting logistics were supported by foundation funding. GOHIT staff
maintained rosters and convened the support staff bi-weekly to identify potential overlapping
issues and gaps that were then discussed at monthly meetings of the chairs, co-chairs and subject
matter experts. The organization chart (Appendix F) for the GOHIT stakeholder engagement
process also involved the state agency directors and secretaries, who met monthly in an executive
advisory capacity to review work group progress and identify any potential conflicts with their
departments’ efforts that might overlap or cause conflicts.
Each work group, with support and guidance from GOHIT, developed its own charter (Appendix
G) to reflect its scope, responsibilities and goals. The work groups were charged to research, discuss
and debate issues necessary to build consensus for the transformational innovations. The number of
meetings reflected the time necessary to process the information and reach consensus
recommendations. Most meetings offered the opportunity to participate by telephone and many
also offered video connections in Chicago and Springfield. GOHIT developed a set of ground
rules (Appendix I), which set standards for work group participant behavior and ensure
professional and respectful dialogue.
As work groups and subcommittees began attracting larger numbers of participants, their leaders
employed quick turnaround surveys to help members see how particular ideas and
recommendations were being received and prioritized by other members. This device also helped
reduce the number of meetings, as more information could be shared between and among
members outside of the formal meetings.
Given the sheer magnitude of the number of meetings that occurred during the summer, GOHIT
staff conducted its own survey of all participants to determine how the work groups and
subcommittees were functioning and identify opportunities for improvement. Staff personally
contacted anyone who requested an individual conversation. The results were overwhelmingly
positive and suggestions to improve the process were shared with the chairs and co-chairs. Mid-
course corrections were made in style and substance in several of the work groups.
This report reflects the intensive work the public and private sectors have accomplished during the
past two years. It will guide future efforts to advocate for and implement the innovations that will
ensure access to affordable, high quality health care for all Illinois residents.

From
InnovatIon
to
ImplementatIon
INTEGRATED
DELIVERy SySTEM
REFORM WORk GROuP
INTEGRATED DELIVERy SySTEM WORk GROuP
The Integrated Delivery System Work Group was formed to recommend ways to implement
integrated delivery systems in Illinois. Illinois committed to pilot several integrated delivery
systems in its SIM grant application and definitions and guidelines are needed. This multi-payer
payment and delivery system innovation that involves transforming from a fee-for-service system
to an advanced system of care where patient outcomes and provider payments are aligned.
PRIMARy RECOMMEnDATIOnS
Integrated Delivery Systems: Quality Metrics
• Adopt benchmark criteria for integrated delivery • Develop a set of quality measures using
systems in Illinois; adopt criteria for health plan recommended principles
participation in integrated delivery system model • utilize recommended quality measures for
• Establish Innovation and Transformation Resource integrated delivery systems
Center, engage with Regional Public Health
Improvement Collaboratives, utilize new health care Community Based Capacity:
worker roles • Survey community-based providers, equip and
prepare them to be active, on-going providers of
Care for the Undocumented: service
• Facilitate integrated health service delivery • Work with community-based providers working
infrastructures in areas with high concentrations of with the Medicaid eligible population to equip and
undocumented individuals prepare them to be providers of services within
• Ensure continued funding to safety net providers new care coordination environment.
• Increase the availability of public and private • Add metrics to Managed Care Organization contracts
coverage options. • Work with Medicaid providers encouraging them to
• Establish a Health care Marketplace for utilize the community based provider infrastructure.
undocumented individuals; Expand requirement for
employers to offer insurance Health Homes:
• Discourage private health insurance companies • Submit federal State Plan Amendment to establish
from requiring SSN for the purchase of coverage Health Home program
Process Leadership IDSR Statistics

This work group was led by • 18 work group and subcommittee meetings
Michael Gelder, Governor’s • 25.5 meeting hours
Office of Health Innovation and • 3 surveys
Transformation director and • Engaged 265 stakeholders from more than 150 organizations
Derek Robinson, MD, director
of the Illinois Hospital Themes
Association Quality Care Critical Issues discussed by stakeholders
Institute. Subject matter • Address the evolving role of community providers in the managed care
expertise was provided by Art and IDS context.
Jones, MD, Health Management • Major changes in Medicaid-funded human service delivery require
Associates. Administrative, new platforms for care coordination
research, and coordination • Address access and affordability barriers for undocumented individuals
support was driven by Health & • Develop working definition of integrated delivery system
Medicine Policy Research • Identify quality metrics for broad and narrow populations that can be
Group and GOHIT. adopted by all payers.

INTEGRATED DELIVERy SySTEM REFORM
Chair: Michael Gelder, Director, Governor’s Office of Health Innovation and Transformation,
Co-Chair: Derek Robinson, MD, Executive Director, Illinois Hospital Association Quality
Care Institute (through november 2014)
Subject Matter Expert: Art Jones, MD, Health Management Associates
Overview
The Alliance for Health Innovation Plan recognizes that a key avenue to changing the health care
delivery system in Illinois to achieve the triple aim is to establish integrated delivery systems and
payment reforms to support them. Integrated delivery systems are provider groups that contract
with health plans, including Medicaid, Medicare, commercial plans or the state. Integrated delivery
systems are not health insurers, though they can share financial risk in arrangements with the
health care payer. This model brings together local physicians, hospitals, nursing homes, and other
essential community providers into a network connected with electronic health records where all
care is organized around the needs of the patient and their family in order to achieve
improvements in cost effective, high quality health care.
The Integrated Delivery System Reform (IDSR) Work Group focused on five key areas necessary
for the development of integrated delivery system options for Illinois residents. Subcommittees
focused on: Integrated Delivery Systems, Quality Metrics, Care for the undocumented,
Community Based Capacity, and Health Homes.
Integrated Delivery Systems: Charged with developing foundation criteria for integrated delivery
systems (IDS) in Illinois, including developing recommendations regarding selection criteria for
potential IDS pilot sites, criteria for health plan participation with IDS, guidelines for funding and
coordination with the public health system.
Quality Metrics: Charged with recommending benchmark and target values for proposed quality
metrics, aligning metrics across payers and populations, creating a set of quality metrics that would
reduce provider reporting burden, ensuring that the strongest quality measures are in use, and
creating a set of quality measures that give consumers confidence in comparing provider quality
from public sources.
Care for the Undocumented: Charged with addressing gaps in coverage for undocumented
immigrants that are excluded from health coverage access through the Affordable Care Act and
Medicaid and to identify strategies to ensure undocumented immigrants have improved access to
care and coverage.
Community Based Capacity: Charged with identifying ways for community based organizations
to continue providing care as part of new integrated health care delivery systems and managed care
entities.
Health Homes: Charged with developing consensus around an Illinois Health Homes program
funded with higher federal match through Section 2703 of the Affordable Care Act including
addressing health home service definitions, population criteria, provider standards, payment,
evaluation, and quality measures.
The Integrated Delivery System Reform Work Group focused on further advancing the model of
integrated delivery in the state of Illinois including helping to increase understanding of integrated
delivery systems and opportunities to use payment methodologies to incentivize better health care.
The work group recommended principles for identifying and selecting quality measures that can be
used to monitor effectiveness and efficiency in health care. It focused on intentionally addressing
gaps in current health systems, including the access gaps that affect undocumented individuals.
Key Themes
The Quality Metrics Subcommittee worked closely with HFS as it was developing quality
measures for forthcoming MCE contracts. The work group differentiated between quality measures
that are directly tied to performance (pay-for-performance) and those that would be reported to
the payer and tracked over time, eventually contributing to increased or decreased payments.
The Care for the undocumented Subcommittee focused on improved access and increased affordability.
The subcommittee relied on a research report identifying the number of people without access to
premium subsidies or Medicaid throughout the state to recommend expansion of voluntary programs,
like Access DuPage, in other regions of the state. They also learned that many people without
documentation had access to insurance at work but for various reasons did not take advantage of it.
The Integrated Delivery System Subcommittee realized it needed a definition of Integrated Delivery
before it could define criteria and developed the working definition described above. A broad
understanding was achieved by review of the talking points used by the chair at a stakeholder meeting
in 2010. (See Integrated Delivery Systems Description Appendix at end of Background Appendix.)
Issues and Concerns

Pursuing health care transformation through new delivery models and payment reforms has raised
issues and concerns that have been considered through the IDSR Work Group. An important
concern that was addressed through the establishment of the Community Based Capacity
Subcommittee was the need to convene community based providers and social service agencies to
address the changing role of community providers and how the established human service
infrastructure can contribute in new delivery models. Similarly, the Care for the undocumented
Subcommittee was established to address the concern that action is necessary and urgent to ensure
that individuals are not blocked from access to health care because of immigration status and that
Federally Qualified Health Centers and safety net providers are sustained.
next Steps
Two subcommittees did not meet yet: Maximizing federal funding and Institutional Transition Fund.
Their work was dependent on the federal CMS response to specific requests of the Section 1115 waiver.
The waiver request for long term supports and services needs to be compared to funding potential under
Community First Choice. This subcommittee is intended to provide stakeholders with an opportunity to
discuss whether CFC could provide more federal funding. The waiver also requested funding for a fund
to help hospitals and nursing homes reduce their oversupply of institutional capacity in a thoughtful and
orderly manner. These subcommittees should meet as soon as these federal waiver issues are resolved.
It is important to continue bringing together the private and public sector, health plans, payers and
providers, to determine funding strategies, additional needs, and ongoing legislative priorities to

incentivize the establishment of integrated delivery systems. Leveraging state agencies that
influence managed care contracts, working with community based providers, and implementing
public coverage programs should continue. Additionally, further engagement with the Illinois
General Assembly on these issues is essential to continue the momentum around these efforts.
The Integrated Delivery System Reform Work Group makes the following recommendations:
1. Integrated Delivery System Subcommittee:
a. To be considered an integrated delivery system, the following benchmark criteria should
be met by the end of a 4 year development period.
i. Organization/Governance: meets but is not limited to the criteria established for ACEs
• Comprised and governed by its participating providers
• Participants must include primary care, oral health, mental health, substance use
disorder, specialty care, hospitals and other providers as appropriate for populations
with specific needs; participants must incorporate human service providers,
supportive housing providers, and other types of providers that might lie outside
the traditional health care system but strongly impact an individual's health
• Lead entity that assumes legal responsibility and meets state requirements
• Governing body able to contract on behalf of its members, accept and disperse
outcomes-based payments to individual providers
ii. Health homes: primary care and behavioral health (mental and substance abuse)
providers utilize team–based practices that meet the Federal criteria for health homes
for moderate/high risk patients in need of these services:
• Comprehensive care management;
• Care coordination and health promotion;
• Comprehensive transitional care from inpatient to other settings, including
appropriate follow-up;
• Individual and family support, which includes authorized representatives;
• Referral to community and social support services, if relevant; and
• The use of health information technology to link services, as feasible and appropriate.
iii. Integrated care model: Integrates behavioral health, oral health and long term
supports and services with the broad array of medical services necessary to achieve the
highest level of health and independent functioning; reflects an innovative approach to
improve outcomes and reduce costs including improvement in statewide outcomes
measures; participates and supports Regional Public Health Improvement
Collaboratives where they are developed; develops in response to a community needs
assessment based on analysis of target population data and community-specific public
health needs.
iv. Member-centric: design process and systems to make it easier and more effective for
members.
v. Cultural and linguistically competent: has a defined set of values and principles and
demonstrates behaviors, attitudes, policies and structures that enable the IDS to work
effectively cross-culturally and linguistically, including access to language services.
Linguistic competence includes people who speak languages other than English and
people who have low literacy skills, and people with disabilities including those who
are deaf and hard of hearing.
vi. Connectivity: Ability to securely exchange actionable clinical data in a timely fashion
including use of the Illinois Health Information Exchange.
vii. Continuous Quality Improvement and best practice development: Contributes to
and participates in collecting, aggregating, analyzing and reporting data from multiple
sources through the Innovation and Transformation Resource Center.
viii. Financial plan: Demonstrates how health care costs for the target population will be
reduced to an amount that equals or exceeds pilot funding; Participants can and are
encouraged to explore creative payment structures as they develop the Integrated
Delivery System's financial plan.
ix. Multi-payer contracts with outcomes-based payments for a significant portion of
provider’s panels: at a minimum, the IDS must have contracts with the State and
health plans that include at least xx% of their Medicaid patients as well as
contractual arrangements with commercial, self-insured and Medicare payers.
x. Provider incentives: distributes outcomes-based payments through an equitable
arrangement that rewards those responsible for increased care efficiency drives down
to the individual care teams.
b. Integrated delivery systems should adopt the following criteria for health plan
participation in their model.
i. Contracting: health plans agree to contract with one or more of the IDS pilots
ii. Care Coordination and care management:
• Health plans should work with the state and IDS to set common standards that
demonstrate IDS ability to coordinate and manage care
• Depending on demonstrated competence, health plan will delegate:
o Initial health risk screening
o Comprehensive risk assessment
o Care plan creation
o Implementing the care plan
o Transition of care post hospitalization and Emergency Department visit
• Health plans may use their own risk stratification algorithm to identify moderate
and high risk members.
• Health plan will pay a per member per month (PMPM) to the IDS for delegated
care management responsibilities
• Health plans will work with IDS to give them secure access to their electronic care
plans
• Health plans will continue to explore the feasibility of adopting a universal
electronic care plan solution for the state
iii. Outcomes measures: health plans will actively participate with providers, HFS and
other stakeholders in selecting a focused, standardized set of measures that have
financial implications for plans and providers
iv. Outcomes-based payment: health plans will offer shared savings opportunities to
IDS pilots that are dependent on meeting certain cost and quality parameters; these
will be plan specific and confidential.
c. Innovation Transformation Resource Center (ITRC) should be available to offer
technical assistance related to planning and implementation of the IDS model.
Specifically, the ITRC can support health centers and provider networks in preparing for
a managed care model as well as supporting social service agencies and potential
providers preparing for a managed care model.

d. Developing integrated delivery systems should engage with Regional Public Health
Improvement Collaboratives (or comparable entities) if they are available in the areas
where the integrated delivery system operates.
e. Developing integrated delivery systems should utilize new health care worker roles
through a team based approach to meet patient health care needs. Specifically, integrated
delivery systems can utilize appropriate models or community health workers as a bridge
between the clinical setting and the community.
2. Quality Metrics Subcommittee:

a. The Governor’s Office of Health Innovation and Transformation and Healthcare and
Family Services should develop a set of quality measures for an Integrated Delivery
System, which are guided by a set of key principles. These principles are meant to be used
by the Governor and state agencies to serve as a resource and help inform policymakers’
decisions on quality measures for Integrated Delivery System pilots in Illinois.
Recommendations for these principles include:
i. Develop a broad set of measures that apply to all populations, as well as a narrow set
of measures for specific populations.
ii. Value metrics should be standardized among plans and payers as much as possible, and
include a small and manageable subset that are tied to financial incentives.
iii. Quality parameters should be aligned among health plans and payers for similar
populations and should be measured in uniform fashion.
iv. Measures should address social determinants of health, including access and equity.
v. Measures should address risk in order to focus on prevention and the availability of
treatment services post-diagnosis.
vi. Measures should be consistent with national standards, yet allow room for innovation
and needs specific to Illinois population.
vii. Measures should be actionable and relevant to a large portion of the enrollees.
b. Recommended Quality Measures:
Measure Endorsement Source
General Population
1. IMMUNIZATIONS: Childhood Immunization HEDIS/NCQA Administrative claims, Electronic Clinical
Status Data: Registry, Paper Medical Records
2. OUTCOMES/PATIENT EXPERIENCE: During HCAHPS Data from Centers for Medicare &
this hospital stay, did doctors, nurses or Medicaid Services (CMS)
other hospital staff talk with you about
whether you would have the help you
needed when you left the hospital?
3. TECHNOLOGY: Universal Documentation NQF Data from Centers for Medicare &
and Verification of Current Medications in Medicaid Services (CMS); Administrative
the Medical Record claims, Electronic Clinical Data: Registry
4. OUTCOMES/PATIENT EXPERIENCE: Before NQF/ HCAHPS Data from Centers for Medicare &
giving you any new medicine, how often did Medicaid Services (CMS); Administrative
someone describe possible side effects in a claims, Electronic Clinical Data: Registry
way you could understand
5. RESPIRATORY: Use of Appropriate HEDIS/NCQA Administrative claims, Electronic
Medications for People with Asthma Clinical Data, Electronic Clinical Data:
Pharmacy, Paper Medical Records
6. CARDIOVASCULAR DISEASE: Controlling HEDIS/NCQA Administrative claims, Electronic
High Blood Pressure Clinical Data, Paper Medical Records
7. RESPIRATORY: Medication Management for HEDIS/NCQA Administrative claims, Electronic Clinical
People with Asthma Data, Electronic Clinical Data: Pharmacy
8. PREVENTION: Breast Cancer Screening HEDIS/NCQA Administrative claims, Electronic
Clinical Data
9. PREVENTION: Smoking Cessation NCQA Administrative claims, Electronic
Counseling Clinical Data
10. CARDIOVASCULAR DISEASE: HEDIS/NCQA Administrative claims, Electronic Clinical
Comprehensive Diabetes Care Data: Laboratory, Paper Medical Records
11. IMMUNIZATIONS: Flu Shots for Older Adults HEDIS/NCQA Patient Reported Data/Survey
12. TECHNOLOGY: Providers have adapted EHR Survey Data from Medicare and Medicaid EHR
Meaningful Use Comments Incentive Program
13. PREVENTION: Colorectal Cancer Screening HEDIS/NCQA Administrative claims, Electronic
Clinical Data
14. PREVENTION: Mental Health Screening Survey Unavailable
Comments
15. TECHNOLOGY: Medication Reconciliation NQF Administrative claims, Electronic
Clinical Data
16. COST EFFICIENCY/ PERFORMANCE NQF Electronic Clinical Data
IMPROVEMENT: Timely Initiation of Care
17. COST EFFICIENCY/ PERFORMANCE NQF Administrative claims, Electronic
IMPROVEMENT: Plan All-Cause Clinical Data, Paper Medical Records
Readmissions (PCR)

Measure Endorsement Source
Specific Needs Population
18. MENTAL HEALTH/ SUBSTANCE USE HEDIS/NCQA/ Administrative claims, Electronic Clinical
DISORDERS: Follow-Up After LTSS/ NQF Data
Hospitalization for Mental Illness
19. MENTAL HEALTH/ SUBSTANCE USE NQF Data from Centers for Medicare &
DISORDERS: Preventive Care and Medicaid Services (CMS); Administrative
Screening: Screening for Clinical claims, Electronic Clinical Data:
Depression and Follow-Up Plan Electronic Health Record, Paper Medical
Records
DISORDERS: Antidepressant Medication LTSS/ NQF Data, Electronic Clinical Data: Pharmacy
Management (AAM)
DISORDERS: Initiation and Engagement of NQF Data
Alcohol and Other Drug Dependence
Treatment
22. MENTAL HEALTH/ SUBSTANCE USE LTSS/ HEDIS Administrative claims
DISORDERS: Medication Monitoring for
Patients with Psychotic Disorders (IMMP)
23. MENTAL HEALTH/ SUBSTANCE USE LTSS/ HEDIS Administrative claims, Electronic Clinical
DISORDERS: Adherence to Antipsychotic Data: Pharmacy, Other
Medications for Individuals with
Schizophrenia (SAA)
24. MENTAL HEALTH/ SUBSTANCE USE Data provided to Illinois Department of
DISORDERS: Successful Completion of Human Services, Division of Alcoholism
Program and Substance Abuse (DASA)
25. HIV/ AIDS: HIV/AIDS viral load suppression NQF Electronic Clinical Data: Electronic
Health Record, Paper Medical Records
3. Care for the Undocumented Subcommittee:

a. Facilitate collaborative and integrated health service delivery infrastructures in areas with
high density concentrations of undocumented individuals (e.g. Access DuPage).
b. Ensure continued funding to safety net providers, such as safety net hospitals and
Federally Qualified Health Centers (FQHC).
c. Increase the availability of public and private coverage options. Expand state funded Medicaid
to cover those “legally present” in Illinois, including those eligible for Federal Administrative
Relief, and “legal permanent residents” who have held that status for less than 5 years.
d. Establish a Health care Marketplace for undocumented individuals.
e. Discourage Private Health Insurance Companies from Requiring Social Security
Numbers for the Purchase of Health care, or allow the Individual Taxpayer Identification
Number (ITIN) as a substitute.
f. Expand requirement for employers to offer insurance.
4. Community Based Capacity:
a. The state should survey community-based providers and that the state work to equip and
prepare them to be active, on-going providers of service.
b. The state should work with community-based providers working with the Medicaid
eligible population to equip and prepare them to be providers of services within this new
care coordination environment.
c. Metrics should be placed into Healthcare and Family Services Managed Care
Organization contracts and further enforced.
d. The state should work with Medicaid providers encouraging them to agree to utilize the
state community based provider infrastructure.
5. Health Homes:
a. Submission of a State Plan Amendment (SPA) to the federal Department of Health and
Human Services (HHS) to establish the Health Home program, and the use of the final
Health Homes Concept Paper written by the Department of Healthcare and Family
Services as a roadmap for implementation.

From
InnovatIon
to
ImplementatIon
SERVICES & SuPPORTS

WORk GROuP
SERVICES AND SuPPORTS WORk GROuP
CHILDREN’S SERVICES SuBCOMMITTEE
The Children’s Services Subcommittee focused on the development of recommendations around
children with complex behavioral health needs.
PRIMARy RECOMMEnDATIOnS CHILDREn’S SERVICES STATISTICS

Governance: • Engaged 205 stakeholders from 84 organizations
• Establish a governance structure to sustain and • 38 Breakthrough Group meetings
implement a statewide Systems of Care framework Membership
for the children’s behavioral health system. • Advocates, parents and families of consumers
Service Coordination & Case Management • Service providers including: behavioral health,
• Develop Care Management Entities, consistent with social services, home & community-based services
Systems of Care that interface with all Medicaid • State staff including: Departments of Healthcare
platforms and private payers. and Family Services, Human Services, Children &
Service Array: Family Services, Juvenile Justice, State Board of
• Expand the Medicaid Service Array to include Education
new services such as Care Coordination, Intensive
In-Home, Mobile Crisis Response and Psychiatric THEMES
Residential Treatment Facilities. Critical Issues discussed by stakeholders
• Create and implement a statewide governance
Provider Contracting: structure to support the transition to System of
• Build a robust network of community-based Care Framework for the Children’s Behavioral
providers should be a higher priority than Health Service Delivery System.
additional out-of-home alternatives. • Promote early intervention and prevention
Entry & Access through global screening and universal assessment.
• universal Assessment by independent certified • Expand the Medicaid service array to include
assessors utilizing the CANS tool to determine additional community-based services.
level of behavioral health needs. • Establish and fund statewide, university-based
Center of Excellence to support a Children’s
48 associated recommendations accompany these Behavioral Health Service Delivery System based
primary recommendations. on a System of Care framework.
• Pursue statewide coverage for youth seeking publicly
Process Leadership funded behavioral health services through a Care
Dr. Lorrie Rickman Jones (GOHIT) and Grace Hou Managed Entity, consistent with Systems of Care.
(Woods Fund) chaired the Services & Supports Work Important considerations for the immediate and
Group. Deb McCarrel (HFS) and Colette Leuck mid-term future
(Children’s Mental Health Partnership) chaired the • Need for an established governance structure that
Children’s Services Subcommittee. Sheila Pires and has legitimacy, authority and accountability.
Shannon Van Deman provided subject-matter • Need to engage families and youth in any system
expertise. Illinois Health and Medicine Policy and program design.
Research Group provided work group coordination.

LONG-TERM SERVICES & SuPPORTS SuBCOMMITTEE
The Long-term Services and Supports (LTSS) Subcommittee focused on the development of
recommendations to ensure ready access to the wide range of services and supports by individuals
based on functional need, and not solely based on disability.
PRIMARy RECOMMEnDATIOnS LTSS SUBCOMMITTEE STATISTICS
Service Integration: • Engaged 464 stakeholders from over 180
• Integrate 96 services within 8 existing Home & organizations
Community-Based Services (HCBS) waiver • 1,780 total stakeholder volunteer hours
services into 23 proposed service groupings • 16 Subcommittee and Breakthrough Group
• utilize 23 service definitions and provider meetings
qualifications approved by stakeholders • 8 surveys with 545 responses
Conflict-free Case Management Membership
• Take a phased-approach with Conflict-free Case • Consumers of waiver services
Management (CFCM) compliance: • Advocates, parents and families of consumers
➢ Step 1: develop a Balancing Incentives Program • Service providers including: behavioral health,
(BIP) CFCM protocol implementation plan for social services, aging, developmental disabilities,
September 2015 home & community-based services
➢ Step 2: develop Conflict of Interest rules that • State staff including: Department of Healthcare
reflect more stringent federal Centers for Medicare and Family Services, Department of Human
& Medicaid (CMS) HCBS requirements Services and Department on Aging
Consumer Bill of Rights:
• Implement Consumer Bill of Rights as proposed THEMES
across all LTSS consumer populations Critical Issues discussed by stakeholders
• unbundle services and broaden service definitions
Person-Centered Planning: to allow for consumer choice, control and flexibility
• Implement the Statement of Intent across all • Address need for new services, rule-making and
Illinois LTSS consumer populations rates-development as part of implementation, and
• Take a phased approach to transforming to a continue to involve consumers in the decision-
Person-centered Thinking system: making processes
➢ Step 1: Translate the Statement of Intent into • Identify gaps and training needs and create
actionable Vision Statement training infrastructure and communications plan
➢ Step 2: Develop a compliance plan for HCBS for all stakeholders
Person-centered Planning regulations • Ensure standardization and accountability across
➢ Step 3: Develop a comprehensive plan for managed care entities, plans, payers and providers
building a Person-centered Thinking system that for compliance with Person-centered Planning,
will identify necessary infrastructure, business BIP and HCBS regulations
process, regulatory, training, and consumer and • Ensure sufficient resources and community
family education changes supports to implement and maintain a system-
53 associated recommendations accompany these wide Person-centered Planning model
primary recommendations. Important considerations for the immediate and
Process Leadership mid-term future
Dr. Lorrie Rickman Jones (GOHIT) and Grace Hou • BIP requirements regarding CFCM
(Woods Fund) chaired the Services & Supports Work • Federal CMS Home & Community Based
Group. Lora McCurdy (HFS) chaired the LTSS Services (HCBS) regulations regarding Conflict of
Subcommittee and two Breakthrough Groups. Steve Interest and Person-centered Planning.
Lutzky (HCBS Strategies) and Gwyn Volk (Navigant) The proposed service integration, service definitions
provided subject-matter expertise. Illinois Public and provider qualifications would inform 1115 waiver
Health Institute provided work group coordination. implementation.
Chair: Lorrie Rickman Jones, Senior Behavioral Health Advisor, Governor’s Office of Health
Innovation and Transformation
Co-Chair: Grace Hou, President, Woods Fund of Chicago
The Services and Supports Work Group had two primary foci: Children’s Services and Long‐term
Services and Supports (LTSS). Children’s Service focused on developing implementation strategies,
consistent with System of Care principles that will result in an enhanced delivery system and full
continuum of care for children with behavioral health needs, and consistent with the requirements
of Early Periodic Screening, Diagnosis and Treatment (EPSDT). Illinois is committed to ensuring
that children and families have access to the full range of services necessary for optimal social
emotional growth and development in the most integrated and clinically appropriate settings.
CHILDREN’S SERVICES SuBCOMMITTEE

Chair: Deborah McCarrell, Illinois Department of Healthcare and Family Services
Co-Chair: Colette Lueck, Illinois Children’s Mental Health Partnership
Subject Matter Expert: Sheila Pires, Partner, Human Service Collaborative
Overview
The Children’s Services Subcommittee, developed under the Services and Supports Work Group,
was created to address issues surrounding children with complex behavioral health needs. The
Subcommittee focused on three main tasks: 1) developing implementation strategies that were
consistent with Systems of Care principles, 2) designing an enhanced delivery system and full
continuum of care for children with behavioral health needs, and 3) helping inform the NB vs
Hamos settlement that meets the requirements of Early Periodic Screening, Diagnosis, and
Treatment (EPSDT). To accomplish this, five “breakthrough” groups were established to complete
the work for the Children’s Services subcommittee:
Governance – governance, decision-making and oversight at the policy level, system management,
communications, protecting privacy, and ensuring rights.
Service Coordination and Case Management – care management, care coordination, utilization
management, managed care interfacing, and financing.
Service Array – crisis management, benefit design, service array, prevention, early intervention,
transportation, and system exit.
Provider Contracting and network – evidenced-based and effective practices, provider network,
family and youth voice, and workforce development.
Entry and Access – outreach, engagement, referral, system entry, system access, screening,
assessment, evaluation, and service planning.
The approach of the Subcommittee was to rely on the considerable amount of work that has been
completed by scholars, administrators, community providers, committees, and other stakeholders.

The intent was to find models that have been shown to work in several different contexts at
improving outcomes and reducing costs. National subject-matter experts were consulted
throughout the process and systems of care in other states were examined including Wisconsin,
Indiana, Maryland, Massachusetts, New Jersey, New york, Louisiana, Texas and Mississippi. The
Subcommittee recognized that Illinois had previously conducted multiple planning efforts for the
reform of the children’s behavioral health system resulting in various strategic plans and
recommendations. using inclusivity as a framework, the Subcommittee sought to leverage Illinois’
previous efforts and utilized those plans and recommendations as a baseline. Those documents, as
well as several national publications, served as guideposts for the Subcommittee’s work.
The result of the Subcommittee process, incorporating National and Illinois specific efforts as well
as current best practices in the children’s behavioral health arena, is a series of recommendations
and implementation plans (See Appendix B) built upon a body of evidence to deliver better
outcomes for Illinois’ youth at a lower cost. The Children’s Services Subcommittee has outlined a
plan to bring the Illinois children’s behavioral health system into alignment with current best
practices and to deliver results.
Key Themes
The subcommittee recognized the need to create and implement a statewide governance structure
to support the transition to a System of Care Framework for the Children’s Behavioral Health
Service Delivery System. This would include establishing a council/body that has decision making
capacity for policy and oversight that has legitimacy, authority and accountability to adhere to
Systems of Care principles. A lead implementing agency would need to be identified among the
state child serving agencies to fulfill system management functions.
The subcommittee also recognized a need to promote early intervention and prevention through
global screening and universal assessment. During every well child visit per the Medicaid/HFS
periodicity schedule, it should be required that approved providers offer behavioral health screening
using one of a menu of approved standardized behavioral health screening tools. This would
include utilizing the Child and Adolescent Needs and Strengths (CANS) as a universal assessment
tool across the state.
The subcommittee believes the Medicaid service array needs to be expanded to include additional
community-based services (e.g., caregiver support & skills development, family & youth peer
support, intensive-in-home, respite, therapeutic mentoring, mobile crisis response, mobile
assessment, and crisis stabilization beds). The state should provide a robust community-based
service array to divert youth from costly out-of-home placement alternatives, improve outcomes,
and reduce costs.
The subcommittee recommends that the state establish and fund a statewide, university-based,
Center of Excellence (COE) to support a Children’s Behavioral Health Service Delivery System
based on a System of Care Framework. The COE should bring consistency across a dispersed
delivery system by overseeing the training, implementation, and quality of children’s behavioral
health services. Proposed functions include policy & financing consultation, engagement &
outreach, training & coaching, research & evaluation, and implementation support.
In addition, the subcommittee recommends that Illinois should have statewide coverage for youth
seeking publicly funded behavioral health services through a Care Managed Entity (CME), consistent
with Systems of Care. These CME’s should be aligned using a regional approach, with the ability to
interface with all Illinois Medicaid platforms (FFS, Managed Care, Care Coordination, ACE’s, etc.)
and other payers (public and private). CME’s should provide care coordination in a conflict-free
manner, develop individual care plans, and establish provider networks for the provision of services for
youth and families. The CME will service as the regional hub for mobile crisis response, mobile
assessment, care coordination, and access to behavioral health services. Access should be determined
by an assessment-based stratification model (based upon the intensity of the needs presented by the
youth) that establishes baseline prior authorizations in the form of behavioral health service packages.
Issues and Concerns

Stakeholders expressed concern about establishing a governance structure that has legitimacy,
authority, and accountability. Some stakeholders suggested that previous attempts have been made
and failed because of a lack of legitimacy and authority for the governance structure.
Several stakeholders expressed concerns about the creation of Psychiatric Residential Treatment
Facilities (PRTFs) in the state. While access to PRTFs is arguably an entitlement under EPSDT,
there were questions around the need for and impact of PRTFs.
understanding the fiscal impact of the proposed changes was of great interest to the stakeholder group.
Consistent with proposed financing strategies for similar reforms in other states, the stakeholder group
expressed concern that any savings realized be reinvested back into children’s behavioral health.
One of the core values in Systems of Care is that families and youth have a voice in system and
program design. While there was some representation among the stakeholders, future planning
and implementation meetings need to ensure increased and ongoing involvement.
next Steps
Moving forward, children’s behavioral health reform will require the creation and implementation
of a strong core statewide governance structure to strategically support the transition to a Systems
of Care Framework. The governance structure must have leadership across all child serving
agencies and stakeholder groups and the ability to build consensus and effective collaboration.
Illinois must invest in a family-driven, youth-guided system building process that has shared values
and principles and is culturally and linguistically competent. The Executive Branch and the
Legislative Branch of state government will need to be strong advocates for successful change.
Many child serving agencies, community providers, stakeholders, families and youth engaged in the
work group process had previously participated in the development of various strategic plans and
recommendations from multiple planning efforts for the children’s behavioral health system. These
documents were also leveraged by the subcommittee (See Appendix L).
The continued use of national consultants will be necessary to help Illinois chart the path forward
to successfully reform the children’s behavioral health system. The creation of a university based
Center for Excellence will allow the state to imbed systems of care values and philosophy at the
community level.

It should be noted that the work of the other GOHIT work groups are interrelated to the work
completed by the Children’s Services Subcommittee. As the Medicaid service array is expanded to
include additional services and providers of services, there will be workforce development needs as
well as data and technology needs. The children’s behavioral health reform efforts are statewide
impacting service delivery systems throughout informing the need for a comprehensive
communication strategy as a public health model.
Critical Members
The Children’s Services subcommittee was greatly aided by several critical partners including, the
Federal Government. In addition, the following groups (but not limited to) will have a significant
role in the reformation efforts:
Illinois Children’s Healthcare Foundation
Illinois Childcare Association
Illinois Collaboration on youth
Early Intervention Stakeholders
Illinois Children’s Mental Health Partnership
Illinois Psychiatric Society
Illinois Association of Rehabilitation Facilities
Illinois Association of Medicaid Health Plans
Illinois Healthcare Association
The Ounce of Prevention
Association of Community Mental Health Authorities
Community Behavioral Healthcare Association
The Children’s Services Subcommittee of the Services and Supports Work Group makes the following
recommendations:
a. Entry and Access Breakout Group
i. The universal Assessment should be conducted as part of a mobile process allowing for
the independent certified assessor to conduct the assessment in a location chosen by the
family.
ii. utilize the Child and Adolescent Needs and Strengths (CANS) as a universal assessment
tool across the state for access to service packages beyond the “Open Access Package”. The
CANS assessment should be connected to an algorithm to determine the intensity of need
within the family that could then be tied to a service package.
iii. An “Open Access Package” should be developed allowing children, adolescents, and their
families to receive a base level of service (minimum number of units) before a referral to an
assessment is necessary.
iv. Ensure recommendations that are provided by the Children’s Services subcommittee are
embedded within the states rule making structure.
v. During every well child visit per the Medicaid/Healthcare and Family Services (HFS)
periodicity schedule, require approved providers to offer behavioral health screening using
one of a menu of approved standardized behavioral health screening tools.
vi. The mental health assessment required in Medicaid Rule 132 needs to be streamlined and
specific to children, adolescents, and their families.
vii. Medicaid Rule 132 should be amended to allow for treatment intervention to occur
simultaneously with the Mental Health Assessment.
viii. Access to services for children, adolescents, and their families should be seamless, ensuring
that they are integrated and blended across child serving systems.
ix. The System of Care (SOC) will encourage child and family outreach and engagement
efforts consistent with Systems of Care values and principles.
x. A comprehensive communication strategy needs to be implemented to assure stakeholders
know what services are available in our system of care and how to access them.
b. Governance Breakout Group

i. Through legislation, establish a governance structure to sustain and implement a statewide
Systems of Care (SOC) Framework for the child and adolescent behavioral health delivery
system.
ii. Create and implement a statewide governance structure to support transition to a System
of Care Framework for the Children’s Behavioral Health Service Delivery System.
iii. Establish and fund a statewide, university based, Center of Excellence to support a
Children’s Behavioral Health Service Delivery System based on a Systems of Care (SOC)
Framework.
iv. Create and implement a statewide marketing and communication plan to support
transition to a Systems of Care (SOC) Framework for the Children’s Behavioral Health
Service Delivery System.
v. Develop a procedure for universal consent and information sharing between agencies and
team members in the System of Care (SOC) process.
vi. Develop and implement a statewide integrated, or compatible, data information and
communication technology system across child-serving agencies to support the goals and
objectives of the Children’s Behavioral Health Systems of Care (SOC) reform.
c. Provider network & Contracting Breakout Group

i. Building a robust network of community-based providers should be a higher priority than
building additional out-of-home alternatives.
ii. The Provider Network should be opened to allow independent Licensed practitioners as
Medicaid service providers.
iii. Each service within the System of Care should have defined standards of practice which
include the use of Evidenced-Based & Evidence-Informed Practices by ensuring the use
of qualified providers. Training and financial support should be developed to facilitate the
implementation of Evidenced-Based Practices in the model and ensure ongoing provider
quality assurance and quality improvement.
iv. There should be family and youth voice represented at both state and local levels.
d. Service Array Breakout Group

i. Include a formal definition of Therapeutic Mentoring Services in the approved Medicaid
Service Array that includes the following components: education, support, coaching, and
guidance in age-appropriate behaviors, interpersonal communication, problem solving and
conflict-resolution, and relating appropriately to others to address daily living, social and
communication needs to support the youth in a home, foster, or community setting.
Services should be designed to support age appropriate social functioning or ameliorate
deficits in the youth’s age-appropriate social functioning. Include a formal definition of
Therapeutic Mentoring Services in the approved Medicaid Service Array that includes the

following components: education, support, coaching, and guidance in age-appropriate
behaviors, interpersonal communication, problem solving and conflict-resolution, and
relating appropriately to others to address daily living, social and communication needs to
support the youth in a home, foster, or community setting. Services should be designed to
support age appropriate social functioning or ameliorate deficits in the youth’s age-
appropriate social functioning.
ii. As Illinois moves forward with implementation of the PRTFs, stakeholders should be
engaged in ongoing research and discussion to determine an effective and sustainable
implementation plan.
iii. Include a formal definition of Intensive In-Home Services in the approved Medicaid
Service Array that includes the following components: Comprehensive home-based
behavioral health assessment; Intensive individual and family therapy; therapeutic skills
development; support services and consultation for child, family and other natural
supports; Close connection to Mobile Crisis Response Services to address crisis situations
that threaten stability of the family or setting; Linkage to lower intensity services as needs
decrease and strengths improve; use of a menu of evidence based practices (Common
Elements, Practice Wise, MAP, Behavior Management Therapy and Monitoring, etc.);
Children eligible for service if returning from an out of home placement, if child is at risk
of out of home placement, and/or if child meets medium to high risk level as determined
by risk stratification tool/process; Service provided by professionals and paraprofessionals
under the direct supervision of an LPHA with a psychiatric resource available; Specific
training criteria must be met before an agency / professional / paraprofessional will be
“certified” or “credentialed” to provide this service (use Massachusetts service definition as
example); Staff to client/family ratios kept small (1:10 or fewer); and, Frequent monitoring
of progress on attainment of treatment plans, goals, and objective.
iv. Develop a formal definition of Respite Services to include in the statewide Service Array.
The definition of Respite services should differentiate this service from emergency child
care, should not require that therapeutic services be provided while Respite is being
provided and should allow for planned and unplanned Respite services. Available funding
sources for reimbursement of Respite services other than Medicaid should be explored.
v. Include a formal definition of Family/Caregiver Support and Skills Development Services
in the approved Medicaid Service Array that includes the following components:
Resolving or ameliorating the youth’s emotional and behavioral needs by improving the
capacity of the family/caregiver to improve the youth’s functioning; Developing the
family/caregiver’s knowledge regarding youth’s mental illness symptoms; and Developing
the family/caregiver’s skills regarding alternative ways of managing youth’s mental illness
symptoms in the home environment.
vi. Develop a formal definition of Crisis Stabilization Settings to include in the approved
Medicaid Service Array and determine other potential funding streams for non- Medicaid
eligible children. Develop criteria to be used to establish level of intensity of crisis
stabilization setting required to meet the needs of the child and family (e.g., PRTF, shelter,
treatment family home, foster home, congregate care setting, etc.). Establish processes to
support families’ active involvement with the child in planning for return home after a
short-term crisis stabilization setting stay. Explore and/or develop funding streams other
than Medicaid to offset costs of short-term crisis stabilization setting stays for non-
Medicaid eligible children.
vii. Revise the current Medicaid service definition of Crisis Intervention to create Mobile
Crisis Response services, to broaden the definition of a behavioral health crisis (e.g., not
only “psychiatric” in nature), to require trauma-informed practices be utilized in crisis
response and to include the availability of additional supports (e.g., peer support, crisis
stabilizers, family members from the Family Run Organization for orientation, access to
Short-Term Crisis Stabilization Settings, etc.), in accordance with System of Care
principles. Allowance should be made for the provision and billing of short-term services
and interventions, prior to the completion of a Mental Health Assessment/ Individual
Treatment Plan, until the child and family are either enrolled with a Care Management
Entity or are connected through a “warm handoff ” to community based services (e.g.,
Community Mental Health Center) or another child-serving system (e.g., Division of
Mental Health/Division of Developmental Disabilities). There should be careful
consideration of the reimbursement level to support service provision after the initial
Mobile Crisis Response and to support outreach and engagement activities across all
child-serving agencies. Required staff credentials and training should be reviewed to
determine if any changes should be made. Training, credentialing, certification and
background checks for crisis stabilizers, peer support staff and family members to provide
orientation should be coordinated and/or provided by the Family Run Organization.
viii. A review of consumer transportation (e.g., getting to and from medically necessary
Medicaid services as well as all necessary social services and supports) should be completed
and recommendations developed to build a comprehensive transportation system for youth
and families.
ix. Include a formal definition of Family/Caregiver Peer Support and a formal definition of
youth Peer Support in the approved Medicaid Service Array that include components
recommended by families and youth who have lived experience in the children’s behavioral
health system.
x. Include a formal definition of Care Coordination in the approved Medicaid Service Array.
The level and intensity of Care Coordination will be dictated by the stratification level
determined by the Mobile Assessment Team. Children who are stratified into highest
service level will receive Care Coordination that adheres to High Fidelity Wraparound
standards published by the National Wraparound Initiative. Children who are stratified
into medium and low service levels will receive care coordination services that will allow
their behavioral health needs to be met effectively.
xi. Develop requirements for a Mental Health Assessment that is specific to the needs of
children for inclusion in the approved Medicaid Service Array. The formal service
definition and Mental Health Assessment process should allow for the provision and
billing of direct interventions (e.g., individual therapy, case management, etc.) while the
Mental Health Assessment and treatment plan are being completed, should focus on
engaging child and family in services and should minimize the number of times that the
child and family have to repeat information related to their service needs.
xii. Include a formal definition of Behavior Management Therapy and Monitoring in the
approved Medicaid Service Array that includes the following components: Initial
behavioral assessment; Development of a specific behavioral treatment plan; Supervision
and coordination of interventions; Training other interveners to address specific behavioral
objectives / goals in the behavioral treatment plan; use of Behavior Management Monitors
to implement the behavioral treatment plan, monitor behaviors, help caregivers implement

behavioral interventions, and report to Behavior Management Therapist regarding progress
toward behavior treatment plan goals. Children must meet medical necessity criteria to
receive this specific service, and specific training criteria must be met before an agency /
professional / paraprofessional will be “certified” or “credentialed” to provide this service.
xiii. Increase system capacity to provide non-youth specific mental health consultation to
child- serving staff to increase the staff ’s capacity to engage with youth who are
experiencing behavioral health issues.
xiv. Increase system capacity to provide earlier identification of and earlier interventions to
alleviate behavioral health issues for children across all age ranges. Improve coordination of
services for older youths who are transitioning to the adult system. Establish positions
within the Children’s Behavioral Health System of Care governance structure for Early
Intervention and Illinois State Board of Education staff involved in prevention and early
intervention services. Focus on prevention and early intervention related to behavioral
health issues in workforce development activities.
xv. The emphasis on the increased delivery of home and community based services, consistent
with Systems of Care principles and values will necessitate the establishment of adequate
financial support for services delivered in a non-office setting with a specific focus on staff
travel costs given the multiple geographic differences found within Illinois (rural, urban,
large county, etc.).
xvi. Increase the availability of flexible funding to purchase non-traditional supportive services
proven to keep children stabilized in home and community based settings.
e. Service Coordination & Care Management

i. Illinois should have statewide coverage for youth seeking publicly funded behavioral
health services through a Care Management Entity (CME), consistent with Systems of
Care, and these CME’s should be aligned using a regional approach, with the ability to
interface with all Illinois Medicaid platforms (Fee for Service (FFS), managed care, care
coordination, Accountable Care Entities (ACE’s), etc.) and potentially other payers (public
and private)
ii. CMEs should be developed using a “conflict free” approach.
iii. A region’s CME should be the central intake point for youth requiring specialized
behavioral health services that cannot be delivered in a primary care setting.
iv. Illinois should adopt a CME stratification model that allows care coordination to scale to
the intensity of the needs presented by the youth.
v. Illinois should adopt a stratification model establishing baseline prior authorizations in the
form of behavioral health service packages, based upon the intensity of the needs
presented by the youth.
vi. A region’s CME should integrate Systems of Care principles and Wraparound values
including Child and Family Teaming and an Individual Plan of Care (IPoC).
vii. A region’s CME should be responsible for the organization and management of a Mobile
Crisis Response (MCR) to ensure that the crisis response in a region is integrated into the
CME and is fully informed of the region’s resources and crisis supports for all youth
seeking to utilize the publicly funded behavioral health system in response to crisis.
viii. A region’s CME should be responsible for the organization and management of a Mobile
Assessment Team (MAT) to perform intake assessments and re-assessment for all youth
in the CME.
ix. A region’s CME should have access to flexible funds in order to create a comprehensive
benefit structure that can be individualized based upon the needs of each youth and family.
x. A region’s CME should be responsible for developing, organizing, and maintaining a
robust Provider Network with an emphasis on behavioral health services in concert with
all Medicaid funding structures in the CME’s region.
xi. A region’s CME should be required to establish feedback loops for consumer, stakeholders,
family members, providers, and others, effectively creating a local locus of accountability
(local governance).
xii. Illinois should build a comprehensive fiscal plan related to Systems of Care.

LONG-TERM SERVICES AND SuPPORTS
SuBCOMMITTEE
Chair: Lora McCurdy, Illinois Department of Healthcare and Family Services
Subject Matter Expert: Steve Lutzky, HCBS Strategies
Overview
The Long-term Services and Supports (LTSS) pathway focused on the development of an
implementation plan that assures ready access to the wide range of services and supports by
individuals based on functional need, and not solely based on disability. Resource allocation, service
definitions and eligibility, business processes for service access and ongoing systems management
and quality monitoring encompass some of the critical decision points for this group. Illinois
remains committed to assuring that older adults and persons with disabilities have access to full
continuum of care appropriate for their needs and in support of their highest level of independent
functioning. These person-centered services should be delivered in the most integrated settings
appropriate for the individual and result in a high quality of life.
To achieve this, four breakthrough groups were formed to address the concerns of the Long-term
Services and Supports subcommittee:
Service Definitions and Provider Qualifications: The Alliance for Health Innovation Plan
includes the Section 1115 Waiver request to the Center for Medicare and Medicaid Services
(CMS) in the Department of Health and Human Services. This waiver is essential to receive
substantial new funding through the Medicaid program and affords the State flexibility to achieve
its rebalancing work force, public health integration and technology objectives. This effort
mandates and benefits from stakeholder engagement and support. The Service Definitions &
Provider Qualifications Breakthrough Group developed recommendations on the set of services for
integration and those to be maintained independently and the service definitions and provider
qualifications for the proposed integrated services.
Key Themes
• Broaden definitions to allow for consumer choice, individualized to needs, flexibility
• utilize language that is person-centered and encourages community integration
• unbundle services where possible (for example, don’t tie service delivery to a specific
residential facility)
• Address need for new services, rule-making and rates-development concurrently with creation
of definitions and qualifications, and involve consumers in the decision-making processes
• Remove service cost maximums and service hour caps to represent determination of uniform
Assessment Tool and approval of state agency
Issues and Concerns

• Rates, resources and budget allocations for proposed service definitions and provider
qualifications
• The charge of this stakeholder group was to focus on integration of existing HCBS waiver
services. There was a desire to discuss new services and a forum or mechanism for capturing
that input.
Conflict-free Case Management & Person-centered Planning: The Conflict-free Case Management
and Person-centered Planning Breakthrough Group was formed to address Balancing Incentives
Program (BIP) requirements regarding Conflict-free Case Management and federal CMS Home &
Community Based Services (HCBS) regulations regarding Conflict of Interest and Person-centered
Planning. The Breakthrough Group’s charge evolved to provide feedback on BIP Conflict-free Case
Management protocol, Consumer Bill of Rights, a plan for addressing HCBS Conflict of Interest
regulations, and a plan for addressing HCBS Person-centered Planning regulations.
Key Themes
• Take a phased approach to complying with BIP Conflict-free Case Management and HCBS
• Take a phased approach to transformation to a Person-centered Thinking system
• Identify gaps and training needs and create training infrastructure and communications plan
for all stakeholders
• Ensure standardization and accountability across managed care entities, plans, payers and
providers for compliance with BIP and HCBS regulations
• Ensure sufficient resources and community supports to implement and maintain Person-
centered model
Issues and Concerns

• Lack of resources and community supports to implement person-centered model
• Lack of clarity around role of managed care and accountability for implementing person-
centered model
• The system-wide culture change required to implement person-centered model
• Lack of resources in rural communities to comply with Conflict-free Case Management/
Conflict of Interest regulations
• Impact on consumers, added costs and time, lack of efficiency in implementing Conflict-free
Case Management / Conflict of Interest
Behavioral Health: This breakthrough group addressed the service needs of individuals with mental
illnesses and/or substance use disorders. This included consideration of the whole health of the
individual, existing gaps in services and areas of disparity in service availability. In addition, the group
discussed the need to increase access to mental health services to individuals with dual diagnoses. The
group discussed the need to develop a sustainable system of care for all individuals with mental illnesses
and/or substance use disorders, including addressing the financial realities of the current system.
Key Themes
• The service system is severely underfunded and the need to focus on sustainability of the
system cannot be overstated.
• There are many sources of disparity in access to services across the state.
• There must be a focus on the whole health of the individual.
• Access to housing is necessary for recovery.
• Prevention based services must become a priority.
Issues and Concerns

The primary concern was the desire to continue the work of this Breakthrough Group. Also,
members were concerned that with the significant budgetary issues facing the state that behavioral

health will not be considered a priority, and that the state will lose out on the opportunities to
pursue some of the federal opportunities that have deadlines approaching in 2015.
Developmental Disabilities: This Breakthrough Group addressed special challenges for persons
with Intellectual and Developmental Disabilities. This included discussion of the Prioritization of
urgency of Need for Services (PuNS) integrity project under the Balancing Incentives Program.
In addition, the committee discussed two new service definitions for consideration that would offer
greater flexibility in promoting the existing policies that support four-person or fewer homes and
Employment First. The group discussed the need for the state to design and implement a
community crisis system for persons with intellectual and developmental disabilities.
Key Themes
• Reducing the PuNS waiting list
• Developmental model for outcome-based reimbursement strategies for the ID/DD system
• Creating service enhancements for persons with mental and other co-occurring conditions
moving from institutions to the community
• Customized employment in achieving Employment First outcomes
The Services and Supports Work Group recommends:

1. Long Term Supports and Services Subcommittee:
a. Service Definitions Breakthrough Group:
i. That the State utilize the 23 draft service definitions and provider qualifications as
described below and in accompanying materials (see Appendix SD-E for service
definitions and provider qualifications). Associated recommendations (below) and attached
documentation describe in some detail the language, rates and rules considerations and
operations and policies required to utilize the proposed service definitions and provider
qualifications. There are 14 associated recommendations that are available in Appendix B.
ii. That the State integrates the 96 services within the eight existing HCBS waiver
services into 23 service groupings as described below and in accompanying materials
(see Appendix SD- A for crosswalk of services). There are 6 associated
recommendations that are available in Appendix B.
b. Conflict-free Case Management & Person-Centered Planning Breakthrough Group
i. That the State take a phased-approach with Conflict-free Case Management
(CFCM) compliance:
• Step 1: develop a Balancing Incentives Program CFCM protocol implementation
plan for September 2015
• Step 2: develop a second phase of Conflict of Interest rules that reflects the more
stringent federal Centers for Medicare & Medicaid Services (CMS) Home &
Community-Based Services (HCBS) requirement
• There are 7 associated recommendations that are available in Appendix B.
ii. That the State of Illinois implements the Statement of Intent across all Illinois LTSS
consumer populations (see Appendix CF-C for Statement of Intent). That the State of
Illinois take a phased approach to transforming to a person-centered thinking system:
• Step 1: Translate the Statement of Intent into actionable Vision Statement
• Step 2: Develop compliance plan for Person-centered Planning regulations
• Step 3: Develop comprehensive plan for building a Person-centered Thinking
system that will identify the infrastructure, business process, regulatory, training, and
consumer and family education changes to inform the entire system
• There are 18 associated recommendations that are available in Appendix B.
iii. That the State implements the Consumer Bill of Rights across all Illinois LTSS
consumer populations (see Appendix CF-F for Consumer Bill of Rights). There are 8
associated recommendations that are available in Appendix B.
2. Behavioral Health Breakthrough Group

a. In order to create better outcomes and provide greater access to supportive housing for a
variety of populations, we recommend the addition (in 1115 waiver service package or
within Rule 132) of Housing Case Management and Tenancy Support Services (see
Appendix BH-A for list of services provided within Housing Case Management and
Tenancy Supports).
b. Establish behavioral health policies for prevention, emphasizing the value of such
policies for all individuals, including those with existing disabilities.
c. Expand eligibility for waiver services to better serve the expanded mental health
population. This would include individuals at risk based on social determinants of
health.
d. Expand services and provider network to fill identified gaps.
e. Design program and service structures which incentivize timely access and identification
of behavioral health issues across health settings and the life span.
f. Increase coordination of care across physical health, mental health, substance use and
intellectual disability/developmental disorders
g. Increase Medicaid Rehabilitation Option (MRO) Fee-for-Service rates to align
payments closer to costs of providing care.
h. Integrate behavioral health with primary care.
i. Remediate current disparities in access to health care services and address social
determinants of health for individuals diagnosed with complex health issues including
mental illnesses and/or substance use disorders.
3. Intellectual and Developmental Disabilities Breakthrough Group

a. The “Puns integrity project” funded under the BIP grant should be continued to its
completion.
i. This project requires PAS agencies to update, and keep updated, all Puns data, so that
it is available to families and consumers on an on-going basis.
b. The state should develop a computer based data system that allows the division to
consistently and accurately track the people on the waiting list, and their place on that
waiting list.
i. PuNS data can quickly become outdated without the ability to make changes or
updates through a web-based application and database.
c. Two new service definitions should be considered that offer greater flexibility in promoting
the existing policies that support 4 person or fewer homes and employment first.

i. The IDD breakthrough group discussed the importance of introducing two new
service definitions that will have significant impact on the current manner in which
services are being delivered. Both of the proposed service definitions were agreed on
by the IDD breakthrough group participants. They are: Individual Community
Support Option definition and Supported Employment – Individual Employment
Support, Customized Employment Services definition.
ii. Both of the proposed definitions would allow for greater flexibility and will have a major
impact on moving the 4 person or fewer homes and the employment first policy forward.
Both definitions are services that are currently being provided in various pockets of the state
by a variety of community service providers. These are not new services but are services that
are very difficult to implement system-wide due to the limits of our current definitions.
Proposed definitions were shared with the Service Definitions breakthrough group.
d. Continue the Rates Work Group that will address improvements or changes to the
Community Integrated Living Arrangement (CILA) Rate determination Model.
i. Without such improvements or changes, community service providers will be unable
to safely and adequately support persons with complex needs resulting in costly and
segregated institutional care. Specific recommendations include:
• Need to significantly raise wages for Direct Service Personnel (DSPs) supporting
individuals in the community. Increase Wages by a minimum of one dollar per hour.
• Implement recommendations of the December, 2014 report of CILA rates
workgroup.
• Continue improvements or changes to the Rate determination Model in serving
persons with complex needs (i.e., severe behavior, intense medical needs, intense
sensory and dysfunctional sexual challenges)
• Continue to address challenges and recommend potential changes to CILA rates
that support homes with 4 or fewer persons.
e. Design and implement a community crisis services for persons with IDD.
i. Continue to develop service enhancements for persons with mental health and other
co-occurring conditions in the community in order to deflect persons from entering
costly institutions and for moving from costly institutions to the community.
ii. Discussed were the components of a community crisis services for persons with IDD.
System components include:
• Pre-crisis supports and training to programs that may be to divert a potential crisis.
Currently being funded and developed through the Balancing Incentives Program
(BIP)
• Create mobile crisis teams that could be rapidly deployed to assess the crisis, defuse
or recommend a stabilization home or hospitalization.
• Develop short term crisis stabilization homes for up to 30-day stay prior to return
to sending agency. Currently being funded and developed through the BIP.
• Create linkages with local mental health services, hospitals and universities that will
support persons with IDD across the State of Illinois. Linkages should be developed in
conjunction with crisis mobilization teams and short term crisis stabilization homes.
f. Work with the Employment and Economic Opportunity For Persons with Disabilities Task
Force to develop Customized Employment in Achieving Employment First Outcomes.
From
InnovatIon
to
ImplementatIon
POPuLATION
HEALTH INTEGRATION
WORk GROuP
POPuLATION HEALTH INTEGRATION WORk GROuP
Improving the health of the Illinois population is central to controlling costs and improving health
care efficiency. To that end, the Population Health Integration Work Group, chaired by LaMar
Hasbrouck, MD, MPH and Stephen Martin Jr., PhD, MPH, sought to enhance the ability of the
Illinois health care system to engage in population health management, by leveraging public health
resources and encouraging linkages between public health and health care delivery systems. The
findings and policy recommendations described below reflect the substantial efforts of the four
Subcommittees of the Population Health Integration Work Group: Creation of Bonus Pool for
Health Plans, Expanding Maternal-Child Home Visit, Asset Based Community Development and
Regional Health Improvement Collaboratives.
1: The Regional Health Improvement Collaboratives (RHIC) Subcommittee recommends that the State of
Illinois evaluate and, where appropriate, pursue policies to require that RHICs engage in an integrated
approach to community health planning; explore requiring participation of key partners as part of state
certification, licensure, and contracting processes; sustain the infrastructure of the RHIC; create an evaluation
plan that helps determine which efforts are impacting outcomes; establish a technical assistance center to
support RHIC’s and other areas interested in collective impact in community health improvement; and
convene an RHIC Advisory Committee to support statewide implementation efforts.
2: The Asset Based Community Development (ABCD) Subcommittee recommends that the State of Illinois
evaluate and, where appropriate, pursue policies to ensure comprehensive, positive strength-based community
development; confirm one of Illinois state agencies initiate a pilot program-partnership with one or more select
communities; develop a new, separate work group to focus on community based capacity; and develop guiding
principles in partnering with communities and pilot sites in developing intersectoral health care systems.
3: The Creation of Bonus Pool for Health Plans Subcommittee recommends that the State of Illinois evaluate
and, where appropriate, pursue policies to establish a new source of funding that would be dedicated to
supporting population health interventions; ensure that a portion of bonus pool dollars funds the work of
RHIC; and create guidelines on how bonus pool dollars may or may not be spent.
4: The Expanding Maternal Child Home Visits Subcommittee recommends that the State of Illinois evaluate
and, where appropriate, pursue policies to seek federal reimbursement for evidence-based home visiting
services; develop a certification system to allow home visitors who are engaged in family support to become
Medicaid-eligible providers; ensure that existing home visiting and care coordination systems are fully
integrated with Medicaid Managed Care programs; and continue to safeguard existing funding for home
visiting services and use additional dollars to expand access.
Process Leadership Membership

In partnership with the Illinois Department of 93 social/advocates, 21 health care system
Public Health, the Health & Medicine Policy organizations, 45 state staff and 5 managed care
Research Group has driven the development of providers
content and supported the Chairs in the
development and execution of strategy for the Work group statisticsd (including sub-committees)
Population Health Integration Work Group. Health • 295 stakeholders
& Medicine has also worked closely with the Chairs • 2155 organizations
of the Subcommittees as well to coordinate internal • 222 meetings; 33 hours
work group efforts with other Subcommittees and • 268 responses to 1st Stakeholders’ Survey
share information. • 232 responses to 2nd Stakeholder’s Survey
Issues under discussion by stakeholders Level of consensus
Asset Based Community Development Over a period of months, the subcommittees met to
Issues discussed were focused on: building on discuss charter goals, do research, gather findings and
community strengths; social determinants of health; identify topics for recommendations. Subsequently, the
linkages to managed care; addressing various subcommittees drafted recommendations that were
geographic areas; and community based capacity in discussed by each subcommittee and feedback was
Illinois. received from stakeholders. Furthermore, stakeholders
were sent copies of final recommendations and given
Creation of Bonus Pool for Health Plans Subcommittee the opportunity to provide additional feedback.
Providing incentives for population health
interventions. Bonus pool dollars should be Important considerations for the immediate and
structured in a way that does not duplicate payment mid-term future
for services that are already reimbursable through In recognizing that additional public health resources
Medicaid fee-for-service payments. and improved integration are necessary to catalyze
Medicaid managed care plans must be at the table in the efforts of isolated health systems and local
these discussions. communities, the Population Health Integration
Work Group identified the following important
Expanding Maternal Child Home Visits Subcommittee considerations for the future:
A number of programs have been providing services • Managed care plans should be engaged further in
that improve health outcomes and should coordinate discussions regarding the creation of a bonus pool
with existing providers. The State needs to develop a for health plans.
strategy through which the State could allow home • The members of the Expanding Maternal Child
visitors to bill Medicaid for providing home visiting Home Visits Subcommittee should be utilized as
services. resources, many of whom are also members of the
Sustainability Workgroup of the Home Visiting
Regional Health Improvement Collaboratives Task Force, and remain committed to moving this
Subcommittee effort forward.
Foundational principles included elements of: multi- • Each RHIC entity will likely have resources that
sectoral representation that was not dominated by can be leveraged towards the common work of the
any specific discipline, active participation, and Collaboratives. The State can facilitate this by
accountability. requiring or encouraging meaningful participation
in RHICs.
• Resources such as pay for success funding is
something that might be very effective for pilots
that wish to engage in Asset Based Community
Development and receive funding based on the
results that their programs can demonstrate.

POPuLATION HEALTH INTEGRATION WORk GROuP
Chairs: LaMar Hasbrouck, MD, MPH, Director of the Illinois Department of Public Health
(Chair), Stephen Martin Jr., PhD, MPH, Executive Director, Association for Community
Health Improvement (ACHI) at the American Hospital Association (AHA), (Co-Chair)
Overview
The Alliance for Health recognized that additional public health resources and improved
integration are necessary to catalyze the efforts of isolated health systems and local communities.
The Alliance Innovation Plan committed to enhancing the ability of the health care system to
engage in population management, by leveraging public health resources and encouraging linkages
between public health and health care delivery systems. The Population Health Integration Work
Group is divided into 4 subcommittees; Asset Based Community Development Subcommittee,
Bonus Pool for Health Plans Subcommittee, Expanding Maternal-Child Home Visits
Subcommittee, and Regional Health Improvement Collaboratives Subcommittee.
Asset-based community development considers local assets as the primary building blocks of
sustainable community development and draws upon existing community strengths to build
stronger, more sustainable communities. To incentivize integration of public health and traditional
health care delivery toward achieving better overall population health outcomes, Illinois will create
a bonus pool, funded at $10 million annually, for health plans that agree to use the funds to develop
population health interventions in conjunction with public health entities. Illinois proposes to
utilize Medicaid administrative match to support the expansion of maternal-child home visitation
models coordinated by the Departments of Public Health and Human Services. The Regional
Health Improvement Collaboratives (RHIC) will serve as a “nexus” between the Illinois
Department of Public Health (IDPH), local health departments (LHDs), communities, and the
health plans and providers serving the region. The RHICs will align and coordinate the multiple
community needs assessments performed in the same regions and can ensure that the best available
data is used to inform the health assessments.
Key Themes
Important discussions in the Asset Based Community Development Subcommittee centered
around the social determinants of health, focusing on communities and building networks within
the communities, addressing geographic areas and increasing focus on community based capacity.
The Bonus Pools for Health Plans Subcommittee focused on the need to provide incentives for
population health interventions and discussing how programs and interventions should be
structured in a way that wouldn’t only target members of a single health plan, nor patients of a
specific health care provider or institution.
A theme that emerged in the Expanding Maternal Child Home Visits Subcommittee was
strategies for continuing the use of home visiting programs. Evidence-based home visiting
programs are an effective strategy for improving the life trajectory of expectant and new families. A
number of programs have been providing services that improve health outcomes for the
populations to be covered by an Accountable Care Entity or Managed Care Organization and
entities should coordinate with existing providers. The State needs to develop a strategy that would
allow home visitors to bill Medicaid for providing home visiting services without duplicating what
home visitors are already required to do through the evidence-based home visiting models. It is
important that the State maintain its current commitment to safeguard investing state funding in
home visiting services and additional dollars should be invested to expand access and further the
State’s health care goals. The State should continue to engage providers and stakeholders as this
effort moves forward.
The Regional Health Improvement Collaboratives Subcommittee discussed foundational principles

for RHIC including multi-sectorial representation that is not dominated by any specific discipline,
active participation and accountability, and understanding that while existing needs assessment
processes must be considered and integrated into plans, the focus of the RHICs should be more on
implementation than assessment.
Issues and Concerns

Specific concerns addressed in the Subcommittee included the need for open minded approach to
different models of asset based community development. There were also several questions about
how bonus pools would be funded, what the requirements for sharing funds would be and how
funds would be accessed. Additionally, the need for ongoing communication and engagement due
to immense scope of change that have been underway in health care was a concern raised in the
Expanding Maternal Child Home Visits Subcommittee. Subcommittees also want to ensure that
the work of this process is leveraged to the fullest extent.
next Steps
Moving forward, it is imperative to ensure that the concept of building communities based on their
strengths rather than weakness is maintained. It is important to consult the communities we wish to
serve when determining what social determinants of health need to be addressed. It is also important
to address questions related to funding sources and structure. Funding for program implementation,
such as the bonus pool, should be done in a way that doesn’t duplicate payments or target membership
of single health plan or single health provider. The intent of establishing a bonus pool is not to award
grants in the way they are traditionally awarded, but to incentivize health plans to engage in initiatives
for population health. Additionally, continuing to nurture the concept of the Regional Health
Improvement Collaboratives, will advance the primary goal of improving the health of populations and
achieving health equity including improving population management and community health.
The subcommittees under the Population Health Integration Work Group utilized expertise of
partners and work group members to develop their recommendations and contribute to the
discussion. Subcommittees heard directly from key partners, such as Medicaid health plans, public
health departments, and advocacy organizations. Previous work, research, and documents were
utilized including the State Health Improvement plan, the Home Visiting Task Force and the
Chicago Hospital Needs Report.
In order to advance this work, the Work Group recommends several strategies. Resources, such as
pay for success funding, may be very effective for pilots engaging in asset based community
development. Managed care plans should be engaged in discussions related to the bonus pool.
Leveraging individuals and their respective organizations as resources can help move this process
forward. The state can facilitate the advancement of Regional Health Improvement Collaboratives
by requiring or encouraging meaningful participation in RHICs.

The Population Health Integration Work Group recommends:
1. Asset Based Community Development:
a. The ABCD subcommittee recommends that a new, separate work group be formed to
focus on community based capacity within the State of Illinois
b. The ABCD Subcommittee recommends the following guiding principles in partnering
with communities and pilot sites in developing intersectoral health care systems. The
following are guiding principles that the subcommittee considers crucial to any
successful framework:
i. The model is based on understanding the interaction between place – where the
community exists – and its residents’ health.
ii. Community engagement is a continuous key strategy that should be included in the
model. The model requires direct engagement with community groups, including
those representing marginalized populations, to support their asset based community
development efforts by linking providers of health care, behavioral health care, social
services, legal aid attorneys, and public health services with schools, community
leaders, and any other parties that could have a positive impact on the community to
evaluate and implement asset based community development projects.
iii. The goal should be place-based improvement in health disparities.
iv. The model requires identifying and utilizing existing assets in the community. This
might entail creating new tools to accomplish this or using existing ones.
v. The strategies that are developed would entail: (a) applying or creating evidence based
interventions for established disease specific disparities; and/or (b) Interventions that
frame improvements in the community that could potentially improve health
outcomes by enhancing community strengths.
vi. Goals of community interventions can include metrics beyond medical outcomes,
including, but not limited to, quality-of-life metrics; such as behavioral health,
supportive housing, employment status or absenteeism and community health measures.
c. The ABDC Subcommittee recommends that a minimum of two pilot sites be developed
with an explicit focus on positive, strength-based community development. The two or
more pilot sites that are selected should differ from one another in order to test
adaptability and scalability of the model across the state of Illinois. Pilot sites could differ
based on whether their level of community development, geographically, or other factors.
If the sites vary based on geography, sites could be selected based on either: (1) differing
regions of the state (e.g., Northern Illinois, Southern Illinois, etc.); or (2) differing
demographics (i.e., urban, suburban, rural.)
d. The comprehensive strength-based community development perspective should be
incorporated in all of the work of Illinois’ health care reform. This includes, but is not
limited to, incorporating ABCD as a key strategy for RHICs. It can encompass diverse
approaches to ensure that the community has a substantive leadership role in identifying
assets, resources, needs and priorities. Communities should be viewed from an asset-
based partnership perspective rather than merely a deficit viewpoint. This is a long term
gradual goal that would require moving away from thinking about communities in terms
of deficiencies and embracing an approach of evaluating communities based on their
assets. This goal requires structuring new ways by which the health care system can
solicit input from community members which would assist in establishing health-related
goals that are rooted in what communities perceive as needs.
e. The ABCD breakthrough group recommends a state agency pilot program. The ABCD
Breakthrough group recommends that the Department of Human Services initiate a
pilot program-partnership with one or more select communities utilizing a strength-
based community development philosophy. All or a part of the health and human
services funding for that community would be based upon the identified gaps and needs
of the community as identified by a body of local leadership, as well as the strengths and
assets that are also identified by the community.
2. Creation of Bonus Pool for Health Plans:

a. Establish a new source of funding that would be dedicated to supporting population
health interventions; the 1115 waiver refers to this funding as “the creation of bonus
pools for health plans”.
b. Ensure that a portion of bonus pool dollars funds the work of Regional Health
Improvement Collaboratives (RHIC).
c. Create guidelines on how bonus pool dollars may or may not be spent. In specific, it is
critical that new guidelines follow the steps outlined below.
3. Expanding Maternal Child Home Visits:

a. Seek federal reimbursement for evidence-based home visiting services in Illinois.
b. Develop a certification system to allow home visitors who are engaged in family support and
who are not presently Medicaid-eligible providers to become Medicaid-eligible providers.
c. Ensure that existing home visiting and care coordination systems are fully integrated
with Medicaid Managed Care programs by creating a small number of geographically
diverse pilots in which those programs would contract with local home visiting programs
to provide home visiting services to eligible clients.
d. Recognizing that maternal-child home visiting is a powerful force toward improved
community health in the future, the State should maintain the current commitment to
safeguard existing funding for home visiting services and use additional dollars to
expand access.
4. Regional Health Improvement Collaboratives:

a. For the purposes of advancing implementation efforts, the Illinois Department of Public
Health (IDPH) should require that Regional Health Improvement Collaboratives
(RHIC) engage in an integrated approach to community health planning, with at a
minimum, a cross walk of existing plans from participating entities, e.g., hospitals, local
health departments.
b. RHICs should be comprised not only of partners from a variety of different sectors (as
articulated in concept paper), but must ensure that each participating sector has adequate
representation at the appropriate levels. Explore requiring participation of key partners
(e.g., local health departments, managed care organizations, and hospitals) as part of
state certification and contracting processes. Within areas served by an RHIC, the

Illinois Department of Human Services and the Illinois Department of Public Health
should require that all recipients of maternal and child health funds (MCH Block,
Family Case Management, etc.) actively participate in RHIC activities.
c. Each Regional Health Improvement Collaborative (RHIC) should have a
comprehensive sustainability plan that considers all potential funding sources, including
bonus pools and community benefits. The focus of these plans should be on sustaining
the infrastructure of the RHIC. Community health transformation does not happen
quickly, so consideration for multiple years’ of funding with an increasing expectation of
local sustainability is recommended, e.g. Phase One, require a 25% (not including in-
kind funds) local match, Phase 2 raises to 50% local match, and Phase 3 results in 75%
local match—with Phase 4 being entirely funded by local resources. This would allow
regions to develop a funding strategy leveraging some cost savings/efficiencies
demonstrated.
d. The State should convene a task force to explore and recommend vehicles for the
institutionalization and long-term sustainability of Regional Health Improvement
Collaboratives (RHIC). Examples of possible efforts would be the establishment of a
‘wellness trust’ funded by a penny per health care encounter fee, or other legislative
initiatives, such as the proposed soda tax bill with some level of revenue supporting
RHICs.
e. Regional Health Improvement Collaboratives (RHIC) outcome measures should be
aligned with the quality measures used by integrated delivery systems. The Governor’s
Office of Health Innovation and Transformation (GOHIT) should establish an
evaluation plan that helps determine which efforts are impacting outcomes.
f. The Illinois Department of Public Health (IDPH) should provide a technical assistance
center to support Regional Health Improvement Collaboratives (RHIC) and other areas
interested in collective impact in community health improvement. The technical
assistance center should provide information and support on evidence-based, best and
promising practices in community and public health improvement.
g. The Governor’s senior staff should convene an RHIC Advisory Committee to support
statewide implementation efforts. The Committee’s membership should include, at a
minimum, representation from each of the Population Health Integration Work Group
subcommittees.
From
InnovatIon
to
ImplementatIon
WORkFORCE
WORk GROuP
WORkFORCE WORk GROuP SuMMARy
The transformation of the health care delivery system in Illinois will require a transformation of the
health care workforce. The Workforce Work Group, chaired Dr. LaMar Hasbrouck, MD, MPH
and Dr. k. Michael Welch, MD assessed the state’s health care workforce needs to assure
alignment with the needs of the Medicaid program; to address workforce shortages in high-need
urban and rural areas; and to build a work force that is ready to practice in integrated, team-based
settings in geographies, populations, and disciplines that are in the greatest demand. The findings
and policy recommendations below reflect the substantial efforts of the 4 Subcommittees of the
Workforce Work Group.
1: The Financial Incentives Subcommittee recommends that the State of Illinois evaluate and, where appropriate,
pursue policies to improve licensure renewal data collecting; expand loan repayment programs to include
community based workers and all clinical careers; design and implement a Medicaid Graduate Medical
Education (GME) training program to help ensure access to services and incentivize health care providers to
create or increase investment in training through loan repayment assistance and/ or bonus payment pool for
safety net hospitals.
2: The Health Workforce Expansion Subcommittee recommends that the State of Illinois evaluate and, where
appropriate, pursue policies related to Community Health Workers (CHW) to ensure that on-going CHW
data is collected and evaluations conducted; establish a CHW certification process, core curriculum standards
for CHW training, and CHW funding opportunities and resources. Additionally, the Subcommittee
recommends that the state evaluate and, where appropriate, pursue policies related to forming and convening a
Scope of Practice (SOP) Review Board; establishing a review process to evaluate the barriers that exist for
health professions; and encourage ways to use each profession “at the top of its license”.
3: The Pipelines & Pathways Subcommittee recommends that the State of Illinois evaluate and, where
appropriate, pursue policies to integrate the concerns of adult learners and job seekers into a pipeline and
pathways process in the traditional educational and workforce pipeline; coordinate exposure and enrichment
programs aimed at k-12 students that steward students through pathways leading to health professional
qualifications in a schema that identifies the spectrum of educational programs from early exposure to late
education; conduct outreach and engagement of low income communities; improve “soft skill” development;
lessen barriers that are created by unsatisfactory criminal background checks; and educate the educators and
practitioners on best practices for inter-professional education. The Subcommittee also addressed reducing
barriers Veterans sometimes encounter where their military training, credentials, and soft skills don’t directly
translate into state required licensing, certification or credentials.
4: The Teleheath Subcommittee recommends that the State of Illinois evaluate and, where appropriate, pursue
policies to implement “The Illinois Telehealth Initiative”; conduct various demonstration projects; and provide
telehealth services to children, hospital Emergency Departments, as well as urban jails and correctional
facilities.
Level of consensus Issues under discussion by stakeholders
Over a period of months, the Subcommittees met to Financial Incentives Subcommittee
discuss charter goals, conduct research, gather findings All recommendations are meant to help Illinois grow
and identify topics for recommendations. To increase the health workforce to meet residents’ needs, ensure
transparency and provide a forum for detailed comment, efficient health workforce planning, and better
the work group circulated a survey after the first draft of understand where there are provider shortages across
recommendations. Stakeholders were invited to indicate different geographies.
their level of support and comment on each
recommendation. From the survey, 83% of responses Health Workforce Expansion Subcommittee
were positive. Each Subcommittee Chair received a Health care reform is focused on outreach and
report of the survey results and comments submitted. prevention. Community Health Workers can provide
Chairs were able to use the feedback to edit the an entry route for low-skilled workers to health
recommendations and present the edited professions. Workplace shortages create increasing
recommendations at the work group’s final meeting. This pressure to have health professionals practice at the
process helped build consensus and ensure transparency. top of their license.
Process leadership
Pipelines and Pathways Subcommittee
Health & Medicine Policy Research Group has driven
the development of content and supported the Chairs Employers need to be included as partners in
in the development and execution of strategy for the training and investment in pipeline and pathways
Workforce Work Group. Health & Medicine has also programs. There are a number of barriers for health
worked closely with the Chairs of the Subcommittees care professions to licensing, employment, and
as well to coordinate internal Work Group efforts with eligibility requirements for pipelines and pathways
other Subcommittees and share information. programs.
Membership Telehealth Subcommittee

57 social/advocates, 15 health care system organizations, There is a need for a neutral platform to bring
15 state staff and 6 managed care providers stakeholders together to learn from each other, to
Work group statistics (including sub-committees) better understand telehealth obstacles, to explore
• 208 Stakeholders ways to eliminate those obstacles and to coordinate
• 117 Organizations their future telehealth plans.
• 22 Meetings Held
• 44 hours of meetings
• 29 Responses to Stakeholder’s Survey
Important considerations for the immediate and mid-term future

In response to changing population and patient needs, federal and state health care reforms, and innovations in
delivery models, professional practices, and technology, the work group recognizes the need to use professional
and paraprofessional health care workers in new roles with different skill requirements. To that end, the following
are important considerations for the future:
• Provide public funding critical to the innovation and sustainability of any pipelines and pathways strategy.
• Matching public resources to private resources that are aligned with meeting health workforce needs in high-
need areas to provide financial incentives.
• Capitalize on new federal funding streams for telehealth projects.
• Leverage colleges that currently and/or will train Community Health Workers, as well as community based
organizations, community health centers, hospitals and other facilities that will employ CHWs.
• Leverage scope of practice resources including trade associations that represent the health professionals, health
care system employers, and other industry commissions that evaluation. quality measures for health
professionals.

WORkFORCE WORk GROuP
Chairs: LaMar Hasbrouck, MD, MPH, Director, Illinois Department of Public Health
(Chair), K. Michael Welch, MD, President and CEO of Rosalind Franklin University of
Medicine and Science (Co-Chair)
Overview
Recognizing that an adequate workforce is foundational to the health care transformations
proposed in the Alliance for Health Innovation Plan and 1115 Waiver application, the Workforce
Work Group was established to concentrate on specific efforts to prepare health professionals for
new care models, and increase the number of health professionals available to serve the population
in both urban and rural settings. The Workforce Work Group was divided into four
Subcommittees: Financial Incentives, Health Workforce Expansion, Pipeline and Pathways (which
was further separated into 3 Breakthrough Groups: Pathways Breakthrough Team, Veterans
Breakthrough Group, and Inter-professional Breakthrough Group), and Telehealth.
The Financial Incentives Subcommittee was charged with studying issues related to establishing
loan repayment assistance to providers and other health care workers who commit to serving
Medicaid populations. The Subcommittee was also responsible for examining the establishment of
a bonus payment pool for hospitals that are designated as Critical Access Hospitals or classified by
the state as a “safety net hospital” that establish their own loan repayment programs for staff on
their workforce. The Healthcare Workforce Expansion Subcommittee was focused on ensuring that
every licensed health professional be able to work to the full extent of their education and training
and examining comprehensive policy and practice changes needed at all levels to address issues of
health care access, quality, cost, and disparities. The Pipeline and Pathways Subcommittee explored
reducing barriers to address shortages in Illinois’ health care workforce and examined the need to
educate the entire health care workforce across an inter-professional spectrum. The Telehealth
Subgroup explored expanding capacity through the use of telehealth and telemedicine services as
well as the growing utilization of telemedicine across the country.
The Subcommittees under the Workforce Work Group utilized several resources to complete their
work. This included leveraging both state agency expertise on topic areas and the time and
expertise of external partners to develop recommendations that fit with previous state planning and
federal programs related to health reform. Additionally, knowledge and experience of work group
participants was incredibly valuable to the work of this group. The Workforce Work Group
leveraged the vast knowledge and resources of the many health care and health care related
organizations and entities involved in the process.
Key Themes
Through the course of this work, important themes emerged in each of the Subcommittees that
reflected the central points of discussion. The Financial Incentives Subcommittee identified that
prospectively collecting comprehensive data on the health care workforce through the Department
of Financial and Professional Regulation license renewal process, state policymakers will better
understand where there are provider shortages across different geographies and populations.
Additionally, discussion on loan repayment versus scholarships contributed to the ultimate
recommendations of the Subcommittee. The Health Workforce Expansion Subcommittee found
that discussion around workplace shortages that create increasing pressure to have health
professionals practice at the top of their license was a theme as well as understanding that
innovations in technology require rethinking of traditional roles of health professions.
The Pathways Breakthrough Team discussed the need to include employers as partners in training and
investment in pipeline and pathways programs, develop ways to connect existing work so individuals
can smoothly transition to next step opportunities, and develop partnerships through outreach to
community based organizations in low income communities. The Veterans Breakthrough Group
prioritized applying military education and training to professional licensing standards as well as
continuing to coordinate and apply military education and training to accredited degree completion
plans and requirements. The Inter-professional Breakthrough Group focused on presenting an inter-
professional statewide “awareness” conference, establishing inter-professional education competencies,
creating inter-professional online education resources/regional education initiatives, and promoting
inter-professional manuals for health care professionals and consumers emphasizing the importance of
understanding and participating with a care team. During the Telehealth Subcommittee, the need for a
neutral platform to bring stakeholders together to learn from each other was a major theme. This is
required to better understand and eliminate telehealth obstacles, increase access to mental health care
for children, prompt emergency telepsychiatry services to coordinate with case management, determine
access to broadband and digital technology needed to provide health care services, and to link the
prison system to the county jail systems and health care providers.
Issues and Concerns

Issues of concerns discussed through the work group included the lack of resources available to
implement several recommendations. Specific concerns included moving from scholarships to loan
repayments, core basic skill sets and qualifications for Community Health Workers, the use of
recommendations as a whole package or specific strategies, stigma attached to returning combat
veterans as damaged individuals, Medicaid reimbursement for telehealth services, and improved
technological infrastructure.
next Steps
To continue the work of the Workforce Work Group, leadership from the executive branch or other
agencies to pursue these recommendations is critical. Where policy changes, rule changes, or other
administrative changes would result in adoption, these recommendations ought to be presented to the
leaders and key managers within the Departments. Specifically for the work of the Health Workforce
Expansion Subcommittee, creation of the Scope of Practice Review Board and the continuation
Community Health Worker (CHW) Advisory Board would be important. Other important activities
for moving this work forward include making sure missing stakeholders, especially employers, k-12
and adult educational providers, and community based organizations in low income communities are
involved in ongoing development and troubleshooting of pipeline and pathways. Funding and
additional resources are also integral to the advancement of these recommendations.
Matching public resources to private resources that are aligned with meeting health workforce needs in
high-need areas may be a way to expand the amount of dollars available for these efforts and increase
community investment. The commitment of external partners to this work demonstrates a
commitment to improve policies to address the long-term health workforce needs and may be
something to leverage moving forward. Additionally, trade associations that represent the health

professionals, health care system employers, and other industry commissions that evaluate quality
measures for health professionals can be leveraged to achieve recommendations. The use of federal
funds and programs provides an opportunity for Illinois to leverage resources that are readily available.
The Workforce Work Group recommends:

1. Financial Incentives:
a. When different practitioners renew licenses, the Illinois Department of Financial and
Professional Regulation (DFPR) should collect data on work locations and assess where
the licensee is serving with an estimate of the percent of practice time at different locations
where possible. This will allow the state to have a better understanding of coverage of the
health and social-service workforce. License renewal would include questions that ask
about the applicant’ current practice/service, perhaps including what address(es) where
work is performed and what percentage of time worked is spent at each address of
practice/service. This may not be included as part of the initial licensure process, as people
who are becoming newly licensed often do not know where they will be practicing.
b. Design and implement a 5-year, Medicaid Graduate Medical Education (GME)
program to both compensate and incentivize health care providers to create or otherwise
increase their investment in the training of health professionals to address the current
shortage of health professionals in the state. The total annual funding available for the
program is $26 million as provided in the Section 1115 Waiver application, $19.5 million
of which would be directed to actual training and $6.5 million to curriculum
development in the first two years. The Medicare program currently has a methodology
in place for funding graduate medical education training sponsored by teaching hospitals.
c. It is further recommended that the Medicaid GME program design incorporate some,
but not all, of the Medicare provisions. The features adopted from the Medicare GME
model should be geared towards reflecting a physician workforce that accommodates
Illinois’ workforce needs. Importantly, the teaching hospitals role in fostering a solution or
serving in a pilot capacity should be examined. This is a complex issue and, for effective
execution, a further work group may need to examine the many details and options.
Provisions of the current Medicare methodology that could be implemented here include:
i. Applying the Medicare “Direct” Graduate Medical Education approach of funding;
i.e., the Medicaid GME funds should be allocated based on “per-resident” trained
amounts and Medicaid utilization.
ii. Recognition in the per-resident amounts referenced above of the differences in costs
between various sponsors, such as Academic Medical Centers or Community-based
health centers and physicians’ practices. Consequently, each sponsoring organization
will have its own unique per-resident amount.
iii. Allocating funding for both primary care and specialty care programs.
iv. Paying the funds directly to the sponsoring organization, because those organizations
are obtaining accreditation and incurring the expenses to administer them. Each
organization’s proportion of the funding would be determined according its specific
cost per-resident amount, its specific number of residents trained and its percentage of
Medicaid patients serviced.
v. Recognizing accreditation of the residency program by the appropriate accrediting
organization; i.e., the Accreditation Council for Graduate Medical Education (ACGME).
vi. Allocating funds to all residents in an approved program, regardless of their year of
study. Fellows would be included in this category.
vii. Allocating the funding based on the facility’s percentage of Medicaid patients served;
if a certain percentage threshold is exceeded, additional bonus funding would be given
(see below).
d. The following recommended provisions for the Medicaid GME program are changes
from the current Medicare policy:
i. Although not specifically provided for in the Medicare program, additional monies
could be allocated to those organizations that sponsor residents to work in
underserved areas (HPSAs).
ii. Residents in their initial residency period, as well as fellows, would be equally counted.
iii. No limit or “cap” on the number of residents trained by a particular organization will
be applied.
iv. Any future changes in the Medicare law resulting in payment reductions in federal
funding for the Medicare GME program will not be applied to this Medicaid GME
program.
e. Expand loan repayment programs to include community based workers such as social
workers, recovery support specialists, community health workers, residential service
associates, certified substance abuse (drug and alcohol) counselors, home health aide,
home care aide, occupational therapists, and other direct service personnel in the
community with commitment to work in health professional shortage areas of the state
and underserved populations for not for profit entities or government agencies. Funds
may come from fees, Medicaid waiver funding or other sources, including but not limited
to general revenue funds or the tobacco settlement. Eligibility for the program would
include licensure, certification or other relevance professional credentialing.
f. Expand loan repayment to include all clinical careers, including but not limited to
physicians, surgeons, psychologists, midlevel providers and allied health professions (i.e.
physician assistant, clinical officer, pharmacist, nurse practitioner, pharmacy technician,
certified nurse’s aide, occupational therapist, clinical social worker). Every qualifying
eligible individual would agree to work in a health professional shortage area of the state
and underserved populations for a not for profit employer/provider or government
employer. As program develops, targeted expansion to for profit employer/providers in
areas of extreme need would be considered. Funds may come from fees, Medicaid waiver
funding or other sources, including but not limited to general revenue funds or the
tobacco settlement.
g. Establish a loan repayment matching program for safety-net and critical access hospitals
that recognizes the clinical and non-clinical needs of the population that includes
caregivers working inpatient, outpatient, ambulatory and community care settings. The
matching program would be funded through an additional Medicaid payment pool add-
on as proposed in the Path to Transformation: Illinois 1115 Waiver.
h. Consolidate many state operated scholarship and loan repayment programs to operate
similarly as strictly loan repayment to enhance marketing opportunities, standardize
reportable outcomes (who/where) and minimize administrative expenses.

i. Incentivize lending through pre-enrollment options with commitment to rural learning
program. Develop rural/underserved learning programs possibly through peer
mentoring. Develop affirmative action guidelines to assure that opportunities for those
with limited financial resources to qualify for loans are not diminished.
2. Healthcare Workforce Expansion:

a. The Healthcare Workforce Expansion Subcommittee recommends that on-going data is
collected and evaluations conducted on Community Health Worker (CHW) policy
being implemented in the state, to continue executing best practices.
b. Establish a Certification process:
i. That the certification process be a voluntary process and not required for the
Community Health Worker (CHW) profession.
ii. That the certification is based on core competency mastery
iii. That a certification process allows for portfolio consideration, also known as
experience-based consideration, to demonstrate the understanding of core
competencies established for the Community Health Worker (CHW) profession.
c. Create core curriculum standards for Community Health Worker (CHW) training.
i. That Community Health Worker core curriculum standards are developed so that
they may be integrated into a curriculum that can be offered by multiple
organizations, including educational institutions and community organizations.
ii. That CHW Curriculum standards are culturally, linguistically, and ethnically
appropriate in order to meet the needs of people who will access CHW services.
d. Funding opportunities and additional resources should be investigated to pay
Community Health Workers a living wage; this should include thorough research of
possible reimbursement sources
e. The responsibility of a background check for Community Health Workers (CHW)
could be placed on the employers. If employers deemed background checks need to be
conducted, the Health Care Worker Background Check Act should be considered.
f. Form and convene a Scope of Practice (SOP) Review Board, supported by Scope of
Technical Expert Advisory Panels, to facilitate a systematic focus on evaluating potential
changes and expansions of health care providers’ scopes of practice that are being
proposed by provider groups and to proactively seek potential changes to better align with
key transformative delivery objectives that best serve the health care needs of the public.
i. The SOP Review Board will make its recommendations regarding potential scope of
practice changes to the Governor and the members of the General Assembly, to serve
as a resource, to help inform policymakers’ decisions on SOP, and to gather
recommendations from various groups that are relevant to their policy decisions. The
Board will develop recommendations based upon changes that have been proposed by
provider groups and other stakeholders, and by reviewing other Scope of Practice
issues that may support health reform and Illinois’ health care workforce.
g. Establish a review process to continue the work of evaluating all of the barriers that exist
for health professions and encouraging ways to use each profession “at the top of its
license.”
3. Pipelines and Pathways:
a. Veterans Breakthrough:
i. under existing legislation and Executive Order 13-02, continue and expand the work
of the Illinois Departments of Financial & Professional Regulation (IDFPR),
Veterans’ Affairs (IDVA), and Public Health (IDPH) in evaluating and applying
relevant military education and training to professional licensing standards.
ii. Continue to coordinate and apply Medical Education and Training Campus (METC)
service-required education and training programs to the ever-increasing degree
completion requirements of the civilian sector. In the cases where service requirements do
not fully satisfy degree completion requirements, METC can assist students and faculty in
pursuit of voluntary post-secondary studies through the establishment of degree
completion pathways that recognize the quality of military education, training, and
experience. Since 2010, METC has established more than 200 METC-specific accredited
degree completion plans with dozens of colleges and universities across the nation. There
is an ever-growing collection of DoD and Service Opportunity College approved schools
that have contacted METC and other federal entities directly for development of new,
military-based and accredited health care degree plans and networks.
b. Pipelines and Pathways Breakthrough:
i. Amend Pipelines and Pathways Subcommittee charge to include the adult population.
ii. Conduct outreach to and engagement of low income communities in workforce
initiatives that could increase work opportunities for community residents.
iii. Improve “soft skill” development among applicants to entry-level health care jobs and
incumbent workers. Soft skills include communication, problem solving, critical
thinking, understanding workplace culture, and teamwork. These skills go beyond job
readiness skills, can be considered “essential skills”, include inter-professionalism and
are focused on equipping candidates and staff to provide person-centered health care
services in increasingly inter-professional team-based, culturally diverse and
integrated health care settings.
iv. Engage the education sector, advocates representing the interests of people with
criminal histories deemed remediable, workforce development programs, community
colleges and employers in understanding and reducing the barriers that are created by
the unsatisfactory criminal background checks on careers in the health care sector.
These barriers include limiting access to workforce training programs, certification,
and licensure in a variety of health care careers.
v. Pathways program pilots must include eligibility for persons with criminal
backgrounds and, for the purposes of data collection and comparison, at least 5% of
participants should be from this population.
vi. Identify one or two communities that are in need of pathways and education for
employment within the health and human service sector. Replicate the model
currently used within Elgin.
vii. Provide funding and oversight role to 21st Century Workforce Development Fund to
give guidance to health care workforce initiatives to provide continuity and
sustainability to these efforts.
c. Intra-Professional Breakthrough
i. Establish/schedule an inter-professional statewide “awareness” conference for the
early calendar year 2015.
ii. Educate the educators on best practices for interprofessional education (Institute of
Medicine (IOM), Inter-Professional Education Collaborative (IPEC) competencies).
iii. Educate practitioners on requirements for interprofessional education, perhaps
encouraging taking the TeamSTEPPS (see below) online course
iv. Establish the Office of Health Innovation and Transformation as the repository of all
online education resources on inter-professional competencies, certificate programs,
curricula, practice models.
v. Establish regional inter-professional education initiatives throughout the state.
Choose one region for a demonstration project.
vi. Establish a patient manual on inter-professional care emphasizing the importance of
understanding and participating with a care team and how a patient can benefit from
being on a team, as well as inter-professional manual for health care professionals and
patients.
4. Telehealth:
a. Support efforts to create a neutral telehealth platform to bring together stakeholders to
develop and implement “The Illinois Telehealth Initiative,” a plan to advance telehealth
in Illinois. Such a platform would eliminate duplicative expenses and foster greater
collaboration among stakeholders. A neutral platform would encourage the creation of
consortia that can plan for the expansion of existing telehealth networks.
b. Establish demonstrations projects including:
i. School Clinic:
1. General: Conduct a demonstration project in both rural and urban settings on how
to provide telebehavioral health services to students in a school.
2. Supplemental: Conduct a demonstration project in an urban setting where
telepsychiatry supplements an existing behavioral health program.
ii. Nonprofit Organization: Conduct a consultation project with one nonprofit at 2
school sites.
iii. Regional Network Plan: Develop a plan for a regional network of school clinics
providing telebehavioral services.
c. Conduct a demonstration project in both rural and urban settings providing telebehavioral
health services to children in locations other than the school. The demonstration project
should include a range of telebehavioral services provided by psychiatrists and other
mental health professionals. Two projects have been recommended:
i. Primary Care. It is recommended that a consultation-based telebehavioral health
model within primary care be conducted. The transformative power of a consultation
based telepsychiatry is not only that an area that is resource challenged gets a needed
resource but that the other providers i.e. primary care, teachers, nurses, psychologist
and social workers receive education that will enable everyone to do more parts of the
work without needing a child psychiatrist. There are less than 300 child psychiatrists
in Illinois. The only way to meet the needs of all children particularly those with
public insurance is to have all providers trained to do as much as possible.
ii. Mental Health Centers & other locations. It is recommended that a demonstration
project be conducted in both suburban and urban settings on how to provide
telebehavioral health services to youth in mental health centers and other locations to
increase timely access.
d. Conduct a demonstration project in both rural and urban settings providing
telebehavioral health services in hospital Emergency Departments (ED), coupled with
care coordination and follow up case management for: Crisis evaluation, triage, and
follow-up care and liaison with local mental health services
i. Conduct a demonstration project
1. Targeting rural, underserved communities and community hospitals with respect
to providing telebehavioral services; and
2. Linking community mental health centers with their respective area hospitals to
provide telehealth crisis services, using established care plans and crisis protocols.
E.g. use of Mental Health Provider or Qualified Mental Health Provider crisis
workers to assess, petition and certify, as needed those individuals requiring
inpatient treatment on an involuntary basis.
ii. After demonstration project is completed, establish a statewide emergency telelmental
health evaluation and linkage service that contracts with qualified providers across the
state to provide standardized evaluation and linkage services to any interested and/or
underserved hospital Emergency Department.
e. Expanded telepsychiatry and telebehavioral health services for Illinois prisoners.
f. Conduct a demonstration project in both rural and urban jails and correctional
institutions on connecting soon to be released prisoners via telehealth with Medicaid
providers who will care for them upon release.
g. Emergency Department (ED): Conduct a demonstration project in both rural and urban
settings on how a telestroke network can increase the quality of and access to care for
stroke patients; Mobile Telestroke unit: Conduct a demonstration project on a mobile
stroke unit that connecting an ambulance and a medical team linked to a stroke neurologist
to facilitate rapid intervention while in transit for a patient suffering acute stroke.
h. Conduct a demonstration project in a rural location using telebehavioral health
intervention CATCH-IT intervention (Competent Adulthood Transition with
Cognitive Behavioral Humanistic and Interpersonal Training), a primary-care Internet
based telebehavioral health model to prevent onset of major depression in youth adults.
i. Expand telepsychiatry and telebehavioral health services for the more than 500 youth in
The Department of Juvenile Justice (IDJJ) facilities needing those services. Psychiatric care
in the Department’s three rural facilities can at time be difficult due to lack of providers.
Expanded psychiatric care through use of telepsychiatry will enable IDJJ youth better access
to quality psychiatric services. Family involvement in the youth’s care improves a youth’s
adjustment to programming and reduces recidivism. However, the location of our facilities
often prohibits consistent family interaction. The use of telebehavioral health services will
allow family therapy that will help in engaging families in the treatment of their youth.
j. Conduct a demonstration project in all Juvenile Facilities on connecting soon to be
released youth via telehealth with Medicaid and non-Medicaid providers who will care
for them upon release to the community.
k. Conduct a demonstration project on expanding primary care capacity in rural areas to
provide best practices care for patients with common complex chronic diseases (e.g.,
obesity, resistant hypertension, HIV, hepatitis C care, etc.,) through a telehealth training
program (e.g., Extension for Community Healthcare Outcomes methodology) that up-
trains primary care providers.

From
InnovatIon
to
ImplementatIon
DATA & TECHNOLOGy

WORk GROuP
DATA AND TECHNOLOGy WORk GROuP
The Data and Technology Work Group focused on developing recommendations that will establish
a framework for leveraging existing systems, promoting standards and technology infrastructure,
supporting interoperable communication and prioritizing elements of additional technical
resources and functionality needed to accelerate the Innovation Model.
PRIMARy RECOMMEnDATIOnS WORK GROUP STATISTICS
Care Coordination: • 21 work group and subcommittee meetings
• Implement the Common Care Platform as • Engaged 162 stakeholders from over 130
described in the proposed framework. organizations
• Implement the Portable Care Plan as described in Membership
the proposed design. • Medical providers, health plans, behavioral health
All Payer Claims Database (APCD): providers, community health centers,
• Continued exploration of the merits of creating an epidemiologists, information managers, data
All-Payer Claims Database (APCD) for the benefit stewards, state staff, including Departments of
of the residents of the State of Illinois Public Health and Healthcare and Family
Open Data: Services
• Establish an Open Health Data Executive
Steering Committee (with participation from all THEMES
Health and Human Services State Agencies) Critical Issues discussed by stakeholders
• Address technology limitations of current site and • Care coordination needs to include social and
backend legacy systems behavioral consumer goals
• Publically release and update a comprehensive • Major changes in Medicaid-funded human service
Illinois health data dictionary/catalog delivery require new platforms for care coordination
• Develop multiple ongoing public • Health care and human service providers are
engagement/feedback mechanisms overwhelmed by the demands made on them to
• Prioritize future uploads based on public automate and integrate service and care delivery
demand/feedback and potential benefit to health • Ensure stakeholders involved, engagement continues
care transformation in Illinois • Leverage existing assets—claims data from payers,
Health Care Cost Institute (HCCI) partnership
Level of Consensus • upload more State data, with a structured timeline
Mary McGinnis (GOHIT) and Pat Merryweather for updates
(Telligen) co-chaired the Data and Technology • utilize metadata standards and best practices across
Work Group. Joseph West (NextLevel Health) agencies
chaired the Care Coordination Subcommittee, Mark • Publish more data related to socio/economic factors
Chudzinski (Marketplace) chaired the APCD of health
Subcommittee and Stephen konya (IDPH) chaired
the Open Data Subcommittee. Illinois Public Important considerations for the immediate and
Health Institute provided work group coordination. mid-term future
• Innovation must be balanced with cost and degree
of difficulty to implement
• Integrated delivery system criteria should be
expressed as goals for desired functionality, not as
technical systems requirements
• Determine if APCD is a voluntary or compulsory
activity; create stakeholder engagement process to
support legislation
• Pursue a potential collaboration with HCCI
• Task proposed Executive Steering Committee with
adopting uniform data standards and a governance
plan to be utilized by all agencies

DATA AND TECHNOLOGy WORk GROuP
Chairs: Mary McGinnis, Director of Operations, Governor’s Office of Health Innovation and
Transformation and Pat Merryweather, Executive Director, Telligen
Overview
Effective use of data and technology is critically important to successfully integrate disparate
services and providers. Innovations in health information technology, such as Illinois Health
Information Exchange (ILHIE), electronic health records and an all-payer claims database
(APCD) can reduce costs and improve care coordination. The Data and Technology Work Group
was charged with looking at a variety of issues that would ensure that data and technology are used
to their maximum potential to drive innovations in health care.
To achieve this, three subcommittees were formed to complete the work for the Data and
Technology Work Group:
Care Coordination: The Subcommittee developed recommendations regarding a common care

platform that can be used by Illinois integrated delivery systems participating in the Innovation
Model, and the development and use of portable care plans by members of integrated care teams.
These recommendations establish a framework for leveraging existing systems, promoting
standards and technology infrastructure, supporting interoperable communication and prioritizing
elements of additional technical resources and functionality needed to accelerate the Innovation
Model. The Care Coordination subcommittee developed and drafted a design for the Portable
Care Plan and a framework for the Common Care Platform (CCP).
Key Themes
• Consumer care needs to go beyond clinical care and embrace social and behavioral goals, as
expressed by the consumer
• Major changes in Medicaid-funded human service delivery (Home and Community-based
Services, Balancing Incentive Program) require new platforms for comprehensive information
management
• Healthcare and human service providers are overwhelmed by the demands made on them to
automate and integrate service and care delivery
• Innovation must be balanced with cost and degree of difficulty to implement
• Requirements for the creation of and changes to integrated delivery systems should be
expressed as goals for desired functionality, not as technical systems requirements
Issues and Concerns

The stakeholders wrestled with the dynamic tension between a desire for innovation and the
associated burdens imposed on providers. While the stakeholders were reminded that the IDS pilot
sites would embrace innovation as a condition of the IDS Model Test, they still put a high premium
on realistic expectations of the anticipated pilot site participants. This is especially clear in the
framework for the Common Care Platform, which is guided by a commitment to goals, not rules.
Open Data: The Subcommittee developed a set of recommendations for the continued build-out
of the Illinois Open Health Data Platform, which includes the supplementation and enhancement
of the existing Illinois Health Data microsite, to facilitate and enhance usage of the site. This also
includes public data sets, open source applications and strategies to help stakeholders interact and
understand the need and uses for data.
Key Themes
The subcommittee discussed the need to ensure that data is easier to find and that there is better
metadata when uploaded. This included the need for community level data, social and mental
health data, and making sure data is more frequently updated. There was also a lot of concentration
on the look and feel of the system.
Issues and Concerns

The subcommittee was cautious about the security of data and making sure that protected data is
not released to the public.
All-Payer Claims Database (APCD): The Subcommittee developed a set of recommendations for the
development and implementation in Illinois of an APCD. This committee does not have an outcome
recommendation, but rather a process recommendation—suggested process for years two and three
and beyond to find a recommendation for how to use money if and when it became available.
Key Themes
The subcommittee discussed the need for stakeholder involvement in order to be successful. This
includes ensuring that the payers are part of any discussions. Identifying and articulating the value
of the APCD and the return on investment is also necessary. The subcommittee also discussed the
need to leverage existing assets such as claims data from payers and outside partnerships.
Issues and Concerns

The subcommittee identified cost and the potential need for legislation as major concerns.
The Data and Technology Work Group recommends:

1. All Payer Claims Database Subcommittee:
a. The All-Payer Claims Database Committee of the Alliance for Health Data and
Technology Work Group recommends a continued exploration of the merits of creating
an APCD for the benefit of the residents of the State of Illinois. The Committee further
recommends broad Illinois health care stakeholder involvement in this exploratory
process, to ensure the development of an Illinois APCD solution of optimal benefit to
Illinois health care stakeholders and foster broad stakeholder support for any legislative
initiatives that may be necessary or desirable for its implementation.
2. Care Coordination Subcommittee:

a. That the State implement the Common Care Platform Framework as described below
and in accompanying materials (see Appendix CC-A for the Framework). The
Common Care Platform Framework includes five major components and recommended
guidance within each component. There are 10 associated recommendations that are
available in Appendix E.
b. That the State implements the Portable Care Plan Design as described below and in
accompanying materials (see Appendix CC-D for the Design). The Portable Care Plan

Design includes four major components, and recommended data elements within each
component. There are 22 associated recommendations that are available in Appendix E.
3. Open Data Subcommittee

a. Establish an Open Health Data Executive Steering Committee (with participation from
all Health and Human Services State Agencies)
b. Address technology limitations of current site and backend legacy systems
c. Publically release and update a comprehensive Illinois health data dictionary/catalog
d. Develop multiple ongoing public engagement/feedback mechanisms
e. Prioritize future uploads based on public demand/feedback and potential benefit to
health care transformation in Illinois
From
InnovatIon
to
ImplementatIon
RELATED REQuIREMENTS
RELATED REQuIREMENTS
The projects listed here are required to continue based on statutory requirements, federal
commitments, grant commitments or law suit settlements. These activities represent important
progress that will continue over the course of the next several years within state government. They
are presented here to demonstrate their connection to health transformation.
Balanced Incentives Program (BIP)

The Federal Balancing Incentive Program authorizes enhanced Medicaid matching funds to States
to increase access to non-institutional long-term services and supports. The Balancing Incentive
Program helps Illinois transform the long-term care systems in the following ways:
1) Lowering costs through improved systems performance and efficiency

2) Creating tools to help consumers with care planning and assessment
3) Improving quality measurement and oversight.
Illinois is committed to a plan to achieve 50 percent of spending on non-institutional care by

September 30, 2015. Illinois will receive $90.3 million if it fulfills this commitment.
The Balancing Incentive Program also provides new ways to serve more people in home and
community-based settings and is closely tied with current Long Term Care Rebalancing initiatives
in Illinois such as the Money Follows the Person program. The BIP supports the integration
mandate of the Americans with Disabilities Act (ADA), as required by the Olmstead decision, and
was created by the Affordable Care Act of 2010 (Section 10202)1.
Money Follows the Person (MFP)

The Money Follows the Person Rebalancing Demonstration was authorized by the Deficit
Reduction Act of 2005 and extended under Section 2403 of the Affordable Care Act. Illinois
developed the Pathways to Community Living under the Money Follows the Person program.
The goals of the Pathways to Community Living/MFP Rebalancing Demonstration Program
include:
• Increase the use of Home and Community Based Services (HCBS) and reduce the use of
institutionally-based services;
• Eliminate barriers and mechanisms in State law, State Medicaid plans, or State budgets that
prevent or restrict the flexible use of Medicaid funds to enable Medicaid-eligible individuals
to receive long-term care in the settings of their choice;
• Strengthen the ability of Medicaid programs to assure continued provision of HCBS to those
individuals who choose to transition from institutions; and,
• Ensure that procedures are in place to provide quality assurance and continuous quality
improvement of HCBS.
1
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and Supports/Balancing/
Balancing-Incentive-Program.html
As of August 1, 2014, the Illinois Pathways/MFP Program has assisted 1,104 individuals with
transitioning to the community. 2
Universal Assessment Tool (UAT)

The purpose of this project is for the State of Illinois, Office of Management and Budget, in
conjunction with the Department of Healthcare and Family Services (HFS), Department of
Human Services (DHS), and the Department on Aging (DoA) to collect information and data to
assist in the acquisition of a uniform Assessment Tool (uAT) (also known as a “Core Standardized
Assessment”). The uAT will also serve as the functional eligibility assessment for Illinois home and
community-based and institutional program of Long Term Supports and Services (LTSS) and will
replace the state’s current Determination of Need (DON) tool.3 The State has selected a vendor,
FEi Systems, that will begin its contract in January 2015.
Home and Community Based Regulations

In January, 2014, the Centers for Medicare and Medicaid Services issued a final rule establishing
requirements for the qualities of settings that are eligible for reimbursement under sections 1915
(c), 1915 (i) and 1915 (k) of the Medicaid statute. In this final rule, CMS is moving away from
defining home and community-based settings by describing exclusions to the rule to defining them
by the nature and quality of individuals’ experiences. The new setting provisions in this final rule
establish a more outcome-oriented definition of home and community-based settings rather than
one based solely on a setting’s location, geography, or physical characteristics. Further, the rule
applies to all settings where HCBS are delivered and not just to residential settings. As such,
standards will also apply to services provided in non-residential settings such as day program and
pre-vocational training settings.
States submitting 1915(c) waiver renewals, waiver amendments or any new waivers (e.g., 1115)
within the first year of the effective date of the rule shall be required to develop a transition plan to
ensure that the specific waiver or the amended state plan meets the settings requirements. A public
comment period on the state’s proposed transition plan is required. Illinois did submit a transition
plan in the Fall, 2014 and the public comment requirement has been partially satisfied by the
GOHIT stakeholder engagement process. Additional work in this area will be required to assure
state compliance and should remain the focus of the Bureau of Long-term Care in the Department
of Healthcare Family Services in collaboration with other Human Services agencies.
n.B. v. Hamos
In February, 2014 a class was certified in the N.B. v. Hamos case, filed against the Department of
Healthcare Family services on behalf of nine named plaintiffs, all children with mental health or
behavioral disorders. The complaint alleges violations of the Early and Periodic Screening,
Diagnostic, and Treatment (EPSDT) provisions of the Medicaid Act, and Title II of the
Americans with Disabilities Act. The certified class includes all Medicaid-eligible children under
the age of 21 in Illinois who: 1) have been diagnosed with a mental health or behavioral disorder,
and; (2) for whom a licensed practitioner of the healing arts has recommended intensive home and
community-based services to correct or ameliorate their disorder. The case is before Judge Tharp in
the united States District Court for the Northern District of Illinois, Eastern Division with the
2
http://www.mfp.illinois.gov/
3
http://www2.illinois.gov/hfs/SiteCollectionDocuments/MAC_051013uATRFI.pdf

next status hearing to occur on January 18, 2015. Settlement discussions are underway and the
Court is intent on moving them forward expeditiously. The GOHIT process has recommended a
behavioral health delivery model that incorporates principles of Systems of Care and includes a full
range of community services and residential programs. It is anticipated that these
recommendations will directly inform settlement discussions.
Section 811
The Section 811 Project Rental Assistance Demonstration Program was created by the uS
Department of Housing and urban Development in 2011 to promote the integration mandate of
the ADA, as required by the Olmstead decision. Illinois anticipates that Section 811 PRA will be a
key element in achieving its rebalancing objectives, connecting affordable housing and support
services to enable people with disabilities to move out of institutional settings and into
community-based settings. HuD has granted the Illinois Housing Development Authority
Section 811 funding to provide approximately 725 project-based rental subsidies, in addition to
800 units already committed by three different Illinois Public Housing Authorities (PHA), for a
target population of extremely low-income, non-elderly, persons with disabilities.
Through the Section 811 program, the State prioritizes housing for the target population to (1)
members of three Olmstead classes that resulted from the entrance into three consent decrees by
Illinois in 2010-2011 in which Illinois agreed to provide community-based housing options for
persons with severe mental illness, physical disabilities and developmental disabilities
complemented by supportive services in cases where the consumer elects to leave institutional care
and is determined capable of transitioning to independent living with person-centered supports;
and (2) Participants in the Money Follows the Person Demonstration Program (MFP). In an
effort to dramatically advance community reintegration of persons with disabilities, Illinois
dedicated the largest number of State-financed units and leveraged the largest number of PHA
units of all of the states funded in the 2012 initial Section 811 Demonstration Program.
State Referral network

The Section 811 program builds upon the existing Statewide Referral Network (SRN) which was
created in 2009 through Intergovernmental Agreement between IHDA, HFS, DHS, and DoA, to
ensure disability-neutral housing referrals and the coordination of housing opportunities with
service provision. The SRN includes targeted units, set aside by affordable housing developers who
have received financing from IHDA, that offer rents at 30 percent of area median income.
Prospective tenants may be homeless, at-risk of homelessness, and/or people with disabilities. They
must come referred by a non-profit or government entity that commits to provide supportive
housing services. The services may be Medicaid-eligible or non-Medicaid eligible. The SRN is the
existing system that will be utilized as a platform to refer persons with disabilities into Section 811
Demonstration Program units.
Community Health Worker Advisory Board

The Community Health Worker Advisory Board was established through legislation in the spring
of 2014 (Public Act 98-0796). The bill provided a definition for Community Health Worker, and
established the Advisory Board to recommend certification requirements and appropriate training.
The Advisory Board was announced by the Illinois Department of Public Health in November of
2014. The Board must develop a report with recommendations within a year of first meeting.
ILHIE
The Illinois Health Information Exchange (ILHIE) is a statewide network for sharing patient
health information electronically between and among health care providers and consumers to
improve patient care. ILHIE follows the most stringent requirements to ensure the accuracy of
information and limit its release to only those who are authorized to access it.
Electronic health records (EHRs) can provide more than what paper records can deliver, including:
• Improved Treatment Outcomes and Care Coordination: Providers receive an accurate, up-to-
date aggregated view of all patient data giving them the information they need to make better
informed diagnoses, care plans and treatment decisions.
• Increases Patient Collaboration: Patients with access to their electronic records are better
informed about their health and can better track their care. Communication between provider
and patient is enhanced, even in situations as simple as receiving electronic answers to
questions right away rather than waiting for a returned phone call.
• Fewer Forms for Providers and Patients to Fill Out: Provider early access to a patient's health
and insurance records will reduce the need for both patients and providers to continuously fill
out duplicate information when visiting various health service providers.
• Improves Public Health Reporting and Monitoring: The ILHIE provides a real-time link
directly to public health to enhance public health and disease surveillance; reduce disparities.4
Current HFS contracts with new Accountable Care Entities require direct or indirect connection
to ILHIE for the exchange of eligibility and health care records. ILHIE is recommended in the
Integrated Delivery System recommendations as the vehicle through which essential clinical and
administrative information can be exchanged to ensure accurate and timely access for everyone
who needs it.
Rebalancing
On January 19, 2012 Governor Pat Quinn announced a plan to rebalance the state’s approach to
care for individuals with developmental disabilities and mental health conditions. Called the Active
Community Care Transition (ACCT) plan, the initiative increased the number of people with
developmental disabilities and mental health conditions living in community care settings across
Illinois.
The current rebalancing effort utilizes existing community care settings, as well as creating new
options for those transitioning to community care. The person-centered approach the
administration has taken in regard to rebalancing has allowed (and required) the creation of
community care settings for those historically deemed “too difficult to serve in the community”.
Community care not only provides better quality of life in an integrated setting, but the cost
savings versus state care are substantial. For persons with developmental disabilities, the state
spends on average, between $225,000 and $250,000 per person per year in a state facility, versus the
$54,000 to $105,000 per year average in community care.
4
http://www.illinois.gov/sites/ilhie/Pages/What-is-the-ILHIE.aspx

under settlements related to the American Disabilities Act and the Olmstead decrees, Illinois
must develop and make available increased community-based settings for individuals with
disabilities. The increase in community care will make some state facilities redundant, and an
orderly facility closure is the most efficient, cost-effective way to close facilities.
Regional Health Transformation Summits

The Illinois Department of Public Health (IDPH), the Governor’s Office for Health Innovation
and Transformation (GOHIT), and the State Health Improvement Plan Implementation
Coordination Council (SHIP ICC) jointly sponsored eight Regional Health Transformation
Summits. More than 600 participants heard firsthand from IDPH, GOHIT, and the SHIP ICC
about their agenda for health improvement over the next two years. Local stakeholders provided
feedback to the state about how it can better support local and regional efforts. These events
provided an opportunity for local stakeholders to discuss how they can align their efforts to take
advantage of new statewide initiatives. These events were held throughout the state in Champaign,
Rockford, Joliet, Marion, Edwardsville, Peoria, Rosemont, and Addison.
From
InnovatIon
to
ImplementatIon
NExT STEPS
NExT STEPS
To truly reap benefits from the extensive public-private planning process, the state would need to
schedule recommendations for implementation. Some recommendations, such as the new children’s
mental health system, are urgent. Many are linked to the Section 1115 Medicaid waiver
application. The new administration should resume negotiations with CMS that have been on hold
since the November election. Once those negotiations resume, the recommendations associated
with the waiver will be immediately useful and can be implemented as recommended or modified,
depending on the waiver’s terms and conditions.
Other recommendations must be implemented to provide the structure for the next round of
Model Design planning that should begin in February. Those that define integrated delivery,
quality metrics, and regional health improvement collaboratives will be useful as requests for
proposals are developed with the funding available from the one-year grant. Other subcommittee
topics, such as the Institutional Transition Fund and Maximizing Federal Funding, have yet to be
discussed and should as soon as the pertinent federal issues in the waiver are resolved.
In particular, advocates for people with disabilities are awaiting the opportunity to discuss
Maximizing Federal Funding to advocate for adoption of the Community First Choice Medicaid
state plan option, which has been on hold pending funding discussions with CMS related to the
1115 waiver. Nursing home and hospital associations are awaiting the Institutional Transition Fund
work group meetings to discuss how this new pool of money requested in the 1115 waiver
application could be applied to create an orderly downsizing of institutional overcapacity.
Pursuing the next round for full model test funding will require the new administration to commit
to initiating as many recommendations as time and budget will permit. Illinois did not succeed in
receiving the large four-year federal model test grant it requested, in part due to the lack of a
specific plan to move 80 percent of Illinois’ population into the integrated delivery systems with
public health resource integration, as recommended in the Innovation Plan and further developed
in this report. Illinois needs a plan that reflects cooperation and commitment from the governor,
major payers such as Blue Cross Blue Shield, Aetna, united, etc., as well as a commitment from the
state’s largest employers, whose active engagement in this effort is essential to achieve the 80
percent level.
This Work Group report is a base from which the new administration should continue to develop
the structure necessary to achieve the triple aim, goals that are important for Illinois residents,
health and human service providers, and the economic recovery. These recommendations may be
used by the hundreds of stakeholders and advocates who have devoted thousands of person-hours
to the work that resulted in these consensus recommendations. They want to see these innovations
accomplished and have worked hard on implementation plans. This report is available to guide
their energy and advocacy.
It also can be of value to the Illinois General Assembly. These recommendations cite proposals that
need legislative action to facilitate implementation. The report also can guide legislators exercising
their fiscal and policy oversight responsibilities.
APPENDIx
APPEnDIX A: INTEGRATED DELIVERy SySTEM RECOMMENDATIONS
APPEnDIX B: SERVICES AND SuPPORTS RECOMMENDATIONS
APPEnDIX C: POPuLATION HEALTH INTEGRATION RECOMMENDATIONS
APPEnDIX D: WORkFORCE RECOMMENDATIONS
APPEnDIX E: DATA AND TECHNOLOGy RECOMMENDATIONS
APPEnDIX F: WORk GROuP STRuCTuRE DIAGRAM
APPEnDIX G: WORk GROuP CHARTERS
APPEnDIX H: PARTICIPANT LIST
APPEnDIX I: WORk GROuP GROuND RuLES
APPEnDIX J: CARE FOR THE uNDOCuMENTED SuBCOMMITTEE -
undocumented and Healthcare report - November 25 2014
APPEnDIX K: HEALTH HOMES SuBCOMMITTEE - HEALTH HOME CONCEPT
PAPER
APPEnDIX L: CHILDREN’S SERVICES SuBCOMMITTEE – Children’s Services
Resources Sheet
APPEnDIX M: OPEN DATA SuBCOMMITTEE - Illinois Department of Public Health
Open Data Directive
APPEnDIX BH – A: BEHAVIORAL HEALTH SuBCOMMITTEE -Services provided
within Housing Case Management and Tenancy Supports
APPEnDIX CF – A: CONFLICT FREE CASE MANAGEMENT BREAkTHROuGH
GROuP - CFCM-PCP Survey Results – Summary
APPEnDIX CF – B: CONFLICT FREE CASE MANAGEMENT BREAkTHROuGH
GROuP - CFCM-PCP Survey Results – FuLL
APPEnDIX CF – C: CONFLICT FREE CASE MANAGEMENT BREAkTHROuGH
GROuP - Statement of Intent
APPEnDIX CF – F: CONFLICT FREE CASE MANAGEMENT BREAkTHROuGH
GROuP - Consumer Bill of Rights
APPEnDIX SD – A: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Crosswalk
of Services
APPEnDIX SD – B: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Combining
Waiver Services Survey Results - Summary
APPEnDIX SD – C: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Combining
Waiver Services Survey Results - Full
APPEnDIX SD – E: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Proposed
Service Definitions and Provider Qualifications for 1115

APPEnDIX SD – F: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Stakeholder
Feedback by Service Definition
APPEnDIX SD – G: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Service
Definitions SET 1 Survey Results - Summary
APPEnDIX SD – H: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Service
Definitions SET 1 Survey Results - Full
APPEnDIX SD – I: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Service
APPEnDIX SD – J: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Service
Definitions SET 2 Survey Results - Full
APPEnDIX SD – K: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Service
APPEnDIX SD – L: SERVICE DEFINITIONS BREAkTHROuGH GROuP - Service
Definitions SET 3 - Survey Results - Full
APPEnDIX CC – A: CARE COORDINATION SuBCOMMITTEE - Common Care
Platform Framework
APPEnDIX CC – B: CARE COORDINATION SuBCOMMITTEE - Common Care
Platform Framework Survey Results - Summary
APPEnDIX CC – C: CARE COORDINATION SuBCOMMITTEE - Common Care
Platform Framework Survey Results - Full
APPEnDIX CC – D: CARE COORDINATION SuBCOMMITTEE - Portable Care Plan
Design
APPEnDIX CC – E: CARE COORDINATION SuBCOMMITTEE - Draft Data Elements
Survey Results – Summary
APPEnDIX CC – F: CARE COORDINATION SuBCOMMITTEE - Draft Data Elements
Survey Results - Full
APPEnDIX CC – G: CARE COORDINATION SuBCOMMITTEE - Draft Portable Care
Plan Survey Results - Summary
APPEnDIX CC – H: CARE COORDINATION SuBCOMMITTEE - Draft Portable Care
Plan Survey Results – Full
APPEnDIX CC – I: CARE COORDINATION SuBCOMMITTEE - Portable Care Plan
Design Recommendations Survey Results - Summary
APPEnDIX CC – J: CARE COORDINATION SuBCOMMITTEE - Portable Care Plan
Design Recommendations Survey Results - Full
APPEnDIX CC – K: CARE COORDINATION SuBCOMMITTEE - IOM Social
Determinants of Health
From
InnovatIon
to
ImplementatIon:
Work Group Report from the
Office of Health Innovation and Transformation
Printed by the Authority of the State of Illinois. 1/15 50 IOCI 15-500

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From Innovation To Implementation: Work Group Report From The Office of Health Innovation and Transformation

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From

December 31, 2014

December 31, 2014

Integrated Delivery System Reform

Major recommendations cover:

Care for the Undocumented:

Community Based Capacity:

Services and Supports

4 From InnovatIon to ImplementatIon:

Service Coordination & Case Management:

Entry & Access

plan for September 2015

Medicare & Medicaid (CMS) HCBS requirements

Consumer Bill of Rights:

The Population Health Integration Work Group

6 From InnovatIon to ImplementatIon:

Workforce Work Group

Data and Technology

All Payer Claims Database (APCD):

8 From InnovatIon to ImplementatIon:

• Improve the health of our population,

The Alliance identified five key system change drivers:

12 From InnovatIon to ImplementatIon:

14 From InnovatIon to ImplementatIon:

Process Leadership IDSR Statistics

16 From InnovatIon to ImplementatIon:

Issues and Concerns

18 From InnovatIon to ImplementatIon:

20 From InnovatIon to ImplementatIon:

2. Quality Metrics Subcommittee:

22 From InnovatIon to ImplementatIon:

3. Care for the Undocumented Subcommittee:

24 From InnovatIon to ImplementatIon:

SERVICES & SuPPORTS

PRIMARy RECOMMEnDATIOnS CHILDREn’S SERVICES STATISTICS

26 From InnovatIon to ImplementatIon:

CHILDREN’S SERVICES SuBCOMMITTEE

28 From InnovatIon to ImplementatIon:

Issues and Concerns

30 From InnovatIon to ImplementatIon:

b. Governance Breakout Group

c. Provider network & Contracting Breakout Group

d. Service Array Breakout Group

32 From InnovatIon to ImplementatIon:

34 From InnovatIon to ImplementatIon:

e. Service Coordination & Care Management

36 From InnovatIon to ImplementatIon:

Issues and Concerns

Issues and Concerns

Issues and Concerns

38 From InnovatIon to ImplementatIon:

The Services and Supports Work Group recommends:

2. Behavioral Health Breakthrough Group

3. Intellectual and Developmental Disabilities Breakthrough Group

40 From InnovatIon to ImplementatIon:

Process Leadership Membership

44 From InnovatIon to ImplementatIon:

The Regional Health Improvement Collaboratives Subcommittee discussed foundational principles