On Wednesday, November 11 HC3 kicked off its Transformation Series with Part I of the State of Legislation focusing on Illinois State policy. The event featured a discussion with public and private sector leaders about the need for health care reforms to promote universal access to affordable care.
Samantha Olds Frey, CEO, Illinois Association of Medicaid Health Plans (IAMHP)
Nadeen Israel, Vice President, Policy & Advocacy, AIDs Foundation Chicago (AFC)
Heather Steans, Illinois State Senator, 7th Senate District
Cyrus Winnett, Senior Vice President of Public Policy & Government Affairs, Illinois Primary Health Care Association (IPHCA)
David Smith, Founder & CEO, Third Horizon Strategies and Co-Founder, HC3
Watch the Recap | Link to YouTube
Senator Heather Steans
The COVID-19 pandemic has impacted health care and the state budget. This year’s budget was built under the presumption that the federal government would provide additional relief and the Fair Tax Amendment would be passed – neither of which is happening, leaving a $6 billion budget deficit. Illinois State policy will be centered around these significant challenges moving forward.
One positive effect of the pandemic has been the expansion of telehealth services. Hundreds of thousands of people have signed up for ACA subsidies and Medicaid under expansion. Preventative health care in vulnerable communities will be one way to address these inequalities and health disparities, especially among low-income and minority communities. Health care transformation dollars are being directed towards communities that have been hit the hardest and facing more-challenging dynamics. However, consolidation activities will continue due to ongoing pressures.
Structural racism is a public health issue. COVID-19 coupled with unrest over police killings have highlighted the need for people to garner a better understanding of the root causes of inequality and the systemic issues our communities face.
Echoing Senator Steans’ concerns, Nadeen reiterated that there is a lot of disappointment that the Fair Tax Amendment did not pass. White the amendment would not have solved Illinois long-standing budget crisis and growing debts, it would have helped.
Nadeen is also closely watching what is happening at the federal level, because it will affect the fiscal year at the state level. Parity in reimbursement and protections for consumers are critical.
Criminal justice reform may seem tangential, but it is not. There is a substantial intersection between those in criminal justice system and those without proper health care, especially in Latinx and Black men.
Cyrus does not expect any additional radical changes for the rest of 2020. Moving into 2021, one of the most pressing questions is, what is going to remain from the temporary measures put into place during the pandemic, and how the continuations will affect the health care system? IPHCA’s top priorities are protecting the health care system and engaging in payment and practice transformation, which includes further expansion of telehealth. Cyrus said in the past, we have not done a good job of investing in preventative care and provider communities have not done a good job of collaborating. Telehealth should not and will not replace in-person care because there will always be a need for in-person care, but it is a means to increase access and provider capacity.
Samantha Olds Frey
Samantha echoed budgetary concerns, noting that the budget will be the main theme of the legislative session. She also added that there will be a strong watch around racial inequities and implicit bias.
Providers do not have access to IT that will consistently reach communities, nor do they collaborate with one another, which is a challenge that needs to be addressed. There is still a lot of work that needs to be done regarding expansion of access to telehealth. The rise of behavioral health needs, along with lower no-show rates, substantiates the important role of telehealth solutions. However, inequities – mostly for Medicaid members, but also for some providers –are being uncovered due to poor broadband connection. The health care system needs to catch up with the necessary technology and tools for telehealth to be efficient.
Samantha also believes that transformation includes addressing social determinants of health, and that fifty percent of outcomes are related to non-health related matters.
David Smith (DS): What is the best/worst case scenario for state and federal funding?
HS: Illinois has one of the lowest per-capita spending in the United States, but the pension drags the bottom line down, and the state must get creative. All the major players should be at the table and deep structural changes will have to be made, especially because the fair tax did not pass.
DS: What does 2021 look like for MCOs?
SOF: There is a lot of opportunity, but Illinois faces unique challenges. For example, Illinois has one of the largest Medicaid programs in the country; being paid two months after care is “on-time” in Illinois. Illinois also has a more bifurcated health care system than other states, which poses different challenges in terms of collaboration. By July, the state saw utilization come back to near normal or even above normal in some cases. Samantha anticipates similar challenges seen in 2020 to continue in 2021. But she hopes that the shuffle of MCOs slows down creating more stability. Additionally, Humana may go state-wide for dual-eligibles.
DS: What are some initiatives that can be pursued by community health centers (CHCs)?
CW: Stability would be a welcomed change. CHCs provide a lot of help for patients and can be the community resource to address social determinants of health for things like housing, jobs, etc.
They can also help prioritize keeping people health. The MCO program needs more stability and we need to consider how the state can prioritize its resources. It is not just about more funding but the allocation of existing funding.
IPHCA is focused on payment and practice transformation. There is a better way of providing care than the existing FFS model. COVID-19 has proven how important transformation is because health systems cannot survive if there are not continuous encounters/billable services being provided. Payment transformation can create efficiencies and improve outcomes because providers will not be as worried about providing billable services but can focus on their patients’ needs instead. Telehealth can support practice transformation. Telehealth does not just include talking directly with a provider, but it encompasses any type of care where the patient is in one place and the provider is in another. Remote monitoring should be taken advantage of.
DS: Are MCOs ready for payment transformation?
SOF: Certain CHCs and providers have already transformed their payment model, but we want to make it available to more providers. Payment should be dependent on outcomes, where there are shared risks. We have already seen some health plans coming out with alternative payment models (APMs) for CHCs. IMAHP is working with the Lurie Children’s on a program called “All Hands Health Network” to coordinate work with a variety of stakeholders. A lot of investments are being made, but a few key motivations are necessary to drive this shift: stable relationships, history to understand what transformation looks like, and sufficient membership volume. We have seen payment transformation come to fruition more and more. The hope is that payment transformation will align with health care transformation.
DS: Do we anticipate a different opportunity to engage business leaders, hospitals, philanthropists, etc. and find new sources of partnership and funding as a result of the events of 2020, ranging from Black Lives Matter protests to the ongoing pandemic? NI: There are a lot of challenges, but a lot of opportunity as well. We have control over changing every aspect of the environment and society that we’re living in, whether at the city or state level. The city and the state should focus on the potential we have with control over legislation and in the governor’s office.
Billions of dollars are spent throughout the criminal justice system of which continues to cultivate greater inequities. Funding needs to be redirected from problematic activities like arresting and holding predominantly Black and Latinx men for petty crimes, to preventative care, acute care, mental health and substance use treatment, HIV, and so on. So many things are interconnected – healthy living, implicit bias training, criminal justice food, exercise and more.
An example of a small initiative is implicit bias training. Even though we may be conscious of racism and try not to be racist, it is ultimately baked into everything we do and deeply rooted in our society so implicit bias training can help drive change. In 2021, we have the opportunity to address these issues.
DS: How is the Medicaid Transformation work going?
HS: Valuable data has shown that there are communities that are being hit disproportionately harder, which we all knew intuitively. We want to focus the budget on those communities, particularly by focusing on collaboration and preventative work.
DS: What do we need to do to make sure there is enough access to high-speed channels? HS: We’ve done a lot of work around mental health access. It is really about implementation and collaboration. One of the promises of MCOs is better care coordination, but we haven’t really seen this yet. It’s a model that we need to further use. And what we need to do is to look at how we structure MCO contracts and how we can incentivize those goals.
SOF: MCOs are going to connect to the existing system. The resources exist, and we need more investment in mental health and more prioritization toward community-based preventative care. MCOs alone can’t transform the system, but they can play an integral role with the support of the administration and legislative leaders.
CW: We need greater collaboration and more accountability to ensure quality doesn’t suffer. We need to be careful with telehealth to make sure that we don’t just create another level of inequity, particularly for rural areas without broadband access and urban areas that cannot afford it. We need better broadband internet for everyone because technology is going to be fundamental to the way care is provided.