CountyCare Network Update

Report
Network Update
Prepared for: CountyCare Network Providers & App Assisters
September 24, 2013 (revised 10/1/13)
Agenda
1. CountyCare Updates
2. The Future of CountyCare
3. CountyCare and ACA Roll-Out
4. Q&A
2
Applications & Enrollment
•
•
•
•
Over 100,000 Apps Initiated
Over 70,000 Apps Submitted for Adjudication
85-90% Approval Rating
65+ day Lag In Processing
– Over 27,000 Apps Pending
• Members Stay with PCPs When Enrolling
– New Members 50/50 Split Between CCHHS &
FQHCs
3
Demographics
•
•
•
•
•
•
Apps From All Corners Of The
County
Adequate Provider Network
in Place
Age: 49% 50+ years old
Gender: 53% Female
Race/Ethnicity:*
– 26% African American
– 12% White
– 60% Other/Unknown
Assignment to PCMH:
– 96% FQHC Apps Pick FQHC
as PCMH
– 70% of CCHHS Apps Pick
CCHHS as PCMH
– 50/50 Split of New/New Apps
*Note: Race/Ethnicity is voluntarily reported.
CountyCare Areas of Focus
•
Permanent Staffing
– Currently filling 20+ positions
•
Referrals Process (including BH/SA)
– Updates to portal completed & training in process;
Revisiting policies and general approach
•
Marketing & Outreach
– New CCHHS Chief Strategy Officer; Hiring Director
of Marketing and Director of Community Affairs
•
Processing Back-log
– State DHS provided plan to be current by 12/31/13
5
Agenda
1. CountyCare Updates
2. The Future of CountyCare
3. CountyCare and ACA Roll-Out
4. Q&A
6
CountyCare Is Obamacare
• CountyCare is the Managed Care Option for
Low-Income Adults (<133% FPL) Living in Cook
County Eligible for Medicaid Coverage under
the Affordable Care Act (ACA)
• Marketplace coverage available (up to 400%
FPL) through GetCoveredIllinois.gov or by
calling 866-311-1119
Persons with CountyCare, or any other
Medicaid coverage, DO NOT need to reapply!
7
Dispelling the Myths
•
•
CountyCare Is Not Going Away 10/1/2013 When
The Marketplace Goes Live…
– Call Center (312.864.8200) continues
– Use of current DHS on-line application systems
continues
…Nor is it Going Away 1/1/2014 When ACA
Coverage Goes Into Effect Statewide.
– IL Medicaid Waiver ends 12/31/2013; CountyCare
becomes a Managed Care Community Network
(MCCN)
– Expect seamless transition for members and network
with no gaps in care.
8
The CountyCare Journey
• Phase IA: Launch
• Phase IB: Stabilization
• Phase II: Transition to MCCN (1/2014)
– Population Focus: Newly Eligible Medicaid Adults
• Phase III: Population Expansion (4/2014)
– Population Focus: Other Medicaid (7/2014),
Marketplace (10/2014), Medicare (TBD)
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Agenda
1. CountyCare Updates
2. The Future of CountyCare
3. CountyCare and ACA Roll-Out
4. Q&A
10
10/1-12/31: The Door You Choose
Determines When Coverage Begins
•
Benefits Begin 1/1/2014
•
– No prior period reimbursement
•
•
Offered Choice of CountyCare
or IL Health Connect through
Client Enrollment Broker
No guarantee of PCP selection
•
•
Benefits Begin 1st of Month
Application is Submitted
Enrolled into CountyCare
Assigned to PCP using
algorithm favorable to
provider assisting where app
Coverage today is possible ONLY through
CountyCare and ONLY when application comes
through an App Assister.
11
Coverage Delays Possible
• Persons Eligible for CountyCare ARE NOT guaranteed
•
CountyCare coverage unless they apply for benefits
through a CountyCare App Assister
Newly eligible adults applying through ABE beginning
October 1, WILL NOT have coverage until 1/1 – even if
they qualify for CountyCare today!
– And they will be required to go through the State’s Client
Enrollment Broker process and choose between
CountyCare or IHC
• App Assisters DO NOT need to transition to new system
(ABE) on 10/1/2013
– Existing systems will be available for CountyCare
applications until at least mid-November
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Key Takeaway Messages
1. CountyCare Updates
• Launch Has Been Wildly
Successful – Thank You!
• There is Work To Be Done
at CountyCare; We are
Continually Improving
2. Future of CountyCare
• CountyCare = Obamacare
• Not Going Away
10/1/2013 or 1/1/2014
• New Populations in 2014
• Call Center Continues
3. CountyCare & ACA Rollout
• The Door You Choose
Determines When
Coverage Begins
• Applying With an App
Assister Guarantees PCP
Assignment; Applying
With “ABE” Does Not.
• App Assisters Continue to
Use Existing Systems until
Mid-November(ish), then
transition to IES
13
Agenda
1. CountyCare Updates
2. The Future of CountyCare
3. CountyCare and ACA Roll-Out
4. Q&A
14
Key Contacts
Cook County Health and Hospitals System
Department of Managed Care
1900 W Polk Street, Suite 220-C, Chicago, Illinois 60612
www.cookcountyhhs.org
www.countycare.com
Provider Relations: 312.864.8200, Option 3
[email protected]
Executive Director
Steven Glass
[email protected]
312.864.1147
Director, Business Operations
Bill Baker (Interim)
[email protected]
312.864.0729
Medical Director
Jen Smith, MD (Interim)
[email protected]
312.864.0729
Director, Business Development
Sidney Thomas (Interim)
[email protected]
312.864.0921
Director, Clinical Services
Mary Sajdak, RN (Interim)
[email protected]
312.864.0918
Director, Finance
Scott Andrle (Interim)
[email protected]
312.864.4649
Director, Enrollment & Provider Training
Jane Longo (Interim)
[email protected]
312.864.6853
15
Thank you!
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