State Innovation Model

In 2015, the Center for Medicare and Medicaid Innovation (CMMI) awarded Illinois a $3 million State Innovation Model (SIM) Design Award. This award provides support for Illinois to develop and test health care models. This is Illinois’ second SIM award. Illinois also received a SIM Design Award in 2013 for $2.5 million. In 2013, over 1,500 stakeholders helped to develop the Illinois Alliance for Health Innovation Plan.

Illinois will use the SIM design process to enhance the current health care system and achieve the Triple Aim: better health for the population, better health for individuals, and lower per capita costs. To achieve this aim, Illinois has identified the following primary drivers:

• Improve care coordination for the behavioral health population
• Focus and evaluate improvement efforts for providers and payers on common goals
• Address population-wide health needs

The State has identified behavioral health (mental health and substance abuse) to be a significant issue across Illinois. Therefore, the State will work to identify recommendations to improve the behavioral health system, including better care coordination for individuals who have behavioral and physical health conditions. One possible solution is to assist managed care organizations (MCOs) and providers to enhance care coordination and service linkages. Another is to enhance provider and community supports to ensure patients are placed in the most appropriate and affordable setting. The State will also consider recommendations to improve data sharing across payers and behavioral and physical health providers. In addition, the State will consider a common set of quality measures to evaluate progress towards better care for people with behavioral and physical health conditions.

The following diagram illustrates how Illinois will work to improve the health care system:

There are four SIM Workgroups, as described below. While participation in the SIM Workgroups is limited, updates from Workgroups will be shared on this Website and through public meetings.

• Physical and Behavioral Health Integration - recommend opportunities to assist payers and providers to enhance care coordination and collaboration to improve the delivery of behavioral health services and physical and behavioral health integration
• Data and Technology - recommend solutions to improve data sharing among behavioral and physical health providers and recommend opportunities for provider technical assistance to improve health information technology capabilities
• Quality Measure Alignment - develop a quality measure alignment strategy that allows for statewide, multi-payer measurement and includes appropriate behavioral health measures
• Patient Needs - inform SIM recommendations from the perspective of patients. The Workgroup will recommend a workforce development strategy and enhancements to community supports and services that will meet the target population’s needs, particularly related to behavioral health services and physical and behavioral health integration