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January 2015

Innovating in the New Year
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The state of Illinois received a holiday gift from the Centers for Medicare and Medicaid Services: a $3 million model design award to developa multiple payer payment and service delivery model. Illinois is one of 17 states that earned funding through the State Innovation Models initiative, with $3 million being the largest sum a state could receive. Public and private entities have one year to outline a plan that improves performance, increases quality, and decreases costs.

Created through the Affordable Care Act, the Center for Medicare and Medicaid Innovation and its State Innovation Models initiative view states as a laboratory for new policies and reforms. In its analysis of the program, the Commonwealth Fundcalled the State Innovation Models initiative "an unprecedented opportunity" to initiate and sustain health reform.

Illinois is already on the health reform path. In February of 2013, the state received a round one model design grant, which funded the development of the Alliance for Health Innovation Plan. Outlined goals included creating a comprehensive, integrated service delivery system and focusing on public health prevention measures, among others. With round two model design money in hand, Illinois Health Matters will monitor the planning process to keep you informed.



hospital sceneFrom our blog

Why Narrow Networks are a Big Deal: A Discussion of Network Adequacy

Network adequacy is the extent to which a health plan has a satisfactory number of primary and specialty healthcare professionals that consumers can access in a timely manner. This idea can have a tremendous influence on a patient’s quality of care. For example, plans can include a hospital in their network yet exclude doctors or specialists working at that hospital.As a result, patients may unknowingly receive care from an out-of-network doctor and be left with an exorbitant bill.

Some of these issues may soon change. TheNational Association of Insurance Commissionsreleased a draft model law for states. The draft model law requireshospitals to develop a process for alerting patients potentiallyseeking treatment from an out-of-network provider at an in-network hospital. NAIC’s model law also proposed network sufficiency standards accounting for elements such as the levelof specialty services available, geographic accessibility, the number of providers, the wait time for receiving care, and the hours of operation for participating providers.
Read more...



On our site

Tax season is almost upon us and Illinois Health Matters is here to help. We have added new resources to answer how the healthcare law will impact consumers during tax time. We have also added blog posts addressing healthcare needs special to small businesses.As always, drop us a line at info@illinoishealthmatters.org with your thoughts and suggestions.



In case you missed it

Higher Deductibles a Growing Concern: The amount consumers must pay before insurance kicks in has doubled over the past eight years and a range of Americans – from professors to the middle class – are impacted.

CHIP Funding in Doubt: The Affordable Care Act funded the Children's Health Insurance Program, CHIP for short, through September 2015. Advocacy organizations, Democrats, and Republicans have called on Congress to continue supporting the program.

Congress Votes onACA Changes: The House of Representatives passed a bill that would alter theACA's full-time employee definition to 40 hours per week. The bill now moves on to the Senate.


Recent resources

Kaiser Health News explains why this age group should shop around for a plan.
How 21-Year-Olds Can Avoid Premium Hikes

The Center on Health Insurance Reforms detailsthe difference between an embedded deductible and aggregate deductible.
Understanding Different Types of Deductibles

This blog post from Enroll America tells how hospital systems can increase the number of insured.
Hospital Enrollment Strategies

The Illinois Department of Insurance describes network adequacy for the average consumer.
What to Know About Provider Networks



Events

Find enrollment events in your area at the Get Covered Illinois Events page.

Find volunteer and community engagement opportunities at Get Covered America Events page.

Download a presentation and/or watch a recording from the EverThrive Illinois Webinar series.

Learn what the ACA means for a small business owner from the Small Business Majority's Thursday talks.



From our social media

On Twitter
@ILHealthMatters: Part A, B, C, and D. Let's break down the MEDICARE alphabet soup. http://go.cms.gov/136TI79 #ACA word of the week #ACAwow

On Twitter
@ILHealthMatters: Not everyone will be auto-enrolled in the same plan. Keep an eye out for a marketplace notice http://bit.ly/19U8Nqh

On Facebook
FACT: 2014 saw the largest health coverage gains in four decades! #?ACAWorks #?GetCovered



For the latest on how the new health care law is impacting Illinois, follow us on Twitter, Facebook, LinkedIn and YouTube. You can also email us at info@illinoishealthmatters.org or send us your question here. If you have friends or colleagus interested in these issues, please feel free to forward the newsletter to them.

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