Illinois Department of Healthcare & Family Services

Illinois Department of Healthcare and Family Services Transforming Maternal Health Model Application - Illinois Is Committed to Advancing the Health and Well-being of Pregnant and Parenting People Through Innovation in Its Medicaid Program. Despite Ongoing Efforts, There Is More Work to Be Done to Address the Significant Disparities in Maternal Health Outcomes. by Participating in the Transforming Maternal Health (TMAH) Model, the Illinois Department of Healthcare and Family Services (HFS) Is Requesting to Use Federal Support, Including $17 Million Award Funding as Well as Technical Assistance, to Improve Existing Programs and Test New Approaches to Payment That May Improve Outcomes for Medicaid Clients and Their Families. HFS Proposes to Test the Tmah Model in Two Regions in Northern Illinois Through Collaboration With Hospitals, Federally Qualified Health Centers (fqhcs), Community-based Organizations (cbos), and Managed Care Plans Serving the Aurora and Rockford Regions. These Regions Serve a Mix of Suburban and Rural Clients and Have Persistent Disparities in Birth Outcomes. Hospitals and Fqhcs in the Region, Managed Care Plans, Sister Agencies, and Legislative Delegations Have All Submitted Letters Indicating Their Commitment to the Success of the Model. HFS Will Work With the Tmah Provider Partners, Community Based Organizations (cbos,) and Partner Care Delivery Locations to Develop the Infrastructure Needed to Provide Whole Person Care With the Goal of Ensuring Hospitals and Outpatient Providers Can Engage in a Value-based Payment Model Tied to Outcomes. Provider Infrastructure Payments Will Be Used to Support Care Delivery Transformation in the Test Regions Including Establishing Infrastructure for Remote Patient Monitoring, Deploying Standardized Screening Tools for Behavioral Health and Health-related Social Needs, and Establishing Bi-directional Referral Pathways Between Managed Care Plans, Providers, and Community-based Organizations. the State Also Will Use Cooperative Agreement Funding to Support Extensive Analysis and Planning, Support Transformation and Its Provider Partners With Additional Staff Capacity, Expand Interprofessional Consultation Benefits for Midwives, Formalize a State Doula Support Council, and Maximize the Data Analysis Capabilities Across HFS to Link the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to Medicaid, Supplemental Nutrition Assistance for Program (snap), and Vital Records Data. During the Second Phase of the Model, HFS Will Collaborate With Partners in the Test Regions to Develop a Value-based Payment (VBP) Model Aimed at Sustaining the Care Delivery Transformations Achieved in the First Phase. the VBP Model Will Aim to Support a Care Delivery System That Addresses the Medical, Behavioral, and Social Needs of Pregnant and Postpartum Individuals, Both During and After Pregnancy. Its Goals Are to Improve Rates of Severe Maternal Morbidity and Reduce Health Inequities in the Test Regions. Upon Completion of the Tmah Model, HFS Expects to Have Refined and Informed Framework for Maternal Health VBP That Can Be Deployed by Other Provider Partners Throughout the State to Further Support a Whole-person Approach to Care for Pregnant and Parenting People.