As a brief update on Washington State’s development of a
healthcare system testing/demonstrating the principles of managed care (joint
and separate, health management and financial alignment), provided below is a
snapshot of each of the programs currently in play or soon to be
launched. These endeavors address the whole of the Medicaid
and Medicare covered health care system, with limited exceptions, in our
state. It is the intent of the federal
and state governments to include long term services and supports (LTSS) in
these demonstrations.
For information, contact Paul Montgomery.
For information, contact Paul Montgomery.
Healthy
Options / Basic Health (HO/BH) http://www.hca.wa.gov/medicaid/healthyoptions/Pages/index.aspx
The Health Care Authority, Washington’s Medicaid agency, adopted
Managed Care principles for their HO/BH clients in Eastern Washington effective
July 2012 and for Western Washington late fall 2012.
The Healthy Options program currently has very limited
impact in Long Term Services and Supports (LTSS). It is thought to be a rare occurrence that a
Healthy Options enrollee will require LTSS.
LTSS, care coordination and transitions are the responsibility of the
health plan. Initial payment for short
term stays is the responsibility of the health plan. If the LTSS stay is deemed to be longer term,
the payment reverts to fee for service through the Department of Social and
Health Services, however.
Health Homes - Managed Fee for Servicehttp://www.hca.wa.gov/pages/health_homes.aspx
Health Homes provide integration - or close coordination of primary, acute, post-acute, long term services and supports and behavioral health/substance use services. They are most commonly, but not always, focused on serving individuals with one or more chronic health conditions. The state projects to use Health Homes to serve 39,000 high cost/high risk Medicaid recipients statewide by year’s end.
Health Homes provide integration - or close coordination of primary, acute, post-acute, long term services and supports and behavioral health/substance use services. They are most commonly, but not always, focused on serving individuals with one or more chronic health conditions. The state projects to use Health Homes to serve 39,000 high cost/high risk Medicaid recipients statewide by year’s end.
Health home services:
·
Comprehensive care management
·
Care coordination and health promotion
·
Comprehensive transitional care and follow-up
·
Patient and family support
·
Referral to community and social support
services
·
Use of information technology to link services,
if applicable
The Health Care Authority is conducting several Requests for
Applications to qualify Health Homes.
Fourteen counties, Pierce and thirteen others primarily in
south to south eastern Washington, are scheduled to start with Health Homes July
2013. For the remaining counties statewide, except at this time King and
Snohomish counties, they are anticipated to begin use of Health Homes in
October 2013.
Health Plans - Managed Care
Three Way Contracts between Health Plan/Washington State/CMS
Three Way Contracts between Health Plan/Washington State/CMS
Washington’s integration project is HealthPath Washington. It is to integrate Medicare and
Medicaid services for people who are dually eligible. Under the CMS
demonstration, Washington State cannot test concurrently both strategies, use
of health homes with fee for service and use of health plans with managed care
financial alignment, in the same county.
Therefore, for King and Snohomish Counties, the state has opted to let
contracts only to demonstrate managed care principles and the use of health
plans.
Request for
Applications / Proposals due: May 15th, 2013
Selection of
Health Plans/ announce successful bidder: June 5th, 2013
Begin - only King & Snohomish Counties, enrolling 36,000
“duals” in a 3 year demonstration - April 2014
·
Comprehensive Plan Benefit Package
o
Medicare A, B & D Services
o
Medicaid State Plan Services
o
Medicaid Mental Health and Substance Use
Services
o
Medicaid 1915c COPES Waiver Services
·
Comprehensive Provider Network
o
Medical
o
Mental Health & Chemical Dependency
o
Long Term Services & Supports
·
Comprehensive Model of Care
o Interdisciplinary
Care Team (ICT)
·
Lead Primary Provider
·
Health Plan Care Manager
·
Care Team members
·
Community-based Care Coordinator
o Comprehensive
Individual Care Plan
·
Comprehensive needs assessment
·
Beneficiary health action plan
·
Care team member individual
Health Plans – full risk; financial; utilization; case, care
and health management.
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