healthier washington through a medicaid lens nathan johnson, chief policy officer, hca maryanne...
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Healthier WashingtonThrough a Medicaid Lens
Nathan Johnson, Chief Policy Officer, HCAMaryAnne Lindeblad, Medicaid Director, HCA
Better Health, Better Care, Lower Costs
Healthier Washington is creating healthiercommunities and sustainable health systems by:
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Improving how we pay for services
Ensuring health care focuses on the whole
person
Improving how we pay for services
Ensuring health care focuses on the
whole person
Building healthier communities
through a collaborative
regional approach
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Integrating behavioral and physical health services
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Strategies
By 2020, physical and behavioral health services must be provided through a fully-integrated managed care health system. — Senate Bill 6312 (2014)
In April 2016:
• Southwest Washington— as an Early Adopter—will have fully integrated healthcare purchasing through Managed Care Organizations (MCOs).
• In all other regions, chemical dependency serviceswill be integrated with mental health servicesthrough Behavioral Health Organizations (BHOs).
Better Health, Better Care, Lower Costs
Value-Based Payment
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Strategies
HCA, as Washington’s largest purchaser of health care—with over2 million Apple Health clients and public employees—is paving the way for more widespread adoption of value-based reimbursement.In 2016:
• Managed care organizations will coordinate physical and behavioral health care for Apple Health beneficiaries in southwest Washington.
• The state will test:- a value-based alternative Medicaid payment methodology for Federally Qualified Health Centers (FQHCs) and Rural Health Clinic (RHCs), and- a new facility type designation in Critical Access Hospitals (CAHs) that encourages sustainability.
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Clinical and Community Linkages
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Strategies
Health Behav-iors30%
Health
Care20%
Physical En-vironment10%
Socio-economic Factors40%
Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper, State Quality Improvement Institute.. Minnesota.
Recognizing that health is more than health care….• Accountable
Communities of Health bring health care providers and community partners together.
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Since passage of the ACA, Washington has increased its Medicaid enrollment by 44%...
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Se-ries1
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Apple Health Enrollment – June 2013 to May 2015
As of September 2015, more than 560,000 adults have been added through Medicaid expansion.
} 548,000
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• Before the Affordable Care Act, 60% of enrollees were children; now the majority of enrollees (55%) are adults.
• 22% of the new adult enrollees have a mentalhealth diagnosis.
• 14% have a substance use disorder.
• And, while the new adult group has lower hospital admission rates than other non-disabled adults,their inpatient stays average 50% longer.
Data provided by Research and Data Analysis, DSHS, June 2015.
…and the enrollees and their needsare different.
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In addition, there will soon be many more people age 65 and over in our state...
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Source: Washington State Department of Social and Health Services, Research and Data Analysis Division
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• By 2035, the number of people age 75 or older will have risen by roughly 150%.
• Between 2010 and 2040, we anticipate a 181% increase in Medicaid clients over age 65 with Alzheimer’s.
• 70% of people who reach the age of 65 are likely to need long term supports and services at some point in their lives.
• Biennial expenditures by the state for long term supports and services are currently $3.4 billion—or 6 percent of all general fund spending.
Data provided by Research and Data Analysis, DSHS, June 2015.
…and their health care needs are likely to increase as they age.
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Better Health, Better Care, Lower Costs
Purpose: Leverage federal savings to invest in delivery system transformation to bring the Healthier Washington vision to scale for Apple Health.
Goals:• Reduce avoidable use of intensive services and settings
—such as acute care hospitals, nursing facilities, psychiatric hospitals, traditional LTSS and jails
• Improve population health—with a focus on prevention and management of diabetes, cardiovascular disease, pediatric obesity, smoking, mental illness, substance use disorders, and oral health
• Accelerate the transition to value-based payment—while ensuring that tribal members’ access to specialty and community services outside the Indian Health system are maintained
• Ensure that Medicaid per-capita cost growth istwo percentage points below national trends
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Medicaid Transformation Waiver
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Transformation through Accountable Communities of Health
Each region, through its Accountable Community of Health, will be ableto pursue transformation projects focused on health systems capacity building, care delivery redesign, and population health improvement.
Service Options that Enable Individuals to Stay at Home and Delay or Avoid the Need for More Intensive CareA broadened array of Long Term Services and Supports (LTSS).
Targeted Foundational SupportsTargeted supportive housing and supported employment services will be offered to Medicaid beneficiaries most likely to benefit from these services.
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Medicaid Transformation InitiativesInitiative
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Initiative 2
Initiative 1
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Waiver Timeline & Process
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What’s next:• 30-day federal comment period• Negotiations with CMS• Ongoing development of demonstration
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All of these initiatives move ustoward a Healthier Washington…
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1 ACHs designated2 SIM evaluation complete3 Fully integrated managed care in SW WA; BHOs in other regions4 Fully integrated managed care health systems statewide5 Proposed waiver approval; transformation demonstration start-up6 Transformation investments begin7 Medicaid transformation evaluation demonstration complete
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Stay informed
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Join the Healthier Washington Feedback Network: [email protected]
Send comments and questions about Medicaid Transformationto: [email protected]
Learn more and take the Medicaid Transformation waiver survey at:http://www.hca.wa.gov/hw/Pages/medicaid_transformation.aspx