WMIP, CCMP and the Blue Ribbon Commission

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Washington Medicaids Innovative Programs
WMIP, CCMP and the Blue Ribbon Commission
Washington State Department of Social Health
Services
Novel approaches to improving care for
high-risk, high-cost clients
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Washingtons innovative programs
A Presentation for NASMD
Doug PorterAssistant Secretary, Health and
Recovery Services Administration
Department of Social and Health
ServicesNovember 14, 2007
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Todays presentation

• Part One
• Washington Medicaid Integration Partnership
  (WMIP)
• - Managed Care Model for Aged, Blind, Disabled
• Part Two
• Chronic Care Management Project (CCMP)
• - Care Management for High-Risk, High-Cost
  Clients with Multiple Chronic Health Needs
• Part Three
• Blue Ribbon Commission on Health-Care Cost and
  Access
• - Reimbursement Reform, Health Promotion,
  Disease Accident Prevention and Reducing
  Emergency Department Use

Washington State Department of Social Health
Services
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Part One
The Washington Medicaid Integration Partnership
W-M-I-P Managed Care Model for
Aged, Blind, Disabled Medicaid Beneficiaries
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The Medicaid Integration Partnership

• Project launched in January 2005 with
  integrated medical and chemical dependency
  treatment
• Mental health services added in October 2005
• Long-term care added in October 2006
• Operates in one county (Snohomish)
• Contracted to one health plan (Molina Health
  Care)
• Program designed to slow the progression of
  illness and disability and better manage
  Medicaid expenditures through an integrated
  health-care program.

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WMIP specifics

• Enrollment is voluntary
• Method of enrollment
• Default, opt-out (most Medicaid only)
• Opt-in (dual eligible Medicare-Medicaid clients,
  Native American enrollees, long-term care
  clients)
• Clients who volunteer to stay in program are
  different from those who opt out, making
  risk-adjustment critical
• Lower historical medical utilization
• Lower historical long-term care utilization
• Current enrollment approximately 3,000

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WMIP Outcomes

• Increased client satisfaction with care
  coordination activities provided through the
  program
• Decreased ED use from 145 per 1000 enrollee
  months to 128 per 1000 enrollee months
• HEDIS measurements for diabetes higher than
  comparable Medicaid experience reported to NCQA
• Decrease in inpatient hospitalizations
  (non-statistically significant) compared to
  fee-for-service clients
• Medical cost savings approximately 100 pmpm in
  2006

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Part Two
Chronic Care Management Program
CCMP Care Management for High-Risk, High-Cost
Clients with Multiple Chronic Health Needs
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CCMP goals

• Improve access, outcomes and cost-effectiveness
  for clients with chronic illness through care
  management interventions.
• Evaluate carefully so we can attribute any
  improvement in health outcomes and
  cost-effectiveness to the CCMP interventions.

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CCMP program design

• AmeriChoice Statewide care management
• Identification of high-risk clients through
  predictive modeling techniques
• Care management interventions to top 20
  high-risk clients outside King County
• Seattle Aging Disability Services Local Care
  Management
• Provides services in King County
• Clients are enrolled in the Medical Home if
  their provider is part of Seattle ADS network
• Infrastructure support is provided to the Medical
  Home
• Care management interventions for selected
  high-risk clients in King County

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CCMP Care Management

• Predictive modeling software gives clients a
  risk score indicating the likelihood of future
  utilization and medical costs
• Top 20 of clients by risk score are identified
  and divided into intervention and abeyance
  groups evaluation will compare outcomes of the
  two groups
• Once identified for intervention, they will be
  offered care management -- clients must agree to
  participate
• Care management staff will assist clients to
  improve their self-management skills with intense
  six-month intervention
• Provide education and coordinate services

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Part Three

• The Governors Blue Ribbon Commission on
  Health-Care Cost and Access
• Three Selected Initiatives
• Reimbursement Reform
• Health Promotion Prevention
• Emergency Department Use

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Blue Ribbon Commission Bill, Section 1

• Legislative charge Health Care Authority (HCA)
  and DSHS to develop a five-year plan to change
  reimbursement within state-purchased health-care
  systems
• Goals of the new system
• Reward quality health outcomes
• Pay for care that reflects patient preference
• Require use of evidence-based standards of care
• Tie rate increases to improvements in access to
  quality care
• Direct enrollees to quality care systems
• Support primary care and provide a medical home
  to all enrollees
• Pay for telehealth and e-mail consultation

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Blue Ribbon Commission Bill, Section 1

• Value characteristics for the future system
• Integrated, coordinated quality delivery system
• Balanced, affordable, accessible health care
• Care is equitable and grounded in evidence and
  safety
• Healthy, knowledgeable members and empowered
  consumers
• Delivery system is transparent and easy to
  navigate for both providers and consumers

• Examples of benchmarks for these characteristics
  
• DSHS clients outcomes are same as commercial
  members outcomes
• DSHS payment rates are similar to other state
  payers
• No geographical variation in clinical practices
• All DSHS clients have a health assessment
• DSHS has a streamlined and transparent process
  for authorization and payment

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Blue Ribbon Commission Bill, Section 39

• Legislative mandate HCA, DSHS, the Department
  of Labor and Industries, and the Department of
  Health shall develop a five-year plan to
  integrate disease and accident prevention and
  health promotion into state-purchased health
  programs by
• Structuring benefits and reimbursements to
  promote healthy choices and disease and accident
  prevention
• Encouraging enrollees in state health programs to
  complete health assessments, and providing
  appropriate follow up
• Reimbursing for cost-effective prevention
  activities and
• Developing prevention and health promotion
  contracting standards for state programs that
  contract with health carriers.

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Blue Ribbon Commission Bill, Section 39

• Agencies will focus primary and secondary
  prevention activities in three or four of these
  topic areas
• Fitness and obesity, diet and nutrition,
  prevention of diabetes
• Smoking cessation
• Substance abuse
• Infectious disease
• Mental health
• Oral health
• Injury, accident and disability prevention
• Screening for cancer and chronic illnesses

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Emergency Department Report

• Report by DSHS and Health Care Authority on
  unnecessary emergency room use, due December 1,
  2007. Includes review of recent trends in
  unnecessary ER use
• Agencies will partner with community
  organizations and local health care providers to
  design a demonstration pilot to reduce
  unnecessary visits.
• Hospitals will link or refer non-emergent clients
  to 24-hour clinics. Clients will have access to
  24-hour nurse hotline.
• Health literacy and patient education about
  appropriate use of services.

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QUESTIONS?

• Doug Porter, Assistant Secretary
• Health and Recovery Services Administration
• 360-725-1867 (portejd_at_dshs.wa.gov)
• MaryAnne Lindeblad, Director
• Division of Medical Benefits and Care
  Management,
• Health and Recovery Services Administration
• 360-725-1786 (lindem_at_dshs.wa.gov)
• Jim Stevenson, Communications Director, HRSA
• 360-725-1915 (stevejh2_at_dshs.wa.gov)
• P.O. Box 45502
• Department of Social and Health Services
• Olympia WA 98504-5502