sw washington and the vision for early integration for medicaid molina healthcare of washington...
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SW Washington and the Vision for Early Integration for Medicaid
Molina Healthcare of Washington
Presented by: Julie Lindberg, LICSWVP, Healthcare ServicesState of Reform Conference – Spokane, WASeptember 15, 2015
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Molina Healthcare began more than 30 years ago in a small medical clinic in Long Beach, California.
• It was 1980 and the healthcare environment was similar to that of today. Patients without a family physician would flock to emergency departments complaining of a sore throat or the flu.
• As an emergency room physician, Dr. C. David Molina knew that treating patients for simple everyday ailments in the emergency room cost more and caused longer waits for people with true emergencies.
• As a result, Dr. Molina established a medical office to help those who were uninsured.
• Three decades later, Molina Healthcare is still led by a physician, the founder's son, Dr. Mario Molina. He and his siblings have gone from sweeping the floors of the first clinic to running the multi-state health company.
The Molina Story
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Our mission is to promote health and provide quality health services to low-income families and individuals covered by government programs
Molina’s Mission
The purpose of integrating financing…
• Support the delivery of all care and services for individual members
• Integrate the systems of care• Improved information sharing• Aligned financial incentives• Coordinated care
• Promote innovation to improve access to care• Telemedicine, co-located and embedded services
• Invest the limited healthcare dollars to improve outcomes and lower total cost of care across whole populations (Triple Aim)
How Molina is preparing – Network & Community
• Deepening Molina’s 6 year relationships in SW WA with the BH providers, social supports, and crisis response systems
• Pursuing contracting strategies to promote:• Integrated care delivery, i.e. co-located services• Co-occurring (MH/CD) disorders treatment services• Community-based services, i.e. outreach and engagement, in-home services• Partnerships with supportive services, i.e. supportive housing
• Developing innovative approaches to care to increase access• i.e. Tele-medicine, tele-psych
• Solidifying community partnerships• Joining community improvement efforts similar to what we do in every community
How Molina is preparing – Care management
• We’ve always managed these members using an integrated approach• Integrated teams – includes RNs and BH specialists (MH/CDP), BH MD• 4 quadrant model for case assignment• Team-based consultation and co-management• Single care plan incorporating all health domains
• Exchange of information foundational to coordinated care• Examples:
• King County RSN data exchange• Snohomish County EMS• PreManage/EDIE
• Community-based Care Coordination/Case Management• Extensive Health Homes experience
Molina Care Management: Bio-Psycho-Social Approach
Recovery Oriented System of Care Adapted for Molina
ROSC Path to Recovery:Coordinated networkPerson centered to:
healthquality of lifewellness
Recovery Oriented System of Care at Molina
Applies evidence-based ROSC, or Recovery-Oriented System of Care, throughout the organization
Source: SAMHSA ROSC Guide 2010
ROSC
Coordination of networkservices & supports
Community based & person centered
Builds on resiliencies, strengths of individuals, families & communities
To achieve improved health, wellness and quality of life
Successes – The Washington Medicaid Integration Partnership (WMIP)
• Pilot program from 2006-2014 in Snohomish County integrating medical, mental health, chemical dependency and Long-Term Support Services for Medicaid Blind/Disabled population
• Access to information greatly improved integrated care coordination• Single, comprehensive care plan• Team-based approach: RN, BH Specialist, Care Specialist, CHW, Transitions
• Flexible funding supported integrated care delivery• Compass Clinic• PEHC social worker
Successes – The Washington Medicaid Integration Partnership (cont’d)
• Flexible funding allowed for effective investments of health care dollars for individual members to improve quality, lower cost
• Acumentra Health Evaluation of WMIP Program• Significant improvement in 7-day post-hospital follow up• Improvement in Anti-Depressant Medication Management• Significant increase in OP visits coupled with significant decrease in ER visits
Challenges/Lessons – The Washington Medicaid Integration Partnership (WMIP)• Never fully integrated with DSHS
• Important that SWWA MCOs integrate with DSHS/BHOs
• Difficult for providers to follow different authorization/billing practices – RSN, County, CD providers, and Molina
• Contracting models were new
• Business processes had to be adjusted
• Transition between managed care and FFS challenging
How Molina is preparing - Internal Operations• Balance integration and specialization – Expertise without silos
• Contracting/Provider services• Keep regional focus but develop SMEs
• Member Services• Cross-training with back up from Provider Services and Care Coordination
• Authorization of services • Specialized teams reporting to single Director• Specialization without silos
• Claims/enrollment systems – modified for new benefits, new funding types
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For more Information, please contact:
Julie Lindberg, LISCWVice President, Healthcare Services
Questions?