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Aging and Disability Services Advisory Council

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1 Aging and Disability Services Advisory Council
What Is the Medicaid Transformation Project? How will it affect Medicaid Services in King County? Aging and Disability Services Advisory Council August 11, 2017 Cathy Knight, Director, Aging and Disability Services Jeff Sakuma, Health Integration Strategist, City of Seattle Human Service Department Jeff

2 Healthier Washington Initiative
* Better Health Build healthier communities through a collaborative regional approach Better Care Ensure health care focuses on the whole person Lower Costs Improve how we pay for services Jeff Better Health, Better Care, Lower Costs – The Healthier Washington initiative is the larger state-wide initiative that the Accountable Communities of Health and the Medicaid Transformation waiver request sit under

3 What is the Medicaid Demonstration Project?
A contract between the federal government (Centers for Medicare and Medicaid Services) and the state (Health Care Authority) to allow for innovation to improve health outcomes for Medicaid beneficiaries. A five-year demonstration program ( ) funded by up to $1.5 billion in new investment. Demonstration goals are to: Integrate physical and behavioral health purchasing and service delivery Convert 90% of Medicaid provider payments to reward outcomes Implement population health strategies that improve health equity Provide targeted services that address the needs of our aging populations and address the key determinants of health Jeff The approved waiver – feds to state to initiative While a demonstration program (not a grant!!) – the funding is about demonstrating how these changes in processes and payment will live-on in perpetuity What we cannot speak to today is the potential impact of a repeal and replacement of the Affordable Care Act – while this may not have an impact on the intent and work of the demonstration waiver, it could impact the future size and scope if fewer individuals are eligible cannot be supported by Medicaid (expansion population) Right now, however, this work moves forward

4 Medicaid Demonstration Project: Three High-Level Initiatives
$1.1 Billion $375 million Initiative 1: Delivery system transformation strategies led by regional Accountable Communities of Health (ACHs) Initiative 2: Long-term services and supports Initiative 3: Supportive housing and supported employment services Jeff The Medicaid Transformation Demonstration Project includes three initiatives Initiative 1 – Transforms the delivery system through ACH and receives the majority of funds Initiative 2 – Long Term Services and supports builds on the AAA’s work with family caregivers Initiative 3 - Is moving forward through various housing and social services entities including HSD’s Office on Housing

5 Initiative 1: Transformation through Statewide Accountable Communities of Health (ACH’s)
ACH’s are a cross-sector regional collaboration with the goal of improving health at the local level. Regional ACHs will pursue projects aimed at transforming Medicaid and accelerate the move toward value based purchasing. Transformation Projects will: Be systems based Address social determinants of health Increase efficiency & effectiveness Jeff Initiative 1 – Read slide Decisions will be made locally and collaboratively Again, value-based purchasing is an extremely important piece of this puzzle –from 30% to 90% by the end of the five year period

6 King County Medicaid Recipient Profile
Approximately 23% of Medicaid recipients in the State reside in King County Approximately 21% of King County residents are covered under Medicaid 427,914 individuals 58% adults and 42% children (under the age of 18) Approximately 200,000 residents in King County are covered under Medicaid Expansion Approximately 26% of the Medicaid population in King County have an identified mental health treatment need Approximately 9% of the Medicaid population in King County have an identified substance use disorder treatment need Jeff This slide is to set some context in the breadth and scope of who will be impacted – it is important to remember that these are individuals with many great strengths to build on but who also have vulnerabilities to be cognizant of – We sometimes forget that upward to 50% of all children in our state are born under Medicaid – that doesn’t mean that they always stay in Medicaid but that we have made a commitment to cover kids up to 300+% of the federal poverty level (fpl). Note: Statewide – as of February of this year 1.8 million people were under Medicaid

7 King County Accountable Community of Health (ACH)
Jeff As of April this is the new structure that was put into place in order to begin to draw down these Medicaid waiver funds The top two boxes are now in place with the middle box in action as we speak Update on ED hiring and other positions

8 King County ACH Governing Board
Name Title Organization Adrienne Quinn Director King County DCHS Amina Suchoski VP Business Development United Healthcare Community Plan Betsy Lieberman Consultant Affordable and Public Housing Group Ceil Erickson Director of Community Programs The Seattle Foundation Daniel Malone Executive Director Downtown Emergency Service Center David Johnson CEO Navos Mental Health Solutions Elise Chayet Associate Administrator Harborview Medical Center Erin Sitterley Councilmember, City of SeaTac Sound Cities Association Esther Lucero Seattle Indian Health Board Jeff Sakuma Health Integration Strategist City of Seattle HSD Jihan Rashid Program Staff Somali Health Board Marya Gingrey Strategic Advisor Regional Equity Network Maureen Linehan Seattle Aging & Disability Services Molly Carney Evergreen Treatment Patty Hayes PHSKC Preston Simmons Chief Operating and Administrative Officer Swedish Health System, Providence Roi-Martin Brown Consumer/Community Member Washington Community Action Network Sarah Rafton WA - American Academy of Pediatrics Shelley Cooper-Ashford Center for MultiCultural Health Steve Daschle Southwest Youth and Family Services Steve Kutz Cowlitz Indian Tribe Teresita Batayola International Community Health Services Tizzy Bennett Seattle Children’s Hospital This is hard to read but just wanted to emphasize that this new board has a broad cross-section of stakeholders including consumers/community members Over 30% are people of color Primary Care FQHC Hospital/health systems (3) Behavioral health providers (3) MCO Public Health King County City of Seattle Suburban Cities Community-based equity network/consumer (3) Tribes (2) Urban Indian Health Board Housing LTC Services Non-profit social services (2) Philanthropy , At large

9 Fund Flow ACH determines if project milestones have been met
To a fiscal intermediary Funds flow from Federal Government to State Government Project partners earn incentive payments Jeff Over the course of the first two years the ACH will be paid for planning and reporting and will begin paying for outcomes by the third year Pay for planning Pay for reporting Pay for outcomes up to $1.1 billion

10 Required Project #1: Physical and Behavioral Health Integration
Focus Address physical and behavioral health needs through an integrated network, better coordination, seamless access. Outcome Metrics Medicaid clients with or at risk for: Behavioral health conditions Mental illness Substance use disorders Evidence Based Approaches Overuse measures (emergency department visits, readmissions) Behavioral health measures Physical health measures Target Groups Two approaches for integrating behavioral > primary (Bree Collaborative, Collaborative Care Model) Cited approaches for integrating primary > behavioral Jeff Connecting the head to the body – this doesn’t mean the all services need to be delivered under one roof, though that could happen, but that services are well coordinated including shared incentives There are established evidence-based approaches to this work

11 Required Project #2: Opioid Use as Public Health Crisis
Focus Reduce opioid related morbidity and mortality through: Prevention Treatment Recovery supports Target Groups Medicaid Clients Focus on youth who use prescription opioids and/or heroin. Outcome Metrics Systems wide Opioid Treatment penetration Overdoses per 100,000 Deaths per 100,000 Project Outcomes Treatment indicators MAT with Bupe MAT with Methadone Evidence Based Approaches Clinical Guidelines: AMDC interagency guidelines CDC Guidelines Substance abuse during pregnancy guidelines Jeff The work of our KC Heroin and Prescription Opiate Addiction Task Force has already set us on a very good course to further this work as we already have the majority of our workplan in place This will apply to much of the recommended work around prevention, expansion of treatment and treatment options, the distribution further distribution of naloxone and expansion of syringe exchange programs

12 Process and Time-line for Projects
Convene Interested Parties King County ACH selects / submits portfolio to HCA Identify project focus & implementing partners 2017 Jan Feb March April May June July Aug Sept Oct Nov Dec Develop project proposal Projects approved Jeff Review timeline Submit to King County ACH 2018 through 2021 Projects Implemented ( )

13 Initiative 2: Long Term Services and Supports (LTSS)
Projected Growth of Older Population in WA State as % of 2012 Population Cathy WA state has been a national leader in keeping people in their homes and communities, saving billions of dollars over the past two decades. Although, we have been successful, our population is aging, increasing the number of individuals who will need these services. The demonstration will allow the state to prepare for the age-wave by testing new services that support unpaid family caregivers and provide targeted supports to people who may or may not be eligible for Medicaid. The main goal of initiative 2 is to delay the need for more intensive Medicaid-Funded LTSS

14 Initiative 2: LTSS – Supporting Caregivers
80% of care statewide is provided by family members and other unpaid caregivers Unpaid caregiving has an economic impact on families: Loss of earning potential Decreased savings for retirement Impacts on ability to provide for their own children’s needs Increased health care costs due to stress and burden If just 1/5 of unpaid caregivers stopping providing care, it would double the cost of long-term services and supports Cathy

15 Initiative 2 - Two New Services: Supporting Caregivers
Medicaid Alternative Care (MAC) A new choice designed to support unpaid caregivers in continuing to provide quality care Has benefits similar to the state family caregiver program such as respite, counseling, support groups Tailored Supports for Older Adults (TSOA) A new eligibility group to support individuals who need LTSS and are at risk of spending down to impoverishment. Note: No Co-Pays or Estate Recovery Cathy

16 Initiative 2: LTSS – Implementation
HSD/ADS staff are engaged in: Systems development - designing benefit package, testing data systems, working with current providers on contracting Hiring of staff Case Manager - assessment, eligibility review Planner – gather input and Develop policies Training staff All HSD/ADS units involved - Planners, Contract Staff, Case Management Outreach to increase numbers Target Implementation – August 2017 Cathy

17 Initiative 3: Foundational Community Supports Supportive Housing
Community Transition Services One-time supports for individuals transitioning out of institutions or at imminent risk of becoming institutionalized Includes rental deposit, move-in costs, household furnishings and other necessary supports Community Support Services Housing assessment and development of a plan to address barriers Assistance with applications, community resources, and outreach to landlords Education, training, coaching, resolving disputes, and advocacy Supportive housing services do not include funds for room and board or the development of housing Cathy 3rd initiative will address unemployment and job insecurity, along with homelessness and unstable housing. Research is clear that these issues affect physical and mental health. The goal of Initiative 3 is to create targeted benefits to enhance the availability of employment and housing for the most vulnerable.

18 Initiative 3: Supportive Housing Target Population
Chronically homeless (HUD definition) Frequent/lengthy institutional contact Frequent/lengthy adult residential stays Frequent turnover of in-home caregivers PRISM Score (Predictive Risk Intelligence System)

19 Initiative 3: Foundational Community Supports Supported Employment
Individual Placement and Support (IPS) model Principles of supported employment: Open to anyone who wants to work Focus on competitive employment Job development and benefit counseling Client preferences guide decisions Integrated with treatment Individualized long-term supports Services may include: Employment assessment and development of a plan to address barriers Assistance with applications, community resources and outreach to employers Education, training, coaching to maintain employment

20 Initiative 3: Supported Employment Target Population
Aged, Blind, Disabled (ABD)/Housing and Essential Needs (HEN) Individuals with severe and persistent mental illness, individuals with multiple episodes of inpatient substance use treatment and/or co-occurring Working age youth with behavioral health conditions Individuals receiving long-term services and supports

21 Initiative 3: Funds Flow
Program Oversight Data Benefits administrator Providers Medicaid HCA – DBHR - ALTSA Third Party Administrator State agencies – HCA, DBHR, ALTSA have oversight Third Party Administrator – has oversight of benefits, contracts with providers, authorizes services, distributes payments, and tracks data/encounters Provider networks – CBOs, Health Care providers, LTSS providers, Tribal providers, community behavioral health agencies Reimbursement rates are still in development HSD/ADS is considering being a contracted provider SH/SE - CBO SH/SE – Health Care Providers SH/SE – Comm. BH Agencies SH/SE – LTSS Providers SH/SE – Tribal Providers

22 What are the expected Outcomes?
Better Health Better Care Lower Costs

23 Questions & Discussion


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