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Tags: new ACH

Today, the Washington State Health Care Authority and the Southwest Washington Regional Health Alliance (Accountable Community of Health) jointly published a report on the first 90 days of fully-integrated managed care in Southwest Washington. We encourage you to read the attached report, and to share with any other interested stakeholders in your community. Please send questions on fully-integrated managed care or the report to: earlyadopterquestions@hca.wa.gov.

Some highlights from the report include:

  • As of April 1, 2016, 100,982 Medicaid beneficiaries were enrolled in the FIMC program with Molina or CHPW, meaning they receive the full continuum of physical and behavioral health benefits through their managed care plan.
  • 14,631 clients are enrolled in the Behavioral Health Services Only (BHSO) program and receive specialty mental health and substance use disorder services through either CHPW or Molina. The BHSO program was designed to provide behavioral health coverage to clients who receive physical health coverage through the Medicaid fee-for-service system or have other coverage (American Indian/Alaskan Natives, Medicare and Medicaid dual coverage, etc.).
  • All behavioral health providers that had been under contract with the county substance use disorder (SUD) program or the RSN (mental health) signed contracts with the MCOs and Beacon, and the provider network has been enhanced and expanded with the addition of one new provider in the Southwest region who had not previously been contracted to serve Medicaid.
  • Medicaid payment rates to providers were no less than 100 percent of the rate before April 1, 2016. Additionally, MCOs continued paying providers using the same payment methods that were in place before April 1, 2016, to ensure stability for providers during this transition process.
  • Molina and CHPW created back up strategies to manually process claims and support cash flow security to providers in case of initial system problems with claims submission.
  • CHPW and Molina have worked collaboratively to standardize processes and minimize the administrative burden on providers, and achieved approximately 85 percent alignment of authorization requirements, contracting structures, and data submission processes.
  • Based on data supplied by the Emergency Department Information (EDIE) system, emergency department visits for Molina members enrolled in a fully-integrated plan averaged 6 percent lower for April through June. While this is promising data, due to the seasonality of ED visits, material reductions in ED visits are best evaluated within a same time period each year.
  • Western State Hospital discharges in the first 90 days held steady at the same rate of discharge before the transition.