Washington State Rethinking Care Project July 22, 2008

1. Washington StateRethinking Care ProjectJuly 22, 2008

2. 2 WHERE WE HAVE BEEN Chronic Care Management Medicaid only, Fee-for-service SSI adults 60,000 people potentially eligible Highest 20% risk Voluntary enrollment 3 Distinct Approaches tailored to 3 populations Hakunamatata Identify Medicaid clients who need care management, using predictive modeling Improve health outcomes for clients using evidence-based medicine Intervene with clients to prevent avoidable medical costs by improving self-management skills and health literacy Support medical home development for program clients Evaluate effectiveness of intervention 6 month intervention Target population penetration is low. Factors include CD, MH, social issues - National Call Center in Indianapolis provides telephonic care management and health education 80% telephonic based interventions and 20% field based care management Total number of clients = 2700 - King County Care Partners Total number of clients = 350 Medical home model. Almost 100% community based care management Hakunamatata Identify Medicaid clients who need care management, using predictive modeling Improve health outcomes for clients using evidence-based medicine Intervene with clients to prevent avoidable medical costs by improving self-management skills and health literacy Support medical home development for program clients Evaluate effectiveness of intervention 6 month intervention Target population penetration is low. Factors include CD, MH, social issues - National Call Center in Indianapolis provides telephonic care management and health education 80% telephonic based interventions and 20% field based care management Total number of clients = 2700 - King County Care Partners Total number of clients = 350 Medical home model. Almost 100% community based care management

3. 3 WHAT WE WANTED TO ACCOMPLISHChronic Care Management Improved health literacy and self- management of chronic conditions Interruption of the spiral of increasing cost and decreasing health status

4. 4 WHERE WE ARE NOW Chronic Care Management Evaluation Cost analysis, clinical measures and clinical file review Report to the Legislature Dec 2008 Information will be very preliminary, especially the cost analysis Will have both qualitative and quantitative measures 6 month intervention Target population penetration is low. Factors include CD, MH, social issues - National Call Center in Indianapolis provides telephonic care management and health education 80% telephonic based interventions and 20% field based care management Total number of clients = 2700 - King County Care Partners Total number of clients = 350 Medical home model. Almost 100% community based care management 6 month intervention Target population penetration is low. Factors include CD, MH, social issues - National Call Center in Indianapolis provides telephonic care management and health education 80% telephonic based interventions and 20% field based care management Total number of clients = 2700 - King County Care Partners Total number of clients = 350 Medical home model. Almost 100% community based care management

5. 5 EFFORTS TOWARDMedical Home Development King County Care Partners have built a Medical Home network as part of local care management Using Washington State definition Accessible and Continuous Coordinated and Comprehensive Client-Centered Compassionate and Culturally Effective complete WA State Medical Home definition http://www.medicalhome.org/ 4Download/ keymessages2007.pdf These are the key components of Medical Home. Our operational definition of Medical Home is based on the WA State definition of Medical Home developed by DOH and 16 other state-wide organizations. These are the key components of Medical Home. Our operational definition of Medical Home is based on the WA State definition of Medical Home developed by DOH and 16 other state-wide organizations.

6. 6 Medical Home EffortsWorkgroup Cross-agency workgroup and steering committee convened in 2007 Goal to expand medical home for aged, blind & disabled adults & children RFI to providers completed and being analyzed/compiled now We currently have a Medical Home Steering Committee and a Medical Home Workgroup. outputs include a work plan and a logic model. A logic model is a word picture of how an organization works; it is the theory and assumptions underlying program development. Our logic model links short and long term outcomes with program activities, resources and principles. Our goal is to expand Medical Homes for aged blind and disabled adults and children. Medical Home Request for Information with a response of XXX# of providers. Our goal in sending this RFI out was simply to see what is going on out in the community�we know larger clinics/provider groups have more of a handle on Medical Home as do pediatricians. Received responses from a range of providers- one boutique clinic, large HMO clinics and private practices.We currently have a Medical Home Steering Committee and a Medical Home Workgroup. outputs include a work plan and a logic model. A logic model is a word picture of how an organization works; it is the theory and assumptions underlying program development. Our logic model links short and long term outcomes with program activities, resources and principles. Our goal is to expand Medical Homes for aged blind and disabled adults and children. Medical Home Request for Information with a response of XXX# of providers. Our goal in sending this RFI out was simply to see what is going on out in the community�we know larger clinics/provider groups have more of a handle on Medical Home as do pediatricians. Received responses from a range of providers- one boutique clinic, large HMO clinics and private practices.

7. 7 MEDICAL HOME EFFORTSCross Agency and National Commonwealth grant supporting a multi-stakeholder work group to improve medical home (08 - 09) NASHP and NASMD both sponsoring conferences on medical home Participate with DOH on collaborative development for 2009 Participate with HCA on reimbursement study The Commonwealth grant affords us a wonderful opportunity to receive technical assistance from Medical Home experts throughout the country, as does a National Academy for State Health Policy Medical Home Summit in DC. The Commonwealth grant team is drafting an action plan that reflects our current Medical Home activities related to expanding Medical Homes for aged, blind, and disabled children and adults, allowing us to capitalize on technical assistance where we need it most. A WA team has been invited to attend the NASHP application for a team to attend the July Summit. The Commonwealth grant affords us a wonderful opportunity to receive technical assistance from Medical Home experts throughout the country, as does a National Academy for State Health Policy Medical Home Summit in DC. The Commonwealth grant team is drafting an action plan that reflects our current Medical Home activities related to expanding Medical Homes for aged, blind, and disabled children and adults, allowing us to capitalize on technical assistance where we need it most. A WA team has been invited to attend the NASHP application for a team to attend the July Summit.

8. Shaping the Future Rethinking Care � Opportunity to Integrate Two Approaches Alice begins this. Alice begins this.

9. 9 CHCS RETHINKING CARETaking it to the Next Level Build upon current efforts and existing infrastructure Target 5% of clients driving 50% costs Interventions � Medical home improvement Care management New focus on mental health & CD services Utilizing current Workgroups Steering Committee composed of Cross Administration Directors Use national resources for learning (Commonwealth, NASHP, CHCS)

10. 10 MULTIPLE STRATEGIES to Build Synergy Medical Home CCMP ER Grant � Directs $$ to CHC�s Health Navigator Children�s Health Improvement Project May Expand Managed Care for SSI Kids GAU-MH Pilot WMIP

11. 11 RETHINKING CARENext Steps HRSA EC has endorsed project Will recommend two project sites to Steering Committee Kick off meeting planned for September Target 1st project start January 1, 2009

12. 12 Rethinking CareNext Steps