Washington State s Financial Alignment Demonstra>on: Evalua>ng Health Homes for Dual Eligibles

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1 Washington State s Financial Alignment Demonstra>on: Evalua>ng Health Homes for Dual Eligibles Alice Lind, Manager Grants and Program Development, HCA October, 2017 Health Home Goals Establish person-centered health action goals designed to improve health, health-related outcomes and reduce avoidable costs Coordinate across the full continuum of services Organize and facilitate the delivery of evidencebased health care services Ensure coordination and care transitions Increase confidence and skills for selfmanagement of health goals Single point of contact responsible to bridge systems of care NASHP 2017 Conference 1

2 Eligible Beneficiaries Identified chronic condition A risk score of 1.5 or greater; future costs predicted to be 50% higher than average population (disability-related eligible group) All ages, proportionally more dually eligible (Medicare/Medicaid) individuals have high risk scores Payment for Health Home Services One time payment of $252 for outreach, engagement and health action plan Monthly allowable payment of: $172 for intensive care coordination services; $67 for maintenance Health Home Leads contract out through network and may also provide care coordination services directly Incentive payment for engagement to begin 2017 NASHP 2017 Conference 2

3 Preliminary Outcomes Managed Fee-for-Service Duals are 1/3 of the Health Home Eligible Health Home Eligible Clients December 2016 TOTAL = 92,131 High Risk Medicaid- Medicare Dual Clients 27% n = 25,219 High Risk Medicaid- Only Clients 73% n = 66,912 NOTES: Includes all Health Home eligible clients DATA SOURCE: Washington State Health Care Authority, ProviderOne (Medicaid) database PREPARED BY: Department of Social and Health Services, Research and Data Analysis Division MAY 2017 NASHP 2017 Conference 3

4 Overall Eligibility, Enrollment, and Engagement Y 2013 MAY ,000 25,000 Washington State s Fee-For-Service Dual Eligible Demonstration Eligible, Chose Not to Participate 20,000 15,000 10,000 Eligible, Not Yet Enrolled Eligible and Enrolled 5,000 Enrolled and Engaged Ever 0 APR MAY JUN APR MAY JUN Engaged in Month APR MAY JUN SOURCE: DSHS Research and Data Analysis Division, Washington State s Fee-For-Service Dual Eligible Demonstration Monthly Report, September Shared Savings with Medicare Projected savings from first year evaluation: In total, the savings for the first demonstration period were $21.6 million after applying outlier adjustments, representing over 6 percent savings. Savings are divided 50/50 with CMS. Once Medicaid increase in spending is deducted, Washington Medicaid stands to receive approximately $10 million in savings per year during demonstration period. In 2017, Legislature approved sharing savings with Health Home Leads who meet engagement goals. NASHP 2017 Conference 4

5 Focus Group Results More than half of participants reported a significant improvement in their health or quality of life: Participants set goals and took responsibility for their own health, working with Health Home Care Coordinators Achieving personal health-related goals had benefits, e.g. decreased use of emergency departments and medications; increased physical activity and weight loss. Focus Group Results Participants value the relationship with the health home care coordinator: Viewed as particularly helpful in setting goals and developing plans to achieve them. Participants indicated that they wanted to be involved in their health care, and emphasized the need to advocate for themselves. Half of participants had achieved a goal or improvement in their health or quality of life: Most participants achieved goals by changing their own behavior rather than accessing additional services. NASHP 2017 Conference 5

6 Resources Websites: Ø Ø Ø Coordination/Medicare-and-Medicaid-Coordination/ Medicare-Medicaid-Coordination-Office/ FinancialAlignmentInitiative/Washington.html Alice Lind NASHP 2017 Conference 6