General Assistance – Unemployable Experience in WA state July 2010

About Community Health Plan of Washington (CHP) Founded in 1992 by community health centers Provider network and health plan Mission-oriented –CHP is a not-for-profit health care services contractor –Our primary mission is to increase access to care for underserved and vulnerable populations. Network serves over 650,000 patients Health plan covers 270,000 patients

CHPW Network

CHP Current Programs Healthy Options/S-CHIP/S-Women ~ 202,800 General Assistance Unemployable (GA-U) ~15,400 Basic Health Plan (subsidized) ~ 45,200 Washington Health Plan (BHP non-subsidized) starting 7/1/2010 ~ <500 Medicare Advantage ~ 5,000 oSpecial Needs Population (SNP) oUrban and Rural plans oWith Pharmacy coverage

Program Description GA-U General Assistance-Unemployable State-funded medical benefits for persons who are physically and/or mentally incapacitated and unemployable for more than 90 days and who do not have dependent children

GA-U Managed Medical Care Pilot Started Dec. 1, 2003 in King and Pierce counties Goals: Increase number of clients exiting public assistance Increase number of clients transitioning to SSI Decrease unnecessary ER visits Decrease unnecessary hospital admissions and readmissions Improve pharmacy management Cost neutral

Managed Medical Care Savings

Complexity of GA-U Population DSHS | GA-U Clients: Challenges and Opportunities August 2006

Most common Dx and Rx

Utilization Trends Medical costs account for half of DSHS spending on GA-U clients. Mental illness and substance abuse increase frequency of ER visits. 50% of all clients qualify for long term disability (SSI) GA-U clients haven’t historically had a Health Care Home Per enrollee

Integrated Mental Health Program Background: 2007 Integrated mental health benefit added to medical pilot 2009 Expanded to GA-U statewide in November Expanded integrated model to additional populations in King County (HO mothers, uninsured veterans, older adults) State reduced biennial funding 20% ($40 million) State signed exclusive contract with CHP

Integrated Mental Health Program Program Benefits: Provide integrated Health Care Home for complex populations. Provide significant relief for primary care providers by providing care coordinator, consulting psychiatrist (MHIP), and funded mental health referrals Track (real-time) for active case management and care coordination through the use of a client registry across silos (Mental Health Integrated Tracking System: MHITS)

Integrated Mental Health Program Program Goals: To achieve better health outcomes and contain costs by maximizing care coordination, high-risk case management and chronic care management. To more quickly transition GA-U clients back to employment services, gainful employment or more stable, federally funded programs (e.g. GA-X/SSI).

Breaking Down the Silos Client centered care (vs.) agency centered care

GA-U Integrated Mental Health Program GA-U Client Specialty Mental Health- CMHC Care Coordinator Consulting Psychiatrists Refer to Communit y Service Office Refer to Chem Dep Treatment Level I Care (Primary Care) PCP Refer to Voc Rehab Other clinic- based mental health providers* * Available in some clinics

Progress to Date Increase Access: Over 17, 000 clients seen statewide as of June % of clients in primary care mental health coordination Increase assessment and treatment: 80% of clients screened for depression 46% screened for anxiety 45% screened for substance abuse Increase Outcomes: 38% of clients with at least two depression scores showed significant improvement in depression symptoms. 49% percent of clients with severe depression and at least two scores show significant improvement 85% of clients transitioned to GA-X successfully

Next Steps for GA-U Program Protect program from elimination (State budget deficit) Opportunities for federal funding through waiver Pilot integrating housing vouchers in 3 counties 2010 legislative changes to GA-U program: Name changed to Disability Lifeline Limits of 24 months eligibility within the last 60 months CHP will more quickly identify members for federal Medicaid programs by: Screening clients within 30 days of eligibility Improving access to incapacity exams Improving provider satisfaction through the redesign of the incapacity evaluation process Improving process for effective transition from GAX and SSI

Criteria for Success with Expansion Populations 1.Incorporate model into Medicaid for at risk populations 2.Payments based on severity 3.Integrate silos with payment methodology. Focus resources to one accountable agency/person 4.Expand state capacity to transition client to highest level of functioning (employment, employ. services, SSI) 5.Bend the cost curve; track, measure and report