Performance contracting Washington state SHIBA

Performance Contracting in SHIP and SMP Todd Dixon, SHIBA Program Manager Statewide Health Insurance Benefits Advisors WA State Office of the Insurance Commissioner

SHIBA investors (budget) State Health Insurance Program (SHIP): $900,000 Senior Medicare Patrol (SMP): $200,000 Medicare Improvements for Patients & Providers Act (MIPPA): $180,000 State funding: $1,000,000

Washington state SHIBA overview 1.2 million Medicare beneficiaries 14 SHIBA staff 20 SHIBA sponsors All 20 SHIP 11 of 20 also Senior Medicare Patrol (SMP) 88,000 Client Contact Records (CCRs), 120,000 Public & Media Activities (PMAs), ranking is 13, Average and Good in preliminary Likert

SHIBA organization

SHIBA regional training consultants

Pay for performance 6 performance tiers – contacts and outreach Tier 4 – 7% penetration, 10% penetration for LIS Levels 6 – performance payments – 10% and 12% Pay points for SMP 65% of SHIP budget is allocated to contracts 40% open enrollment, 20% in non OE quarters Base amount $1,000 per quarter, per county Legislative language

Support for success Field supervisor and regional training consultants Budget and contracts coordinator Contracting and procurement training Customer Service staff in larger counties Sponsors targeting rural counties Sponsors targeting Limited-English Korean Women’s Assoc., Latino Community Fund, Chinese Information Services, farmworker organizations Event based contracting with diverse community agencies. Progressive budgeting

Example - CCR

Example – CCR with fraud (SMP)

Example – CCR with low income

Sample invoice

Payment worksheet