SW Washington and the Vision for Early Integration for Medicaid Molina Healthcare of Washington Presented by: Julie Lindberg, LICSW VP, Healthcare Services State of Reform Conference – Spokane, WA September 15, 2015

The Molina Story Molina Healthcare began more than 30 years ago in a small medical clinic in Long Beach, California. It was 1980 and the healthcare environment was similar to that of today. Patients without a family physician would flock to emergency departments complaining of a sore throat or the flu. As an emergency room physician, Dr. C. David Molina knew that treating patients for simple everyday ailments in the emergency room cost more and caused longer waits for people with true emergencies. As a result, Dr. Molina established a medical office to help those who were uninsured. Three decades later, Molina Healthcare is still led by a physician, the founder's son, Dr. Mario Molina. He and his siblings have gone from sweeping the floors of the first clinic to running the multi-state health company.

Molina’s Mission Our mission is to promote health and provide quality health services to low-income families and individuals covered by government programs

The purpose of integrating financing… Support the delivery of all care and services for individual members Integrate the systems of care Improved information sharing Aligned financial incentives Coordinated care Promote innovation to improve access to care Telemedicine, co-located and embedded services Invest the limited healthcare dollars to improve outcomes and lower total cost of care across whole populations (Triple Aim)

How Molina is preparing – Network & Community Deepening Molina’s 6 year relationships in SW WA with the BH providers, social supports, and crisis response systems Pursuing contracting strategies to promote: Integrated care delivery, i.e. co-located services Co-occurring (MH/CD) disorders treatment services Community-based services, i.e. outreach and engagement, in-home services Partnerships with supportive services, i.e. supportive housing Developing innovative approaches to care to increase access i.e. Tele-medicine, tele-psych Solidifying community partnerships Joining community improvement efforts similar to what we do in every community

How Molina is preparing – Care management We’ve always managed these members using an integrated approach Integrated teams – includes RNs and BH specialists (MH/CDP), BH MD 4 quadrant model for case assignment Team-based consultation and co-management Single care plan incorporating all health domains Exchange of information foundational to coordinated care Examples: King County RSN data exchange Snohomish County EMS PreManage/EDIE Community-based Care Coordination/Case Management Extensive Health Homes experience

Molina Care Management: Bio-Psycho-Social Approach

Recovery Oriented System of Care Adapted for Molina ROSC Path to Recovery: Coordinated network Person centered to: health quality of life wellness

Recovery Oriented System of Care at Molina Applies evidence-based ROSC, or Recovery-Oriented System of Care, throughout the organization Source: SAMHSA ROSC Guide 2010 ROSC Coordination of network services & supports Community based & person centered Builds on resiliencies, strengths of individuals, families & communities To achieve improved health, wellness and quality of life Recovery-Oriented System of Care is the EBP

Successes – The Washington Medicaid Integration Partnership (WMIP) Pilot program from 2006-2014 in Snohomish County integrating medical, mental health, chemical dependency and Long-Term Support Services for Medicaid Blind/Disabled population Access to information greatly improved integrated care coordination Single, comprehensive care plan Team-based approach: RN, BH Specialist, Care Specialist, CHW, Transitions Flexible funding supported integrated care delivery Compass Clinic PEHC social worker

Successes – The Washington Medicaid Integration Partnership (cont’d) Flexible funding allowed for effective investments of health care dollars for individual members to improve quality, lower cost Acumentra Health Evaluation of WMIP Program Significant improvement in 7-day post-hospital follow up Improvement in Anti-Depressant Medication Management Significant increase in OP visits coupled with significant decrease in ER visits

Challenges/Lessons – The Washington Medicaid Integration Partnership (WMIP) Never fully integrated with DSHS Important that SWWA MCOs integrate with DSHS/BHOs Difficult for providers to follow different authorization/billing practices – RSN, County, CD providers, and Molina Contracting models were new Business processes had to be adjusted Transition between managed care and FFS challenging

How Molina is preparing - Internal Operations Balance integration and specialization – Expertise without silos Contracting/Provider services Keep regional focus but develop SMEs Member Services Cross-training with back up from Provider Services and Care Coordination Authorization of services Specialized teams reporting to single Director Specialization without silos Claims/enrollment systems – modified for new benefits, new funding types

Questions? For more Information, please contact: Julie Lindberg, LISCW Vice President, Healthcare Services Julie.Lindberg@Molinahealthcare.com