1. 1 State of Reform: The Practical Challenges of Medicaid Integration Karen Lee, CEO

2. 2 We’ve got you covered. Relax.

3. Columbia United Providers: Fast Facts Medicaid Health Plan for 20 years Owned entirely by local providers Currently serving ~55,000 members in Clark County Currently managing Medicaid, Medicare, Self-Insured/TPA, Exchange lines of business Provider partnered, member-centric, community engaged Data-driven, evidence-based, holistic approach to care 3

4. Columbia United Providers: 2014, a Milestone Year 2014 was a year of Reinvention… Became a Qualified Health Plan (QHP) on the WA State Health Exchange Earned NCQA accreditation Completed the HCA’s application and passed readiness review (Audit) Highly engaged in mental health and physical health clinical integration process in preparation for Early Adopter Contract in 2016 Re-contracted with HCA in 2015 for Apple Health 4

5. Medicaid Integration: Progress with Stakeholders Embarked on early integration efforts in late 2013 Current stakeholder engagement in integration: – Southwest Washington Behavioral Health (RSN) – Regional Health Alliance (RHA) – Healthy Living Collaborative – Providers: behavioral and physical – Medicaid health plans – Other community agencies: SWAAAD, Coalition for the Homeless, Transportation, Schools, Corrections... 5

6. Medicaid Integration: Progress with Stakeholders (continued) Strong relationship with SWBH – Improving care coordination and transitions of care between systems; developed joint ROIs and Joint Operating Agreement in 2014 – Joint complex case management; integrated care plans In 2015, jointly utilize EDIE to push care plans to ED for high-risk members – Participate on RSN Medical Services Coordination Committee, a venue for Medical Directors to dialogue on care coordination and best practices – Exploring opportunities for integrating providers into each others clinics; introducing pay differential for these clinics – Exploring innovative pay structures/incentives to improve access and support care coordination – Planning QI pilot; may or may not involve the local ACH who is considering smaller scale pilot with grant money from innovation plan 6

7. Medicaid Integration: Progress with Stakeholders (continued) RHA – Large Board; leadership driven by small subset of members – All volunteer Board/Committees; lack of full time engagement. MCO’s and RSN, who now manage risk, included late in the game; often viewed with limited role by some – Conflicts of interest and control issues prevalent; health plans requested refocus to build a consensus of roles/purpose of the ACH. – Limited engagement, progress with group as a whole. Currently have greater engagement with individual entities Healthy Living Collaborative eager for payer perspectives, data, & partnership – CUP participates in focused interventions and drills down into neighborhood/census track to improve health outcomes (Heat map on next slide) – Supporting HLC on the “Build Health Challenge” grant PCP’s interested in increased engagement; some experienced in integrated medical home models BH & CD Providers generally interested in partnering closer with CUP 7

8. Columbia United Providers: Health Services Planning (3+ ED Visits/yr) 8 Mill Plain Rose Village Orchards Washougal W. Vancouver (Shelters)

9. Columbia United Providers: Data-driven, Targeted Interventions—“Hot Spotting” 9 Utilizing claims data to identify concentrations of high-risk members in target areas Partnering with HLC to utilize community health workers Aids in member engagement Support of housing transitions when 90+ CUP members evicted from low cost housing

10. Medicaid Integration: Challenges Fear/Uncertainty – Change/unknown – Loss of control of $’s, processes, systems, people… – Lack of experience / complexity of caring for whole person – Risk of getting it wrong Communication Chasm – Lack of time/energy/relationships/trust/experience – Disparate systems that do not communicate/share data – Lack of policies, procedures, processes – Real or imagined contract and/or regulatory barriers with communications regarding MH/CD Policy/Regulatory Barriers Consolidation – Anti-trust/anti-competitive issues abound; clear lack of understanding of FTC guidance Conflicts of Interest Need for Flexible Benefit Design Waivers 10

11. Karen Lee, President and CEO Klee@cuphealth.com | 360-449-8867 11