1. 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

2. 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.

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

4. 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)

5. 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

6. 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

7. Molina Care Management: Bio-Psycho-Social Approach

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

9. 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

10. Successes – The Washington Medicaid Integration Partnership (WMIP)
Pilot program from 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

11. 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

12. 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

13. 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

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