Report: Health care integration running smoothly in Southwest Washington

Washington state counties are moving toward fully integrated managed care (FIMC) for physical and behavioral health by 2020, and new data out of Southwest Washington suggest early adopters of the model have made stable progress in the first 90 days of implementation.

The FIMC model requires counties to transition Medicaid beneficiaries to managed care health plans that cover the full continuum of physical health, as well as substance use disorders (SUDs) and mental health services.

In Clark and Skamania counties — the first to launch FIMC — that means a choice between Molina Healthcare of Washington (Molina) or Community Health Plan of Washington (CHPW).

According to a new report by the Regional Health Alliance and Healthier Washington, both plans are overseeing a relatively smooth transition from the traditional Medicaid fee-for-service system.

While the report notes the changeover has not been without challenges, success in the first 90 days — which the report defines as stability — appears to have been achieved.

Some highlights from the report:

  • As of April 1, 2016, nearly 101,000 Medicaid beneficiaries were enrolled in FIMC with Molina or CHPW.
  • Nearly 15,000 clients are enrolled in the Behavioral Health Services Only (BHSO) program through Molina or CHPW, which was designed to provide behavioral health coverage to clients who receive physical health coverage through the Medicaid fee-for-service system or have other coverage.
  • Medicaid payment rates to providers have remained stable at no less than 100 percent of the rate before April 1, 2016.
  • Based on early data, emergency department visits for Molina members enrolled in FIMC averaged 6 percent lower for April through June. This figure is to be taken with a grain of salt, though, as ED visits can be seasonal and material reductions are best evaluated within a same time period each year.
  • Crisis system data collected from Beacon Health Options suggests a stable crisis system consistent with baseline data.

As noted in the report, there have been hiccups along the way. Technical issues and submission errors with claims nagged CHPW in June when behavioral health claim submissions increased in volume as providers gained familiarity with the new claims processing system.

Molina was also confronted with the task of transferring 1,400 members to a new primary care provider after a high-volume provider left a large group practice. However, grievances specifically related to behavioral health only represented 0.1 percent of complaints.

Looking further ahead, the Department of Social & Health Services (DSHS) will measure the first nine months of implementation on four key performance targets: mental health treatment penetration; SUD treatment penetration; hospital readmission rates; and emergency department use, reporting results quarterly.

By statute, all counties in Washington state are required to transition to the FIMC model by the end of the decade.