State health officials have launched a new array of services for Medicaid patients with complex medical needs.
The goal is to not only improve those individuals' care and health outcomes, but to also save the state money by reducing the number of preventive hospitalizations and emergency room visits, said MaryAnne Lindeblad, Medicaid director for the Washington State Health Care Authority, which oversees the program.
About 62,700 people across the state -- including about 4,100 Clark County residents -- are eligible for the new program, called "health homes."
Contrary to the name, health homes aren't actually brick-and-mortar homes. Instead, they're a collection of services administered by state-selected companies.
Health homes are designed for individuals with chronic illnesses who are at significant risk for health problems that lead to unnecessary use of hospitals and other expensive institutional settings. The Health Care Authority uses a risk modeling system to identify those who are at significant risk.
Essentially, the health homes coordinate and manage the many services -- physical health, behavioral health and substance abuse treatment -- those individuals need, Lindeblad said.
An example of a person who would qualify for the services is a middle-aged individual with diabetes and hypertension and who has been diagnosed schizophrenic. He or she would have many health care needs being met by more than one delivery system and would also likely be in and out of the hospital because his or her diabetes is unstable.
"It's somebody who has pretty complex behavioral and physical health issues," Lindeblad said.
To be eligible for health homes, individuals must also be eligible for Medicaid, or both Medicaid and Medicare.
The program is a component of the Affordable Care Act, which gave states the option to provide the new service to Medicaid clients. The program launched in Clark County and 13 other Washington counties on July 1 and will roll out in most other counties later this year.
Currently, the federal government and the state government split the cost of Medicaid services about 50-50. Through the Affordable Care Act, the federal government will boost its share to 90 percent for the first two years of the new program. After two years, the split returns to 50-50, Lindeblad said.
However, Lindeblad expects the program to be budget-neutral by the end of the first two years. In the long term, she expects the program will save the state money. During the first two years, the program will cost the state an estimated $6.7 million.
Health home operations
The Health Care Authority selected several companies to serve as "qualified health homes" in each region of the state. In Clark County, the four health homes are Coordinated Care, Community Health Plan of Washington, UnitedHealthcare and Optum Regional Support Network.
Those companies will provide service coordinators. The coordinators may be employees of the companies or they may be employed by local organizations -- such as medical offices or substance abuse treatment centers -- and contract with the companies.
Coordinators will connect with eligible individuals and ask them to participate in the program. Many times, the coordinator will be someone who is stationed somewhere the individual already receives care, such as a primary care physician's office.
The coordinator is expected to engage with the individual at least once per month, Lindeblad said. That interaction can come in a variety of ways, including visiting the individual at home, going to his or her doctor's appointments, meeting with family members and checking in with the individual by phone, she said.
The coordination of care not only makes the system of care more effective, but it benefits the individual receiving care, said Doug Bowes, Washington Health Plan president for UnitedHealthcare.
"If I'm a member, and I'm getting psychiatric care, and I have diabetes and another medical problem, I could have three different sets of providers coming at me, and they may not be telling me the same thing," he said. "What we hear, members get a lot of information, phone calls and prompts to do things, but they can't keep track of everything."
The coordinators help to prioritize and organize treatment and follow-up care, Bowes said. And that, he said, leads to better patient care and improved health.
"Our company drive is to help people live healthier lives; that's the goal of the company," he said, "and I do think this kind of program, particularly for this population, is going to make a big difference."