Original Publish Date: February 6, 2018
One out of five individuals experience behavioral health issues – both mental health and substance use disorders (SUD) – at least once in their lifetime1. Behavioral health conditions also have physical and social consequences, such as worsening of health prognoses (e.g. heart disease, diabetes and cancer), homelessness, and loss of employment. Fortunately, these individuals can benefit greatly from a whole person care approach.
Owen* was one such individual. He was released from jail with physical and behavioral health conditions ranging from drug and alcohol use to hepatitis C and schizophrenia. Owen functionally was not able to maintain employment and his behavior had estranged him from his family. Fortunately for Owen, he had managed care services in addition to insurance available to him from his health plan. While receiving inpatient treatment for his schizophrenia, Owen’s health plan connected him to a Molina Healthcare case manager who helped him change the self-damaging trajectory he was on. His case manager invested time in Owen. She met with him in person weekly, collaborated with his care team at the facility, and eventually helped him take ownership of his health, and transition back into the community. Today, Owen is sober, actively engaged in his treatment plan, and living in an adult family home. His marked improvement is also helping him to re-establish relations with his family.
Owen's story is an example of what is being achieved through "fully integrated managed care" – one part of the State's Healthier Washington Initiative, launched in 2014, to help people experience better health throughout their lives and receive better care when and where they need it. One of the three stated goals of the Healthier Washington initiative is to provide health care that focuses on the whole person by integrating the delivery of physical and behavioral health care to better meet the multi-faceted needs of individuals like Owen.
Washington State has moved forward with integrated Apple Health (Medicaid) behavioral and physical health care purchasing ("fully integrated managed care") through its Managed Care Organizations. As of today, two of the nine regions in our state have transitioned to Integrated Managed Care (IMC): Southwest Washington (Clark and Skamania counties) on April 1, 2016; and North Central Washington (Chelan, Douglas and Grant counties) on January 1, 2018. The directive from the Legislature is for all nine Washington regions to transition to IMC by 2020.
Promising early results:
Molina Healthcare of Washington, who today serves over 140,000 Apple Health IMC clients in the Southwest and North Central regions, ensures access to a full continuum of physical health, mental health and substance use disorder services. Integrated purchasing (or financing) of behavioral and physical health services was an important and necessary first step on the road to achieving truly integrated care delivery, and removing many of the barriers associated with the historically siloed behavioral and physical health delivery systems.
Early results look promising. Molina's internal performance metrics show that Molina IMC clients have consistently accessed both primary care and behavioral health care at substantially higher rates than prior to IMC.
In August 2017, David Mancuso, PhD Director of the Washington State Department of Social and Human Services Research and Data Analysis Division published "Preliminary First Year Findings from the Evaluation of Fully Integrated Managed Care in Southwest Washington." The report evaluated 19 outcome metrics for adult Medicaid beneficiaries in the Southwest Washington region between CY2015 and CY 2016 compared to the rest of the state. The results were encouraging. After only 9 months of IMC implementation, Southwest WA improved in 13 of 19 measures and demonstrated statistically significant improvement relative to the rest of the State in the 10 measures noted in the Table below:
As we approach the second anniversary of the launch of IMC in Southwest WA, Molina is working to build on early successes through continued collaboration with community partners including primary care, mental health and chemical dependency providers to advance integrated care delivery. Molina is also working to help communities expand local behavioral health services and capacity. In 2017, Molina was able to expand local behavioral health service capacity in Southwest Washington by investing over half a million dollars of State General Funds to expand programs to close historic gaps in services and care. Examples of some of Molina's investments in Southwestern Washington to-date include: supporting start-up operating costs for a new local youth psychiatric evaluation & treatment unit, expanded substance use disorder treatment services for pregnant and parenting women, and the expansion of opiate treatment and mental health stabilization programs by increasing access to Medication Assisted Treatment (MAT) services.
At the end of the day, the true success of Integrated Managed Care will be measured one person at a time. Individuals like Owen are the reason that Molina is committed to the successful implementation of whole person care in every region of the state. The early returns provide us with optimism that the State of Washington and the spread of fully integrated managed care is on the right track for individuals, communities, and taxpayers.
1 Ratnasingham S, Cairney J, Manson H, Rehm J, Lin E, Kurdyak P. The burden of mental illness and addiction in Ontario. Can J Psychiatry. 2013;58:529–537.
*Not a real member name.