Elevate Health is Helping to Usher in Integrated Managed Care

In a few weeks all of the Apple Health (Medicaid) clients in Pierce County are moving to integrated managed care (IMC) health plans. Washington state’s original goal for completion of the transition to IMC plans was 2020, but Pierce County is a full year ahead of this goal and is set to implement integrated managed care on January 1, 2019, with support from our organization. This marks a major milestone in transforming health care delivery in Pierce County. IMC is designed to allow clients, payers and providers to improve care while lowering costs and eliminating prior obstacles standing in the way of coordinated care. This new approach breaks down some of the silos in which Medicaid clients are managed and helps bridge the divide between physical and behavioral health. Previously, behavioral health organizations managed behavioral health needs, while Managed Care Organizations (MCOs) managed physical health. IMC, however, enables providers to deliver whole-person health care under one plan, fully integrating and coordinating behavioral health and physical health, as well as other services like drug and alcohol treatment. Through IMC, patients can more efficiently access the services they need in order to treat or care for co-occurring disorders. It also allows an individual to receive or request care at any point, ensuring that there is no wrong place to begin when reaching out for care. Pierce County MCOs: In May 2018, Washington State Health Care Authority (HCA) announced the MCOs that were chosen to provide IMC plans to regional Medicaid clients in Pierce County. The selected MCOs were Amerigroup, Coordinated Care, Molina and UnitedHealthcare. These MCOs were specifically chosen to address the health and social determinants of health of the communities they’ll serve while supporting providers as they make the transition to IMC. Kim Zacher, Chief Executive Officer of Comprehensive Life Resources, a Tacoma-based not-for-profit mental health agency that also provides community support services, sees IMC as a significant step forward in providing whole-person care, especially when it comes to connecting a client’s behavioral and physical health care providers.

“Integration is one of the ways that we’re delivering health care that’s preventative- and recovery-focused, rather than reacting to someone who has, for example, an immediate health care emergency,” said Zacher.

Over the past few months, we have been using its IMC Learning Network through the Washington Resource Portal to work with behavioral health and substance abuse organizations, as well as MCOs and several state entities. The aim is to help them better understand the IMC payment system and other processes in order to prepare for implementation at the beginning of the year. In total, there are 156 participants in the IMC Learning Network who are working with us to develop a regional approach to identify and mitigate any gaps in service or payment practices that may arise once IMC begins. Our Chief Executive Officer, Alisha Fehrenbacher credits the IMC Learning Community for their role in helping achieve this milestone.

“We’re grateful to the all the partners who’ve informed our regional IMC strategy – health care is local, and hearing from our local health care leaders has helped us develop unique solutions that will help close gaps and pave the way for a healthier Pierce County,” said Fehrenbacher.

The integration of IMC into our health care systems here in Pierce County marks a significant change for many providers and MCOs in our area. Our short-term goal of having billing practices in place by the beginning of the year will help us toward our end goals for behavioral health agencies to remain successful and for Apple Health clients to receive quality, whole-person care. To fully support whole-person health services not covered by MCOs, Beacon Health Options will continue to provide crisis care in Pierce County. Beacon serves as the Administration Services Organization (ASO) in this structure and provides services for all county residents experiencing a behavioral health crisis, county-funded services, Ombudsman services and leadership of committees previously led by BHO-Optum. While most of the preparation for IMC implementation has taken place with providers, MCOs and the ACH, information about this change is beginning to be communicated to clients. In addition to information about the transition sent to Apple Health clients in September, HCA plans to send a letter outlining their new health plan, along with a benefits book by early December. For additional assistance, people may contact HCA directly at askmedicaid@hca.wa.gov or directly contact their health plan.