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Elevate Health Submits Medicaid Transformation Plans to the State

By Alisha Fehrenbacher

Elevate Health is proud to announce that it has submitted plans to implement four Medicaid Transformation Projects to the Washington State Health Care Authority today, has included the remaining four projects to be rolled into the overarching strategy. Each plan will focus on transforming how health care is delivered to Medicaid beneficiaries in Pierce County. The goal is to work across health care providers, community-based social services, public safety, payers/managed care organizations, emergency services and other sectors to improve access and quality of care. “We want better prevention that keeps our residents healthy. We want higher quality care to be available when they need it. We want improved health to be a foundational value for our community, and we want to make sure that outcome is shared equitably by all,” said Elevate Health Chief Executive Officer Alisha Fehrenbacher, FACHE.

Elevate Health is one of nine Accountable Communities of Health (ACH) in Washington State. The ACHs are a ground-breaking effort to improve health care, lower costs and better align payments systems to support patient-centered practices. Up to $102 million has been earmarked for Pierce county region for this five-year program to stand up a new and transformative health care models.

Following months of input from a diverse range of partners, including health care agencies, providers, financial experts, payers, community leaders and most importantly, community members, Elevate Health will leverage local resources and partnerships to increase access to appropriate, high-quality prevention, treatment, recovery and wellness services and activities; reduce disparities between the availability of services for mental and substance use disorders compared with the availability of services for other medical conditions; and ensure that behavioral health and physical health services are well integrated and coordinated. The four projects include:

Bi-Directional Integration: The goal is to enhanced integration and coordination of primary, acute, behavioral health (mental health and substance use), and long-term services and supports for those with chronic illness.

Community-based Care Coordination: This project area provides health care providers with tools that improve the connectedness of experiences for patients across clinical and other community systems. Community-based care coordinators will be able to bridge gaps between families, health care providers, and support services.

Chronic Disease Prevention and Control: By moving the current system away from responding to sickness, we will help create support for individuals to manage their health challenges and achieve their health goals, which will be critical to reducing the total long-term burden of complex health on the systems and partners in our community.

Addressing the Opioid Use Crisis: Elevate Health will address this critical public health crisis with a strategy that focuses on the needs of the whole person, including aspects of a patient’s life, such as homelessness, hunger, and unemployment, that have detrimental effects on health care and recovery.

“Elevate Health selected these four areas as foundational initiatives based upon regional health needs and stakeholder input,” said Fehrenbacher. “However, our board and our shared learning stakeholder structure voted that we also address the project areas that were not selected (oral health, reproductive and maternal child health, transitions of care, and diversions) by linking them into our planned work for the areas we did select.”

The initial Demonstration Project will focus on health care improvements for the state’s Medicaid beneficiaries. In 2016, Pierce County served nearly 228,000 Medicaid enrollees; representing 12 percent of Washington’s Medicaid population and 27 percent of the total Pierce County population. The success of the plans is particularly important for Pierce County. According to the Washington State Department of Social and Health Services, Pierce County residents experience higher rates of physical and mental illness, a shortage of treatment options and increased unemployment and poverty compared to the rest of the state. “We believe that healthy, vibrant people and communities are better able to achieve their full potential and that better health for all is the cornerstone of community vitality,” said Fehrenbacher.

Elevate Health"s overall strategy will incorporate three specific aims:

• Work to transform the care system in the community to better address the needs of the whole person;

• Move toward a high-quality, value-based healthcare model organized around the fundamental goal of creating health rather than delivering services; and

• Improve the community’s capacity to identify and solve problems together. “An infrastructure with data at its core will allow us to identify data-driven opportunities, engage with our communities, create rules of engagement, monitor performance and provide feedback, capture evidence of savings or other community impacts, and reinvest those savings back into the community via a Community Resiliency Fund that supports health-generating activities and programs over the long term,” said Fehrenbacher.

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