Washington Department of Social and Health Services

For nearly a decade, Washington State has operated a highly successful managed fee-for-service model demonstration under the federal Financial Alignment Initiative to better coordinate the care of dual-eligible individuals. The demonstration enrolls high risk dual-eligible individuals with fee-for-service Medicare into Medicaid health homes. The state’s project under the Advancing Medicare & Medicaid Integration initiative seeks to apply lessons from the demonstration and other integration efforts to increase enrollment in integrated care programs by focusing on dual-eligible individuals enrolled in Washington’s Highly Integrated Dual Eligible Special Needs Plans (D-SNPs).

Project Goals

With support from Arnold Ventures, Washington’s activities to advance integration include: (1) implementing new D-SNP policies and contract requirements; (2) enhancing state capacity for Medicare and Medicaid data analytics; and (3) engaging dual-eligible individuals and enrollment assisters about care coordination and the value of integrated care options.

Project Approach

To achieve project objectives, Washington is undertaking a 30-month effort that includes:

• Implementing new D-SNP policies to enhance integration of care and service delivery for dual-eligible individuals. Washington will implement new contract requirements in its State Medicaid Agency Contracts (SMACs) with D-SNPs, including: (1) aligning provider networks and geographic coverage of D-SNPs and Apple Health Medicaid Integrated Managed Care plans; (2) implementing default enrollment; (3) enhancing state-specific care coordination requirements; and (4) expanding the health home program to be included within the D-SNPs’ Model of Care.
• Enhancing capacity for data analytics for programs that serve dually eligible individuals. Washington will add data analytic capacity to its integrated client databases and Predictive Risk Intelligence System (PRISM) to support the state’s ongoing policy enhancements and evaluate the effectiveness of its efforts to enhance integration. The state is using Medicare and Medicaid data to develop better awareness of D-SNP enrollment and alignment with Medicaid managed care plans and to support default enrollment. The state will use encounter data for program evaluation and performance measurement and address health disparities by using enrollment and service data to evaluate quality measures by race and ethnicity.
• Increasing enrollment in D-SNPs through better understanding of consumer perceptions of program options and improving communication processes and tools about the value of integrated care. The state will survey dually eligible individuals about what they value in terms of care coordination and what would help them make educated decisions about health plan options. The state will use the survey findings to update communication methods and resources, including working with State Health Insurance Assistance Program (SHIP) counselors to enhance their communication with dual-eligible individuals about the value of integrated care.

Support for Other States

Many states are in the same position as Washington — they know they want to improve care for their dual-eligible populations by providing fully-integrated programs, but face resource gaps that prevent them from moving forward. Arnold Ventures launched the Advancing Medicare & Medicaid Integration initiative to support states and help fill those resource gaps. Learn more about funding opportunities.