Medicaid Transformation Project Demonstration Planning
Washington has reached an agreement with the federal government to implement a five-year Medicaid Transformation Project Demonstration. A key component of this effort is transforming the Medicaid delivery system within each region to care for the whole person and use resources more wisely through the Accountable Communities of Health (ACH).
Primary care and behavioral health providers, hospitals, social service agencies, and other community partners all have a part to play in building a system that improves health outcomes.
As part of this transformation effort, each ACH is required to select and monitor a portfolio of projects in their region. The parameters for these projects are outlined in guidance from the Health Care Authority entitled, the Medicaid Transformation Project Toolkit. This guidance outlines two project areas that are required for each region and a menu of six optional project areas.*
The Demonstration Project Committee (DPC) in the King County region is providing guidance to project design teams. Learn more.
Want to learn about how the funds will flow through the Demonstration? This slide deck from the Health Care Authority helps provide some of the details.
Informational meetings held for each project area
The King County ACH hosted informational meetings for each project area. The purpose of these meetings is to share information, discuss the parameters for the project area, assess potential opportunities and challenges for King County in engaging in this project area, and identify potential project implementing partners.
The ACH backbone staff worked with community partners to organize these meetings as information gathering and networking opportunities. More information about the project selection process will be available soon from the Health Care Authority. It is anticipated that each ACH will submit an overall project plan (portfolio of projects) by September of 2017 for review, approval and implementation in the 2018-2021 time frame.
- Project 2A: Physical and Behavioral Health Integration (*Required)
Through a whole-person approach to care, physical and behavioral health needs will be addressed in one system through an integrated network of providers, offering better coordinated care for patients and more seamless access to the services they need. This project will advance Healthier Washington's initiative to bring together the financing and delivery of physical and behavioral health services, through managed care organizations, for people enrolled in Medicaid.
- Project 2B: Community-based Care Coordination
This project seeks to coordinate care especially for high-risk populations, such as those living with chronic conditions, those impacted by the social determinants of health such as unstable housing and/or food insecurity, the aging community, and those dependent on institutionalized settings. Without a centralized approach to "coordinating the coordinators," a single person might be assigned multiple care coordinators who are unaware of one another, potentially provide redundant services, and risk creating confusion for the individual.
- Project 2C: Transitional Care
This project seeks to provide opportunities to eliminate avoidable admissions and readmissions. Points of transition out of intensive services/settings and into the community are critical intervention points in the care continuum. One population particularly at-risk for disruptions in care and barriers to (re)engaging with care are people incarcerated in prison or jail. This project includes multiple care management and transitional care approaches from which the ACH will select at least one.
Project 2D: Diversion Interventions
This project will implement diversion strategies which provides opportunities to re-direct individuals away from high-cost medical and legal avenues and into community-based health care and social services that can offer comprehensive assessment, care/case planning and management to lead to more positive outcomes.
Project 3A: Addressing the Opioid Use Public Health Crisis
Washington State, along with the nation, is in the midst of an opioid crisis, which affects communities, families, and overwhelms law enforcement, health care and social service providers. State agencies, public health, Tribal governments, and other partners are coming together to focus on strategies for implementing the state opioid response plan.
Project 3B: Reproductive and Maternal/Child Health
This project is focused on ensuring that women have access to high quality reproductive health care throughout their lives and improving the health and safety of Washington’s children by promoting intended and healthy pregnancy, promoting prenatal health care and supporting positive parenting practices that facilitate the infant and young child’s safe and healthy development.s
Project 3C: Access to Oral Health Services
This project focuses on providing oral health screening and assessment, intervention, and referral in the primary care setting, or through the deployment of mobile clinics and/or portable equipment. The project seeks to leverage the primary care workforce, and to strengthen relationships between primary care and dental providers, through stronger referral networks, improved communications, and shared incentives.
Project 3D: Chronic Disease Prevention and Control
This project focuses on integrating health system and community approaches to improve chronic disease management and control. Within the project, there is opportunity to include specific change strategies that target the regionally defined health disease/condition and to address the identified barriers to care for Medicaid beneficiaries experiencing the greatest burden of chronic disease.