General Assistance – Unemployable

Experience in WA state

July 2010

About Community Health Plan of Washington (CHP)

• Founded in 1992 by community health centers• Provider network and health plan• Mission-oriented

– CHP is a not-for-profit health care services contractor– Our primary mission is to increase access to care for

underserved and vulnerable populations.• Network serves over 650,000 patients• Health plan covers 270,000 patients

CHPW Network

CHP Current Programs• Healthy Options/S-CHIP/S-Women ~ 202,800• General Assistance Unemployable (GA-U) ~15,400• Basic Health Plan (subsidized) ~ 45,200• Washington Health Plan (BHP non-subsidized)

starting 7/1/2010 ~ <500• Medicare Advantage ~ 5,000

o Special Needs Population (SNP)o Urban and Rural planso With Pharmacy coverage

Program Description

GA-U General Assistance-Unemployable

State-funded medical benefits for persons who are physically and/or mentally

incapacitated and unemployable for more than 90 days and who do not have dependent

children

GA-U Managed Medical Care Pilot

Started Dec. 1, 2003 in King and Pierce countiesGoals:• Increase number of clients exiting public assistance• Increase number of clients transitioning to SSI• Decrease unnecessary ER visits• Decrease unnecessary hospital admissions and

readmissions• Improve pharmacy management• Cost neutral

Managed Medical Care SavingsHRSA-Medical Assistance Expenditures

GA-U Clients per member per month Time Period King/Pierce Comparison Counties Other Counties Baseline 12/03 – 11/04 $456 $471 $542

CY 2005 $419 $464 $551

Outpatient ER Costs GA-U Clients per member per month

Time Period King/Pierce Comparison Counties Other Counties Baseline 12/03 – 11/04 $40 $38 $38

CY 2005 $39 $39 $45

Inpatient Medical Costs GA-U Clients per member per month

Time Period King/Pierce Comparison Counties Other Counties Baseline 12/03 – 11/04 $86 $76 $90

CY 2005 $79 $83 $116

Member months: 2550 monthly enrollment 30600 30600 30600

Annual savings $1,377,000 $1,499,400 $5,355,000

Complexity of GA-U PopulationDSHS | GA-U Clients: Challenges and Opportunities August 2006

Most common Dx and Rx

Utilization Trends• Medical costs account for half of

DSHS spending on GA-U clients.

• Mental illness and substance abuse increase frequency of ER visits.

• 50% of all clients qualifyfor long term disability (SSI)

• GA-U clients haven’t historically had a Health Care Home Per enrollee

Integrated Mental Health ProgramBackground: 2007 • Integrated mental health benefit added to medical pilot

2009 • Expanded to GA-U statewide in November• Expanded integrated model to additional populations in King County (HO

mothers, uninsured veterans, older adults)• State reduced biennial funding 20% ($40 million)• State signed exclusive contract with CHP

Integrated Mental Health Program

Program Benefits:• Provide integrated Health Care Home for complex

populations.• Provide significant relief for primary care providers

by providing care coordinator, consulting psychiatrist (MHIP), and funded mental health referrals

• Track (real-time) for active case management and care coordination through the use of a client registry across silos (Mental Health Integrated Tracking System: MHITS)

Integrated Mental Health Program

Program Goals: • To achieve better health outcomes and contain costs

by maximizing care coordination, high-risk case management and chronic care management.

• To more quickly transition GA-U clients back to employment services, gainful employment or more stable, federally funded programs (e.g. GA-X/SSI).

Breaking Down the Silos

Other Other CommunityCommunity

based based

Social Social ServicesServices

SocialSocialServicesServices

Vocational Vocational RehabRehab

Alcohol & Alcohol & Substance Substance

Abuse Abuse TreatmentTreatment

Community Community

Mental HealthMental Health

CentersCenters

PrimaryPrimaryCareCare

• Client centered care (vs.) agency centered care

GA-U Integrated Mental Health Program

GA-UClient

Specialty Mental Health-CMHC

Care Coordinator

Consulting Psychiatrists

Refer to Community Service

Office

Refer to Chem Dep

Treatment

Level I Care (Primary Care)

PCP

Refer to Voc

RehabOther clinic-based mental

health providers*

* Available in some clinics

http://integratedcare-nw.org

Progress to Date• Increase Access:

• Over 17, 000 clients seen statewide as of June 2010• 20% of clients in primary care mental health coordination

• Increase assessment and treatment:• 80% of clients screened for depression• 46% screened for anxiety• 45% screened for substance abuse

• Increase Outcomes:• 38% of clients with at least two depression scores showed significant

improvement in depression symptoms. • 49% percent of clients with severe depression and at least two scores show

significant improvement • 85% of clients transitioned to GA-X successfully

Next Steps for GA-U Program• Protect program from elimination (State budget deficit)

• Opportunities for federal funding through waiver• Pilot integrating housing vouchers in 3 counties

• 2010 legislative changes to GA-U program:• Name changed to Disability Lifeline• Limits of 24 months eligibility within the last 60 months• CHP will more quickly identify members for federal Medicaid

programs by:• Screening clients within 30 days of eligibility• Improving access to incapacity exams • Improving provider satisfaction through the redesign of the

incapacity evaluation process• Improving process for effective transition from GAX and SSI

Criteria for Success with Expansion Populations

1. Incorporate model into Medicaid for at risk populations

2. Payments based on severity3. Integrate silos with payment methodology. Focus

resources to one accountable agency/person4. Expand state capacity to transition client to highest

level of functioning (employment, employ. services, SSI)

5. Bend the cost curve; track, measure and report