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The right model to improve health outcomes for Washington

Medicaid in Washington

Washington’s Medicaid program, Apple Health, provides healthcare to many individuals facing economic and social barriers, as well as expanded benefits and services to improve their health and wellbeing.

Apple Health currently serves 2 million Washingtonians. This number has grown by over 100,000 people since February 2020.1 In Washington, Medicaid covers 1 in 6 adults, 3 in 8 children, 3 in 5 nursing home residents, and 1 in 3 individuals with disabilities.2 88% of Washingtonians on Apple Health are managed by MCOs.3

2M

Washingtonians are served by Apple Health1

Program history

Serving Washington since 1987

Washington has long been a leader in using MCOs to deliver healthcare to its citizens. The Health Care Authority (HCA) first implemented a Medicaid managed care program for physical health in 1987.4 Between 2016 and 2020, HCA worked to integrate physical health, mental health, and substance use disorder treatment services into one system for the millions who receive care through Apple Health.5

2014

Apple Health launches in Washington.

2020

Five MCOs serve the Medicaid population of Washington.6

Managing costs and risks

Delivering predictability and lower financial risk

Washington needs a way to plan and manage its budget, while ensuring that a growing number of Medicaid enrollees obtain the quality healthcare they deserve.

Washington’s Medicaid per capita costs increased 12.3% from 2015 to 2018, a lower rate compared to the national increase of 16%, suggesting the State’s managed care program has helped to curb costs.

With managed care, states pay a fixed, per-member, per-month rate, which allows them to budget with transparency and predictability. The estimated 2017 Medicaid savings for Washington was $183 million.8

The managed care model also allows for less financial risk to Washington. If a member needs more services than the fixed rate provides for, MCOs take on that additional cost. This allows managed care to pay for more expensive preventive care up front that helps members stay healthier.

With states facing unprecedented care and economic pressures in the midst of a pandemic, the managed care model delivers critically needed stability to millions and strengthens our country’s Medicaid health safety net.

$183 million

estimated 2017 Medicaid savings for Washington8

Higher quality care

Improving population health

The managed care model is structured to hold MCOs to high standards set by federal and state governments. Washington requires all Apple Health plans to be accredited by the National Committee on Quality Assurance (NCQA). On NCQA’s overall rating scale of 0 to 5, the Apple Health MCOs have averaged between a 3.4 and 3.5 rating over the past three years, which is slightly above the national median in recent years.9

87% of the parents and caretakers of children under the age of 18 enrolled in Washington Apple Health rated their Medicaid plan 8 out of 10 or higher in a customer experience survey done in August 2019.10

Washington releases an annual Apple Health Plan quality report card which documents MCO performance and helps Medicaid-eligible enrollees choose a high-quality plan that is right for them. This report card is developed in collaboration with the state’s Health Care Authority and Washington Healthplanfinder.

Patient experience

Driving innovation for patients

The competitiveness of the Medicaid procurement process in Washington strongly incentivizes MCOs to innovate and enhance services in order to serve any given region.

The Apple Health MCOs are committed to implementing innovation by:

  • Providing telepsychiatry and telehealth services for members in rural areas or with access barriers.
  • Offering free virtual urgent care to reduce unnecessary emergency department visits.
  • Supporting community grants.
  • Partnering with re-entry organizations to provide supports for care coordination, medication adherence, and community resource referrals.11
  • Collaborating with community organizations to address food insecurity, housing, and non-emergency medical transportation.12

Provider experience

Helping states help providers

Through Medicaid managed care, providers benefit as well. MCOs use value-based payment models that incentivize, empower, and reward providers for the quality of care they provide. This approach helps to align all involved parties – the providers, the MCOs, and Health Care Authority – to achieve quality health outcomes for Apple Health’s enrollees.13

MCOs align resources across the continuum of care to form strong and mutually beneficial partnerships with providers. MCOs help to:

  • Equip providers with enhanced clinical data to support their practices.
  • Ensure providers have an informed view of their patients’ complete clinical picture.
  • Support community-based care coordination directly with employed staff who work and live in the region as well as sub-contract relationships with local community-based partners.

MCOs in Washington are committed to ensuring that providers have access to the right tools to deliver integrated care to Medicaid members across the state. These resources include:

  • Trainings on care coordination, integrating behavioral health in primary care, the use of telehealth, and other key topics.
  • Access to partnerships with mental health, addiction, and recovery organizations.
  • Research on improving and standardizing care delivery and industry best practices.14

Learn more about how MCOs are supporting providers in Washington.

Due to the flexibility of the managed care approach, MCOs can provide relief payments to support providers in times of crisis. During COVID-19, MCOs are providing advanced payments, directed payments, and temporary or permanent rate increases to providers (separate from the CMS payment program) and advocating for additional federal action that can ensure critical support to providers during this pandemic.15

Preventive care

Preventing long-term health issues

The managed care model is based on the delivery of quality care that provides services for people when they need them and in the appropriate setting.

From 2018 to 2019 Washington’s performance on many preventive care measures, including immunizations, improved or remained steady.16

In 2019, both well-child visits for children 0-15 months as well as primary care access for children 12-24 months were above the 50th percentile nationally.16

Downloads

A Look at the Numbers in Washington

pdf 143.90kB

Sources

  1. “Apple Health client eligibility dashboard,” Washington State Health Care Authority, 2022.
  2. “Fact Sheet: Medicaid in Washington,” Kaiser Family Foundation, 2019.
  3. “Total Medicaid MCO Enrollment,” Kaiser Family Foundation, 2020.
  4. “Managed Care in Washington,” Medicaid.gov, 2011.
  5. “Washington State Managed Care Quality Strategy,” hca.wa.gov, 2020.
  6. “Apple Health Managed Care,” Washington State Health Care Authority, 2022.
  7. “Medicaid MCO Financial Performance,” The Menges Group, 2020.
  8. “Potential Savings of Medicaid Capitated Care: National and State-by-State Estimates,” The Menges Group, 2017.
  9. “Medicaid Quality Improvement and Performance,” The Menges Group, 2020.
  10. “Apple Health Child Medicaid with Chronic Conditions,” hca.wa.gov, 2021.
  11. “Evolution and Summary of Managed Care in Washington,” The Menges Group, 2020.
  12. “Medicaid Access & Coverage in 2019: Results from the Institute for Medicaid Innovation’s 2020 Annual Medicaid Managed Care Survey,” Jennifer E. Moore, PhD, RN, FAAN Caroline Adams Chloe Bakst Kelli DePriest, PhD, RN Giselle E. Kolenic, MA, 2020.
  13. “Medicaid Quality Improvement and Performance,” The Menges Group, 2020.
  14. “WA State Managed Care Organizations Provider Resources,” Association of Washington Healthcare Plans, 2022.
  15. “WA State Managed Care Organizations Provider Resources,” Association of Washington Healthcare Plans, 2022.
  16. “Annual Technical Report Washington Apple Health Washington Health Care Authority,” Comagine Health, 2020.