State Integrating Healthcare

Washington State’s Health Care Authority (HCA) on January 1, 2020, has finished a multi-year effort to integrate physical health, mental health, and Substance Use Disorder (SUD) treatment services into one system for nearly 2 million Apple Health (Medicaid) clients. 

Before care was integrated, Apple Health clients with co-occurring disorders had to navigate three separate systems in order to access needed physical and behavioral health services. The physical health, mental health, and SUD treatment services delivery systems often weren’t able to communicate about clients’ care.

This led to duplication of services, poorly coordinated care, worse health outcomes, and a frustrating experience for Washington State’s Apple Health clients and the providers who serve them.

At the request of Governor Jay Inslee, the 2014 legislature passed Senate Bill 6312, which required the change so that the community behavioral health system was fully integrated into a managed care system by January 2020.

Under the transformed system, managed care organizations are now responsible for physical and behavioral health services for the Apple Health clients they serve. In addition, behavioral health administrative services organizations deliver crisis services that are available to all, and manage regional functions and the community behavioral health advisory board.

The Southwest Region in the state has chosen to integrate care ahead of the mandatory deadline. The Department of Social and Health Services Research and Data Analysis Division has been tracking key metrics in the Southwest in comparison to the rest of the state.

It was found that the Southwest region has performed better in several areas, including SUDs and mental health treatment penetration, follow-ups after emergency room visits for mental illness, and employment.

Many states are moving to integrate managed care for Medicaid. Washington State has made integrating managed care part of their value-based purchasing roadmap. HCA as the state’s largest health purchaser has set the goal of shifting 90 percent of the state’s state-financed healthcare to value-based payments by 2021.

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