Coordinating medical and mental health care to improve outcomes

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In a perfect world, a patient’s physical and mental health care would be coordinated among his or her various doctors, providing whole-person care that not only treats ongoing health issues but addresses prevention to avoid painful and expensive crisis interventions. Instead, Medicaid patients must navigate a fragmented, frustratingly-complicated system to receive medical, mental health and drug and alcohol treatment. Because providers work in silos, they are often unaware of what other services and treatments their patients are receiving.

On Jan. 1, 2019, Pierce County will take a huge step towards providing coordinated care by fully integrating medical and mental health and behavioral health services for patients covered by Medicaid through a state-mandated initiative called Integration 2020. The model combines physical health, mental health and substance use disorder services under one managed care plan.

During the 2014 legislative session, the Legislature passed two bills to create regional service areas throughout the state and require full integration of payment and delivery of Medicaid services by January 2020. Pierce County has chosen to adopt the plan early, implementing it this January.

To assist and monitor the progress of the plan, the state has established an Integrated Oversight Board to provide work closely with the medical community. Chaired by Steve O’Ban, Senior Counsel for Behavioral Health with the County, and who happens to be a Washington State Senator for the 28th Legislative District, other members include Connie Ladenburg, Pierce County councilmember; Peter Ansara, director of Pierce County Human Services; Carol Mitchell, director of Justice Services; Kim Zacher, chief executive officer of Comprehensive Life Resources; Tim Holmes, president of MultiCare Behavioral Health; and Alisha Fehrenbacher, chief executive officer of Pierce County Accountable Community of Health.

“The Board, taken from a cross section of our health care community, will provide leadership in identifying gaps in service and strategies for improving health care for the poor and most vulnerable in our community,” says O’Ban.

O’Ban says that integration is no small task. There is a mountain of work that must be completed to prepare providers for the change before the January implementation date. Since March 2017, Pierce County Accountable Community of Health (Pierce County ACH) has been leading that charge, bringing together providers to meet and discuss strategies, training opportunities and resources.

Operating under Washington’s Section 1115 Waiver, Medicaid Transformation Project (MTP), Pierce County ACH is the essential backbone of driving regional health system transformation. “We are a neutral party that can add value in ways specific partners within sectors cannot,” Fehrenbacher says. “Our work is organized around the core principle that healthy, vibrant people and communities are better able to achieve their full potential, and that better health for all is the cornerstone of community vitality.”

When the work is completed, integrated managed care will become reality for the county’s 203,000 Medicaid enrollees, representing 12 percent of Washington’s Medicaid population and 27 percent of the total Pierce County population.

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