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  • Governor's Communications Office, 360-902-4136

Washington receives $1 million grant to integrate Medicare-Medicaid patient care

For Immediate Release: April 15, 2011

With funding made available through the federal health care reform law, the Centers for Medicare & Medicaid Services awarded Washington a $1 million grant to improve care for the state’s 137,000 elderly and disabled patients covered by both Medicare and Medicaid. The Washington State Department of Social and Health Services will use the grant to integrate delivery of services to these patients, including medical care, behavioral health and long-term care.

“Washington is one of only fifteen states to receive this funding, which recognizes and builds on our tradition of health care innovation,” Gov. Chris Gregoire said. “With this money, we can continue to cut health care costs and improve care for our Medicare-Medicaid patients.”

The grant will fund a multi-phase effort to boost care for these patients, known as dual eligibles, and reduce health care costs for both the Medicare and Medicaid programs:

• Phase one will incorporate high-cost, dual eligibles into chronic care management initiatives that now serve other Medicaid clients.
• Phase two will explore how Medicaid managed care can better serve dual eligibles.
• Phase three will finalize models and set up integrated, managed care systems for dual eligibles, and analyze shared-saving opportunities.

“This is a major step forward for Washington state and health care in general,” said DSHS Secretary Susan Dreyfus. “Currently, our systems are fragmented, sometimes limit available services and payment options, and are often confusing to the clients themselves. This planning grant offers the opportunity for real improvements in care as well as a support system that puts patients and their needs at the center of care.”

Washington has pioneered integration of care systems since 2005, when it launched in Snohomish County the Washington Medicaid Integration Partnership, which brings together multiple forms of care — from medical and long-term care to substance abuse treatment and mental health services — for a population of disabled residents.

Washington’s Medicaid program was also an early adopter of technology to improve disease and chronic care management for patients who require intensive care because of serious, long-term illnesses, such as congestive heart failure or diabetes.

DSHS developed the computer system PRISM (“Predictive Risk Intelligence SysteM”) to analyze claims data and identify high-risk Medicaid clients who would likely benefit from chronic care management.