Washington receives $17.9 million in shared savings for sixth year of Health Home demonstration

Washington recently received $17.9 million from the federal Centers for Medicare & Medicaid Services (CMS) as part of our portion of the preliminary savings achieved for the Medicare program during year six of our Health Home demonstration program.

The savings are based on meeting cost and quality benchmarks and can be used to reinvest in the program.

Medicaid eligible clients enrolled in both Apple Health and Medicare are known as “dual eligible clients,” and individuals who meet program criteria are eligible to participate in Washington’s Health Home demonstration project.

Dual eligible clients receive Health Home services through managed fee-for-services (MFFS) agencies since they are not enrolled with an Apple Health managed care plan. (HCA also offers the Health Home program for Medicaid-only clients through managed care plans). Currently, 38% of the enrolled dual eligible clients are engaged and actively participating. The achieved savings are directly related to dual eligible clients.

Health Home services, administered by Health Care Authority (HCA) in partnership with the Department of Social and Health Services (DSHS), support clients with chronic illness by increasing engagement and enhancing their care coordination between medical and social service providers. Other program services include:

· Transitional care following hospitalizations.

· Building individual and family supports to maintain and promote quality of life.

· Referrals to other services intended to improve clients overall health.

The result is improved patient care while cutting costs, as seen with “Mr. L,” a Health Home program participant in Pierce County.

This 71-year-old client has heart disease, hypertension and hyperthyroidism, and experienced homelessness for many years. He had just been relocated to Pierce County after living under Seattle’s bridges and hopping from shelter to shelter.

Thanks to Seattle’s housing services, Mr. L was able to get his own apartment. He had no clean clothes and had no furniture or food in his home, basically coming to Pierce County with the clothes on his back. His Health Home coordinator dropped off many care packages and home necessities such as warm blankets, detergent, cleaning supplies, and food from the food bank.

Through the Health Home program, he was able to develop an action plan. His long-term goal was to live a long healthy life, and he had several short-term goals, including finding a primary care provider in the area close to his new home. He had loved his old doctor in Seattle and wanted to find one who genuinely cared about his health.

Mr. L was not familiar with health care resources in Pierce County and did not know where to start. His coordinator helped him research doctors in his area that accepted his insurance. After arranging an initial appointment, Mr. L was extremely happy and grateful for the assistance because his new doctor had been very “thorough.”

Another of his short-term goals was to lower his blood sugar and blood pressure. His coordinator helped him obtain a glucose meter and blood pressure monitor. He stopped eating sweets and so far his blood sugar and blood pressure levels have been stable. He recently shared that he was very happy and felt like he was 20 years younger after learning to remove the foods from his diet that were not healthy for him.

For more information

Centers for Medicare & Medicaid Services: Washington State Health Home demonstration

HCA’s Health Home program