IMC Workgroups

Three workgroups have been established to help move the work forward.

1. Early Warning System: Develop recommendations for an Early Warning System that allows a feedback loop and triage process to identify and resolve system issues as they arise.

2. IT/EHR: Identify and resolve IT/EHR issues including but not limited to MCO/ASO billing capacity, EHR compatibility, provider data reporting requirements, technical assistance needed by providers.

3. Communications: Provide recommendations and work to engage the consumer sector in system change efforts related in integrated managed care. Ensure that consumers maintain confidence and continuity in the care they are receiving. Ensure smooth transition to IMC through the development of clear communication materials, client notifications, and transparent transition processes.

Composition: Open to any Spokane, Pend Oreille, Stevens, Ferry, Lincoln, and Adams stakeholders who are interested in participating.  Representation from the following organizations will be strongly encouraged.

Authority: These are not a decision-making bodies, but will provide recommendations that will ensure concerns surrounding IMC are addressed and resolved in the Spokane region.

Meetings: Held no less than monthly through January 2019. All meetings will have an option to participate via teleconference for those unable to attend in person. BHT staff, in collaboration with workgroup members, HCA and the SCRBHO, shall be responsible for establishing the agenda. Notes for all meetings will be provided by BHT staff within two weeks of each meeting.

Standard Indicators for Early Warning System

This list is provided by the Health Care Authority (HCA). You can view the entire presentation here.

Provider Payments (Provided by MCO’s)

• BH claims received by MCO’s
• BH claims rejected by MCO’s
• Reasons for rejections

EDIE Data (Provided by HCA/AIM team)

• ED Utilization
• ED Utilization for client with past BH diagnosis
• Portion of ED visits with BH diagnosis

State Hospitals- WSH and ESH (Provided by HCA)  

• Average Daily census
• Discharges
• Forensic flips  

Crisis System (Provided by BH-ASO )

• Crisis Hotline Calls
  • # of incoming calls
  • # calls answered
  • # call answer timeliness (within 30 seconds)
  • Average speed of answer
  • Abandonment rate
• DHMP response time
• # ITA investigations and outcome
  • Detention
  • Discharge with referral
  • Voluntary admit
• # of no bed reports
• # of single bed certifications

BHT's Navigator, Israel Vidales, Goes to D.C. for 2018 Families USA Conference

The Navigator Network team gave their newest team member, Israel Vidales, the opportunity to attend the 2018 Families USA conference in Washington D.C. last month. Israel learned about the various ideas that states are planning with their Medicaid waivers. These ideas included Medicaid buy-in options and payment reform. He also attended a panel discussion on lowering prescription costs and how states were strategizing to implement bills pertaining to price gouging and drug pricing transparency. Israel had the pleasure of hearing inspiring speeches from Senators Cory Brooker, which can be found here, and Elizabeth Warren, which can be found here. Besides the exciting topics and speakers from the conference, Israel managed to visit all the national monuments around the D.C area. Out of all the monuments, he enjoyed the Lincoln and Jefferson Memorials. Our Navigator team are making east coast connections and enjoying the sites in their spare time.

Managed Care Contracting Training with Adam Falcone

As part of our FIMC investment in Behavioral Health providers in the region, BHT hosted a presentation and training session on Managed Care Contracting, presented by Adam Falcone. With a turnout with 23 agencies and 60 individuals participating, it was clear this was a topic of importance for our region! His presentation included preparing for Managed Care contracting, evaluating contracts, negotiation, and key terms and legal protections. Check out the agenda of the presentation here to take a look at the full span of everything that was covered. 

ACH Communications Council Recap

Last Wednesday, BHT sat in on a call with the eight other ACHs and the HCA for our monthly Communications Council call, an opportunity for all parties to align on communication projects and language for Healthier Washington.

One discussion point during the call was around the use of the word “Demonstration” in our project work. This word was determined to be insensitive because of its association with experimental medical and surgical practices in the antebellum South. Going forward, it has been decided that ACH work will be referred to as the Medicaid Transformation. For more information, see the full guidance here.

A second point of discussion was the HCA’s VBP webinar series, which launched in January and will continue through March. This series is a great opportunity to get familiar with all things VBP, so we encourage everyone to participate if they are able to or listen to the recordings of the webinars when they find time. Find out more about the series here. 

Community Voices Council Meets for the First Time

The Community Voices Council met officially for the first time this week in its very early stages. Co-chairs Phil Tyler and Marion Lee led a lively discussion on factors to consider as we work together building the rest of the council in a way that best represents the diverse needs and interests of the Medicaid community in the BHT region.

The nomination survey is still open—we would love to hear who you consider to be a strong community advocate with either lived experience as a Medicaid beneficiary or experience navigating the Medicaid system on behalf of others and who is willing to make their voice heard.