Medicaid Transformation

Medicaid Transformation Project

The Medicaid Transformation Project (MTP) aims to improve health and wellness in Washington State. MTP is grounded in a five-year agreement between the State of Washington and the Centers for Medicare & Medicaid Services (CMS). MTP invests up to $1.5 billion in local health systems, with a focus on Apple Health (Medicaid).    

Medicaid Transformation goals include:   

• Building healthier communities through a collaborative regional approach   

• Integrating how we meet physical and behavioral health needs so that healthcare focuses on the whole person  

• Improving how we pay for services by rewarding quality over quantity 

OCH provides funds and support to partners to further collaborative efforts related to the following six MTP areas:

Click the icons for more information about each individual project area.

Contracted partners create individual change plans which are focused approaches to improving regional health. Change plans take into consideration social determinants of health, clinical-community linkages, and whole person care.​

OCH contracts with primary care providers, behavioral health providers, community based organizations, and social service providers to better meet the health needs of Clallam, Jefferson, and Kitsap Counties.

Integration of Physical & Behavioral Health

Partner Spotlight

Olympic Medical Center has expanded workforce to include behavioral health specialists.

 Purpose:

To better address physical and behavioral health needs through an integrated network of providers. This project supports the Washington State Health Care Authority’s initiative to bring together the financing and delivery of physical and behavioral health services for Medicaid beneficiaries.

 Target Population:

This project works to better provide for all Medicaid beneficiaries particularly those with or at-risk for behavioral health conditions, including mental illness and/or substance use disorder (SUD).

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 Approach:

Change plans include components of evidence-based approaches: the Bree Collaborative Behavioral Health Integration Report and Recommendations and the Collaborative Care Model. OCH also supports the region in its transition to Integrated Managed Care to ensure partner success.

 

Emergency & Jail Diversion Intervention

Partner Spotlight

In just six months, the Port Angeles Community Paramedicine program has seen a 50% decrease in EMS calls and transports to the Emergency Room after initial contact with the Community Paramedic.

 Purpose:

To improve access to primary care and social services, especially for medically under-served  populations in order to preserve emergency resources and provide better care.

 Target Population:

This project works to better meet the needs of Medicaid beneficiaries who access the emergency care services for non-emergent situations, and Medicaid beneficiaries with mental health and/or substance use conditions who come into contact with law enforcement.

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 Approach:

In addition to the use of Premanage, a ED notification system, OCH integrated Community Paramedicine and all elements of the Seven Best Practices initiatives from “ER is for Emergencies” into the primary care and behavioral health change plans. The seven elements are electronic health information, patient education, identify frequent users of the ED and EMS, develop care plans for frequent ER users, narcotic guidelines, prescription monitoring, and use of feedback information. 

 

Oral

Health

Regional Success:

Expansion of three new dental clinics across all Natural Communities of Care.

 Purpose:

To facilitate integration of dental health care with primary care, behavioral health care, and substance use disorder treatment by leveraging existing partnerships between providers and forming new connections between providers in the Olympic region.

 Target Population:

Access to oral health care is crucial for general well-being, especially among children. This project seeks to increase access to oral care and move towards upstream solutions/prevention.

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 Approach:

OCH is facilitating alignment with multiple state efforts to improve access to oral health services for the Medicaid population. Change Plans encourage clinical providers to integrate dental screening and basic preventative procedures into practice, incorporating the mouth as a part of the whole person.

 

Reproductive, Maternal/Child Health

Partner Spotlight

Kitsap Children's Clinic Achieved silver status for adolescent immunization rates.

 Purpose:

To ensure that communities within the Olympic region have access to high quality reproductive health care throughout their lives and promote the health safety of Washington’s children.

 Target Population:

The reproductive, maternal, and child health project works to address disparities among Medicaid beneficiaries who are of reproductive age, pregnant women, mothers of children ages 0 – 3, and children ages 0 – 17.

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 Approach:

Providers are encouraged to develop referral processes to community-based programs that address perinatal and early child health disparities by income and race, including Head Start, Nurse Family Partnership and Parents as Teachers.

 

Chronic Disease Prevention & Control

Partner Spotlight

Olympic Area Agency on Aging in partnership with OlyCAP have partnered with primary care providers to offer chronic disease self-management programs on-site at North Olympic Healthcare Network, Olympic Medical Center, and Jamestown Family Health Clinic.

 Purpose:

To improve chronic disease management and control and prevention of chronic disease in the first place.

 Target Population:

This project works to provide better care and resources for Medicaid beneficiaries (adults and children) with, or at risk for, arthritis, cancer, chronic respiratory disease (asthma), diabetes, heart disease, obesity and stroke, with a focus on those populations experiencing the greatest burden of chronic disease(s) in the region.

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 Approach:

OCH aims to guide practice transformation around the management of diabetes, cardiovascular disease, hypertension, and asthma. Primary care and behavioral health change plans are designed to align with existing state efforts which include offerings of Chronic Disease Self-Management (CDSM), including Wisdom Warriors, and Diabetes Prevention Programs (DPP), primarily through community-based organizations and Tribal clinics.

 

Opioid

Response

Partner Spotlight

Jamestown S'Klallam Tribe completed the 6 Building Blocks program, a team-based approach to improving opioid management in primary care .

 Purpose:

To expand access to treatment and prevent overdose deaths by increasing naloxone access, promote awareness about opioid use disorder, and improving prescription practices.

 Target Population:

This project aims to better care for Medicaid beneficiaries, including youth, who use, misuse, or abuse, prescription opioids and/or heroin.

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 Approach:

The OCH Three-County Coordinated Opioid Response Project (3CCORP) is a multi-sector collaborative effort made up of a Steering committee and a treatment workgroup. These groups provide guidance for identifying existing efforts and gaps to reduce opioid-related morbidity and mortality. OCH has also invested in 6 Building Blocks, which is a team-based approach to improving opioid management in primary care.