Washington gets funding boost to integrate Medicare and Medicaid

The Centers for Medicare & Medicaid Services has awarded Washington a $1 million grant to integrate the state’s Medicare and Medicaid delivery services. The Washington State Department of Social and Health Services will use the grant to focus on improving service delivery of medical care, behavioral health and long-term care.

Washington is one of just fifteen states awarded this grant and is the result of the state’s existing patient focused health care system. The grant will fund a multi-phase effort to boost care for patients known as dual eligibles that qualify for both programs. The state will divide the funding into three phases. The first phase will integrate dual eligibles into existing chronic care management programs. Phase two will streamline managed care offered through Medicaid and phase three will finalize the integration and look for more opportunities to share services.

Washington has been working on integrating Medicare and Medicaid for dual eligibles for the last six years. The state’s Medicaid program has been able to accelerate integration by adopting new technology for disease and chronic care management for patients. 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.

“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.”