IntegratingHepatitisCCoverageintoMedicaid
NicoleDronenBusinessDevelopmentSpecialist
PROJECTGOALSStrategiesthatWAstateareimplementingtoimprovecollaborationandalignmentbetweenMedicaidandpublichealth– IncreaseourcollectiveHCVpreventioneffort– Improvequalityofcare– Gainaccesstotreatment– Ensurethatpublichealthinvestmentswerebeingintegrated,maximizedandleveraged
WAMEDICAIDLANDSCAPEPaymentReform
Pre-ACAFeeforService
Post-ACAManagedCare
Medicaid
Providers/Practices
Medicaid
ManagedCareOrganizations
Providers
Contracts
ProviderGuides
CURRENTSTATE• PublicHealth(PH)isinvisibleandMedicaiddoesnotunderstandPHvalue
• ProvidersgetconflictinginformationfromMedicaid/PH
• Confusionaroundinterpretingservices• Paymentpoliciesdon’tlineupwiththeprovisionofcareresponsibilities
• ThereisnationalguidancefromUSPSTFandCDCandthereisstillconfusion
FUTURESTATE• ClearcollaborativeplanningprocessbetweenPHandMedicaidduringthedevelopmentofthecontract– EnsureinformationisbeingsharedbetweenMCOsandprovidersthataccuratelyalignwithclinicalguidanceandbestpracticeforhepatitisC
– DeduplicationofPHinvestments– Clearguidanceonpaymentprotocols– Timelyimplementationofbestpractices
6
Providers
Providersystems
Healthplans
Healthplanregulators
GreaterSystems-LevelChange
GreaterInd
ividua
l-LevelCha
nge
LowerIntensity/Success(Microscope)
HigherIntensity/Success(Telescope)
PS17-1702ImprovingHepatitisCCareCascade;FocusonIncreasedTesting
andDiagnosis
CHCTargetedScreening
MedicaidPolicyWork
MASTERCONTRACTRATIONALE• ComprehensiveapproachtoHCVpreventionandtreatment
– Accesstolargernumberofprovidersandpatients– System-wideapproachtoimproveaccesstoandensurehighqualitycare– WantedtoembedPHclinicalexpectationswithinthecontractualrelationship
• Researchedhowtoinfluenceproviderpractice– MedicaidMasterContractwithMCO– contractualrelationshipbetween
MedicaidandtheManagedCareOrganizationsthatdefineshowallclinicalservicesareprovided
– MedicaidProviderGuides– Actualcoveredservicestomeetcontractualrequirements• ServicesCodes• ICD-10• GuidelinesandlinkstoCDC.USPSTF• Thisisthefloor.Candomorebutcannotdoless
• BuildrelationshipwithMedicaidpointofcontactforaccesstoMasterContractProcess
MasterContract ProviderBillingGuide
WHEREDOYOUSTART?WHATDOYOUNEEDTOKNOW?
MASTERCONTRACTPROCESS1. Locaterelevantmaterialsforyourstate
– AskyourMedicaidpartnersforacopyorlink– OrgoogletofindthemastercontractwithMedicaid– OrnavigateyourwaythroughyourlocalMedicaid’swebsite
2. Reviewmaterialsforinfectiousdiseaselanguageandactivities– ReadandusedcontrolFtofindcriticalkeywords– Lookatthetableofcontentsforinformationthatwouldindirectlyaffect
hepatitisCactivities– UsethesearchfunctiontofindanyinformationonhepatitisC.IfIfoundhep C
(onesection)lookedaboveandbelowthatsectiontoseewhatelseyoumayfind
– LookforotherIDprofiles.HIV,STD’setc.wasthereanyoutdatedormisrepresentedinformation?
3. Documentprocess– Documentwhatyoufind(ordidn’tfind)andthechangesthatshouldbe
made.– Documentthegaps,outdatedinformationandmisinformation– OffertodraftthelanguagethatyouwillaskMedicaidtoincludeorrevise
movingforward4. Reviewrelatedmastercontractmaterials
– providerguidesforhepatitisC
HIV
WHATDIDWEFINDFORHEPATITISC??MasterContract
ProviderBillingGuides
EXAMPLESOFWHATWEWANTINTHECONTRACT/GUIDES
• MirrorthedetaillevelwithinHIV– Timelyaccesstocare– CareCoordination
• Providerguides– Indepthguidesandpracticesforactivitiessuchas:• AddsectioninforUSPSTFrecommendations• Casemanagement• Recommendeddiagnostics• Telemedicine
SUCCESSES•ContractworkhasgarneredtheattentionofCDC/HMA– interestinprovidingTechnicalAssistancetohelpreplicateinotherjurisdictions.•Medicaidhasagreedtothefollowingbasedonourcollaborationwork–•HepatitisCAffinityGroup- pending
• 3areas• Testing/linkagetocare• Contractchanges• Datasharing
• LeadershipsupportfrombothDOHandMedicaid
• Competingprioritiesinhealthcare• IdentifyingtherightpeopleatMedicaid– decision
makers• Decisionpriorities:populationhealthoutcomesvs.
budgetoutcomes• Data:Lackofresources/bandwidth/uncertaintyaround
dataavailability• Stigmaassociatedw/hepatitisCtreatmentespeciallywithPWIDandreinfection/adherence
]rates
CHALLENGES
WHEREWEARENOW!• MedicaidwillrequireMCO’stosharecopiesoftheproviderguides
• DOHwillworkwithMedicaidtoupdatehepatitisCguidanceinformation
• CDCisworkingwithDOHtoprovideTAandresources
• DOHandMedicaidareinprocesstoidentifypeopletoserveon:– Specialemphasisworkgroups– HepatitisCAffinitygroup
QUESTIONS?
NicoleDronenBusinessDevelopmentSpecialistNicole.dronen@doh.wa.gov
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