PLAN TO TRANSFORM THE REGIONAL SYSTEM OF CARE Transforming the regional system of care in our region must begin with restructuring the Medicaid program and financing. Roughly one-fourth of Pierce County residents are insured through Medicaid. As the primary source of insurance coverage for low-income people, Medicaid plays a key role in covering and financing behavioral health care as well as physical health care. Meeting the needs of people with behavioral health conditions is critical for the success and financial sustainability for the Medicaid program. Compared to Medicare or commercial insurance, Medicaid covers a significantly higher proportion of adults with behavioral health conditions, including serious mental illness (SMI) and substance use disorder (SUD). 2 For this reason, we propose a three-pronged strategy to transform the regional system of care in Pierce County:
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Implement a provider and community-led Medicaid ACO model in the region.
2
Implement the Data Strategy Collective.
3
Any new County revenue should be allocated to complement the Pierce ACO Model and Data Strategy Collective Model, including to expand critical services to vulnerable populations outside Medicaid.
https://www.medicaidinnovation.org/_images/content/2019-IMI-Behavioral_Health_in_Medicaid-Report.pdf
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STRATEGY 1
The Pierce County ACO Model MultiCare, Sea Mar, CHI Franciscan, Community Health Care, independent behavioral health providers and Elevate Health have developed a potential pilot project to better serve the Medicaid population in Pierce County, improve health outcomes, lower health care costs for the state and make significant investments to address health inequities and disparities. These partners propose forming a single community-based entity in place of the existing managed care structure in Pierce County. This innovative model places the responsibility and accountability for health care access, quality and cost in the hands of the local community and its health care providers, and it could serve as a model for other public and private health care purchasing.
