State eyes system to streamline health care

FRIDAY, OCT. 26, 2012

OLYMPIA – State officials think they can save $14 million over the next five years and provide better health care to a group of patients who are among the most expensive to treat.

Washington received a waiver Thursday from the federal government to start a new program for people who qualify for both Medicare and Medicaid. The state hopes to put about 30,000 so-called dual-eligibles into a single program that provides someone to coordinate their care, reducing costs that arise from conflict between the programs.

Washington has about 115,000 dual-eligibles, Gov. Chris Gregoire said Thursday. They represent about 13 percent of the state’s Medicaid rolls but account for about 30 percent of its overall costs. That’s because they are predominantly elderly, disabled and chronically ill. Medicare is covered by the federal government, but the state pays for part of the costs of Medicaid.

Those patients may go to their Medicare doctor for some health problems but use a Medicaid program for other problems. The records might not reflect the different treatments, and one doctor might not know what another prescribes. Gregoire said her late aunt was once hospitalized when two different sets of prescriptions created a dangerous reaction.

On Thursday, the U.S. Department of Health and Human Services gave the state permission to implement a program called Health Path Washington, which will allow dual-eligibles to volunteer for a “care coordinator” that will develop plans to integrate all their medical treatment and monitor their progress. The coordinator will be available to go to doctor’s appointments and be available to answer questions when a doctor is not.

The waiver from the federal government is available under changes approved in the Affordable Care Act. Gregoire said Washington is the second state in the nation to receive a waiver.

The program has been tested through pilot projects around the state and will start enrolling volunteers next April. State officials estimate they could have 30,000 enrolled by the end of 2013. While that’s only about one-fourth of the state’s dual-eligibles, Gregoire called it a “walk before we run” approach.

“We’re getting ready for 115,000, but we want to get it right,” she said.

Click here to comment on this story »