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