Innovative Funding Streams Driving Health
Laurel Lee - Vice President, Member & Community Engagement
State of Reform January 8, 2015
Agenda
• Who is Molina – a brief overview
• How Molina is Partnering to improve Health and
further the Triple Aim
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Patient Engagement
Aligned incentives (Risk Sharing not Risk Shedding)
Delivering Community Based Care Coordination
Transparent Data Sharing
Innovation in Service delivery
Behavioral Health Integration - “Whole Person” care
Who is Molina Healthcare?
From a single clinic in Long Beach, CA…
“I hope that no one ever forgets
that it all began with a single
clinic.”
C. David Molina, MD, MPH, Founder
Confidential & Proprietary
Who is Molina Healthcare?
4
…To a multi-state Health Company
State Health Plans
• California
• Florida
• Illinois
• Michigan
• New Mexico
• Ohio
• South Carolina
• Texas
• Utah
• Washington
• Wisconsin
Clinics - Care Delivery
MMIS – Molina Medicaid Solutions –
Managed Medicaid Information System
Our Markets (3Q 2014)
Who is Molina Healthcare?
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…The largest Medicaid Health Plan in Washington
2015 Medicaid Service Area - Washington
473,000 Members*
*(3Q 2014)
Partnering to Improve Health - Patient Engagement
• Member Rewards/Incentives for Healthy behaviors
• Case Management & Disease Management
• Community Outreach
During the first three quarters of 2014 Molina
created or participated in
more than 750 member facing
events.
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Partnering to Improve Health – Aligned Incentives
Accountable Care Continuum
Programs that meet providers where they are…
• Providers as Partners
• Risk Sharing; Not Risk Shedding
• Focused Outcomes: Triple Aim
Pay-forPerformance
Bonus
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Primary Care
Capitation
“ACE” Accountable
Care Entity
Cost &
Quality
Program
Total Cost of
Care
Capitation
Partnering to Improve Health – Care Coordination
Molina’s Community Connector Program
• Community Health Worker model launched in 2012
• Face to Face, community based care coordination and
connections to community resources, health providers, and
clinical teams.
• Molina Staff or Strategic partnerships with Community
Based Care Coordination
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Partnering to Improve Health – Data Transparency
Care Management –
 Near “real time” Emergency and Hospital Admission data
sharing with Providers & Community Based Care
Coordinators
Cost & Utilization Management –
 Data and analytics to help drive Right Care, In The Right
Place, At The Right Time, In The Right Way
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Partnering to Improve Health –
Innovation in Service Delivery
Telemedicine
– Partnering with an Integrated Delivery System to offer Virtual
urgent care telemedicine visits with an MD – Go live, Q1 2015
– Exploring Telepsychiatry – increasing access to appropriate
high quality mental health care through direct delivery of care
(Telepsych) and through consultation with PCPs to enhance
community based management of psychotropic medications.
Expanding Access; Changing the Models of Care
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Partnering to Improve Health – Whole Person Care
Behavioral Health Integration Partnerships:
• RSN Data Sharing
– 2-way Data Share with King County RSN Go Live Jan 2015
• Care Coordination Collaboration Pilots
– Partnering with IDS and another MCO to jointly fund a
licensed clinical social worker at a high volume Primary
Care Clinic
– Co-locating Molina Community Connector and case
management staff at high volume Primary Care Clinics
Better understanding
the Social Determinants of Health
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Molina Healthcare
Service
Delivery
Innovation
Delivering
Community
Based Care
Coordination
Transparent
Data Sharing
Aligned
incentives
Patient
Engagement
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Behavioral
Health
Integration