Health Integrated significantly impacts the cost curve for a health plan in the Northwest. The partnership yields an improved member experience and 8% point reduction in Medical Expense Ratio.
Health Integrated, a recognized innovator in data-enabled care management services, has helped drive an 8% point reduction in Medical Expense Ratio (MER) for Community Health Plan of Washington (CHPW)
while improving member experience through their total care management solution. Health Integrated’s scalable solution, which uniquely leverages psychosocial interventions to impact medical outcomes and which coordinates care at unparalleled levels, was deployed for 20,000 CHPW members within their Medicare Advantage (MA) and Medicare Dual Eligible Special Needs Plans (SNP).
“When I joined CHPW in the Fall of 2012, I realized we were facing some difficult challenges,” said Dr. Victor Collymore, CHPW’s then-new chief medical officer. “They were all surmountable, but we needed the help of a strong partner,” he said. “We turned to Health Integrated to help us and the results have been excellent.”
CHPW’s challenges included: high regulatory hurdles; gaps in risk identification and mitigation; under-performing metrics for HEDIS, HOS, CAHPS and Stars; and a medical expense loss ratio exceeding 103%.
Health Integrated responded to CHPW’s needs with a highly integrated total care management solution that includes medical and behavioral case and utilization management, a fully compliant SNP Model of Care, Transitions of Care, and their flagship Synergy Targeted Population Management.
“As a partner, Health Integrated understood our performance needs and immediately went to work to support them,” said Lance Hunsinger, chief executive officer for CHPW. “They quickly identified opportunities to help us improve our clinical services and satisfaction as well as helped us provide appropriate utilization. In less than a year, by leveraging Health Integrated’s solutions, along with our own improvements in network design and within our quality department, we’ve realized more than $13 million in savings and an 8% point drop in our medical expense ratio. That’s significant.”
“Health Integrated has been a true partner, driving our overall performance and clinical improvements with an integrated care model that is in lockstep with CHPW’s philosophy to put members first,” Hunsinger said. “Based on the success of our initial partnership with Health Integrated with our MA and SNP populations, we recently expanded access to their solutions to our 285,000 Medicaid members.”
Specifically, Health Integrated impacted key clinical utilization measures as follows:
- 15% increase in office/home visits
- 54% increase in physical exams
- 7% reduction in overall inpatient utilization with a decline of 19% in surgical utilization
- 9% reduction in outpatient utilization
- 14% reduction in radiology in all settings
Additionally, Health Integrated helped CHPW decrease overall member and provider complaints.
“These results are the kind that CMS likes to see as they hit the goals of the Triple Aim: better care for individuals, better health for populations and reductions in costs,” said Charlene Frizzera, president, CF Health Advisors and a Leavitt Partners senior advisor. Frizzera was the acting administrator for the Centers for Medicare and Medicaid Services (CMS) for 16 months beginning in January 2009.
“The relationship between Health Integrated and Community Health Plan of Washington has yielded benefits for everyone — members, providers and the plan — that are readily apparent,” said Margaret Murray, chief executive officer, Association for Community Affiliated Plans (ACAP).“We’re proud to count CHPW among our safety net health plan members. These outcomes quantify the benefits of ACAP’s strategic alliance with Health Integrated for plans that participate, and validate the alliance itself.”
“We are honored that CHPW chose us to support them with their strategic objectives around costs, quality and member satisfaction,” said Shan Padda, chairman and chief executive officer of Health Integrated. “We firmly believe that individuals deserve to be treated with dignity in their care experience and that the best way to do that is to provide quality care. At the same time, we can improve the health of populations and reduce per capita costs.”
About Community Health Plan of Washington
CHPW’s mission is to deliver accessible, quality managed care services that meet the needs and improve the health of Washington State residents. As one of the only not-for-profits to provide state programs in Washington, CHPW serves as the safety net for the underserved. They have a long history of working with Medicaid, particularly working with families in need and now with Medicare and dual-eligible Special Needs members (SNP).
CHPW is the only health plan in the state founded by local community health centers. This network brought together shared values for equal access to health care, years of experience in community organizing, and effective health care administration. CHPW serves more than 300,000 members of all ages and provide access to high-quality doctors, nurses and specialists across the state. For more information, visit www.chpw.org.
ACAP represents 58 nonprofit safety net health plans in 24 states, which collectively serve nearly 12 million people enrolled in Medicaid, Medicare, the Children’s Health Insurance Program (CHIP) and other public health programs. For more information, visit www.communityplans.net.