Molina Healthcare - https://www.molinahealthcare.com/ - Molina presentation powerpoint

• Jorge Rivera, State Director for community engagement, Molina Healthcare - rivera@molinahealthcare.com - 425-424-7119
• Thanks you for the work all of you do.  I have been in 34 of the 39 counties (I’m just curious to know which counties you skipped – was one Garfield County? It is tiny, but has the cutest Courthouse in the State – not that I’ve ever had to report there, or anything even remotely like that.  –ed) – in meetings like these – presenting or being part of a coalition.  We are so humbled and grateful you decided to do this work.  The highest reward is when clients look you in the eye and say thank you (I don’t know, aggregating data that shows amazingly successful housing outcomes is pretty high on the reward ranking – or is that just me? –ed). 
• Keep three things in mind
  • Molina Healthcare if here and wants to help and can help.  We have ways to help the work you do.
  • Healthcare is super complex (for starters, I’m not even sure if Healthcare is one word or two – and I just read a whole article on it - https://www.arcadia.io/final-word-healthcare-vs-health-care/  –ed) – the connections between healthcare and homelessness are complex.  You don’t need to understand anything today to know that Molina is working to serve folks experiencing homelessness.
  • Molina is blessed to have Carrie Ching in this community, she is a great asset and is a super connector and is very resourceful.  She gets things done for the community.  (Hear! Hear! –ed.)
• About Molina
  • Can be called an insurer, or a payer – formally we are a Managed Care Organization (MCO).  Molina works for vulnerable people in states across the County. 
  • Our profit is limited by the State to no more than 3%.  We work to put the money to use for the people we serve.
  • With 750k people, Molina is the largest Managed Care Organization in Washington State- double the size of the next larger Medicaid provider in Washington.  
  • 5 years ago – there were just 2 Managed Care Organizations.  State invited 3 more Managed Care Organizations in, and even in that time Molina has grown dramatically.  The growth was by the choice of the people.  When you are accepted into Medicaid, you are offered a choice, and many folks choose Molina. 
  • We have been able to keep up the quality of our services and keep up the highest level of accreditation.  Also have “multicultural healthcare” distinction, which shows we care for and serve well everyone.
  • Have the largest medical provider networks, including 101 of all 102 state hospitals ( I just have to know, which hospital didn’t make the cut?  I hope it isn’t the Garfield County Hospital, because they have a “compassionate and dedicated staff supported by the latest technology and current treatment options”, or so says their website – and I’ll have to take their word for it, as I certainly have no personal experience there –ed), and more than 25,000 providers of primary and specialty care in all 39 counties.
  • Carrie can provide information on all the different options available. 
• Integrated Managed Care – an invention of the State and a trend across the County. 
  • For a long time, we separated mental health, physical health, and substance use disorder.  Before integrated managed care, coordinating their care was very difficult.   
  • If you have a team that integrates services, you get better outcomes. 
  • By 2020, Managed Care Organizations must integrate care.  Molina decided to be an early adopter – started serving 80,000 members 3 years ago.  Added another 70,000 recently.  Pierce County is coming live on January 1^st.  You now have options to treat people in an integrated way – the Primary care doctor becomes a point of entry.  Integrating care will make it easier by just going to see someone who is your primary care provider – it creates more access and works around many of the stigmas of mental health services or substance use services.    
  • We are proud of scoring so well in state competition to operate the Integrated Managed Care.
  • Some say it is just integrated financing, but it is also integrated teams that work together. 
  • Provide services that range from case management to substance use disorder.  (seems like there should be some more words on the end of that sentence, but I must have missed them –ed)
  • Comparing pilot program data for 2 years -  outcomes – like reduction of unnecessary ER visits or people that exit a hospital and do not come back, most of the metrics improved more in integrated care compared to other regions that did not implement integrated managed care.  We believe in integrated care, and the data shows it works.  You pick someone up on the streets, connect them to physical care, connect them to housing, and start giving them space to work on things
  • Molina provides over half of the Medicaid services in the region. 
• Benefits and incentives for Medicaid with Molina
  • Provide virtual Urgent Care -  through cleint phones or computers at 3am (or whenever).  Can get a doctor on the screen within 8 minutes.  For many conditions, you can get a prescription right there. 
  • Free cell phones for members – so member can have cell phone for access to services.  Community Connectors make extensive use of these resources. 
  • HealthinHand app – new features
  • Health Incentives – members get paid to use the services.  This is for working families and very vulnerable individuals and everyone.
  • We provide services to LGBT community.  Molina (and every Managed Care Organizations is required to provide these services)
• Social Determinants of Health – when you are homeless, it is impossible to address health issues.
• Molina Dental Managed Care.  Dental services have been underfunded and difficult to access.  If 100 individuals could get dental care from the state, only a few would actually get appointments.  We did not bid for this work, but have a partnership with Delta Dental.
• Call Center Operations.  New automatic renews for many members.  Many folks do need to renew, and we make about 30,000 calls per month to remind and assist clients renewing.  We can help clients that haven’t renewed. 
• Molina and Medicare Dual Eligible Needs Service Plan (DNSP)
  • Jim Maguire, Medicare Sales Manager - maguire@molinahealthcare.com - 253-441-9182
  • Medicare health insurance card is a new change.  If they are on Social Security Disability or are 65 or over.  Molina offers a dual care option.
  • Provide Medicare A coverage – hospital stays and skilled nursing
  • B coverage - Medical coverage for outpatient and doctor visits
  • C – Medicare advantage – Managed Care Organizations manage their healthcare.  Coordination of care is fundamental – outcomes are better – Part C plans see improvements with wellness programs and such.
  • D – prescription coverage
  • Offered in 8 Counties, including Pierce (but not Garfield, I noticed… -ed)
  • Must have Medicare Health Insurance and Provider 1 card to be in the Dual Special Needs Plans, and be in service area.
  • Medicare does a great job for our seniors and the folks on it.  Molina adds on to that – adds fitness, hearing aids, transportation, dental.
  • Model of Care – used to be to treat individual by body part – but chronic conditions and behavioral health require coordinated care. 
• Next month, 14,000 members will be moved to a different health plan.  Community Health Plan is going away, which will create confusion.  It is important that you know Carrie can be a resource to figure out what is going on.  We care and want to help on this.  Clients did not lose coverage – they were moved to other plans.
• Molina focuses on the most vulnerable.
• Our Benefits are focused on improving our people’s health and helping direct providers such as community health centers to engage more with members. 
• Our regional engagement team is here to help. 
• Question - Are benefits free or is there a co-pay?  Jorge – if you are on Medicaid – there is no deductible – the state covers the entire cost.   There are no maximum out of pockets.
• Abiodun – I want to commend Carrie and Pamm – honestly, they are doing the footwork – coming to where our clients are to just allow clients to ask questions.
• Marcus – this is the right direction.  What do we do when the needs outweigh the resources?  Need more detox beds – we have folks with needs but no facilities for them.  Jorge – the needs will always be larger than our financial abilities to support them.  I don’t have a solution, but know that we need to keep this connection going.  With the Accountable Communities of Health, we are trying to working on getting better resources.  The healthcare providers are now talking with different agencies – we are trying to keep integrated and are on a good pathway. 
• Al – your program and presentation is very impressive.  I think you for that.
• Al – a systems question – you key this all to the Primary Care Providers – these folks are the least paid and have the least time to do care coordination.  Jorge - I agree this is an issues – there is a lot of advocacy to better pay Medicaid doctors.  We need to continue to build capacity around doctors. 
• Kelley – I love Molina – thanks for the support.  At goodwill, we have the Center for Strong Families – supporting folks getting livable wage jobs.  Mothers lose Medicaid when they get around $20 per hour.  They are opting for no Medical Care at all.  Is there any talk about eliminating that benefits cliff.  Jorge - The Affordable Care Act has been under attack since it was passed – since ½ of the County does not believe your clients need that help.  We do have a Qualified Health Plan (QHP) in the County – but if the Federal Government cuts funding that makes it difficult.  We are committed to the Qualified health Plan – we don’t make any money on it, but we want to keep this program alive.  Carrie – if  you have question on the Qualified Health Plan – just ask Jim Maguire with questions.  I also have brochures on the table in back. 
• Sharon – I’ve got to get 3 jobs – though I’m past that now.  Now I have to pay $3,500 before I can use healthcare.  I’m diabetic, and I can’t get anything.  Jorge - stay close to the eligibility rules.
• James – Molina is listening and has put programs in place to experiment with filling some of our needs.