Washington State’s Fee-For-Service Dual Eligible Demonstration Quarterly Report

January 14, 2021

This report provides a month-by-month look at dual Medicare-Medicaid beneficiaries' eligibility, enrollment, and engagement in Washington State's Duals Demonstration and Health Home program. A few key things to note:

 Health Homes was implemented in 14 counties in July 2013, 23 additional counties were added in October 2013, and the remaining 2 counties (King and Snohomish) joined in April 2017.  Beneficiaries identified as "already aligned" with another Medicare shared savings program are not included among those deemed "demonstration eligible", though they are still eligible for Health Home services.  Health Home dual beneficiaries are enrolled with one of twelve Health Home Fee-for- Service Lead Entities.

The report was prepared by DSHS Research and Data Analysis Division in collaboration with Washington State's Health Care Authority.

Eligibility and Enrollment updated through December 2020 Engagement updated through September 2020 Health Home Team Review Date: January 13, 2021

DATA SOURCE: Washington State Health Care Authority, ProviderOne (Medicaid) database.

CONTACT David Mancuso, PhD Director DSHS Research and Data Analysis Division 360.902.7557 | [email protected]

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 1 Washington State’s Fee-For-Service Dual Eligible Demonstration Quarterly Report EXECUTIVE SUMMARY

Eligibility, Enrollment, and Engagement Trends  The number of duals eligible for the program has dropped 3% from 30,539 in December 2019 to 29,565 in December 2020. There are three known issues contributing to this trend.

1) There has been an increase in duals enrolled in Medicare Advantage (and thus excluded from Health Home eligibility).

2) Clients who once met the criteria of a PRISM score of 1.5 or above but are now below a PRISM score of 1.0 for 9 months or longer and who have lost eligibility.

3) There has been a slight decrease in overall dual Medicare-Medicaid eligibility.  The percent of duals who are eligible but have chosen not to participate (or can’t) has increased from 22% in December 2019 to 33% by December 2020. It is unlikely that the real proportion of those unwilling to participate has changed; it is more likely that we as a program are more effective in identifying and disenrolling those who are unwilling to participate.

 As of September 2020, 33% of enrolled duals were engaged in the month while 45% of those enrolled had been engaged in September 2020 or during a previous month. Overall engagement has remained fairly steady, even as eligibility and enrollment have fluctuated at times.

COVID-19  Currently, we have not seen drastic changes to Eligibility, Enrollment, or Engagement levels for Dual Demonstration eligible beneficiaries since the beginning of the COVID-19 pandemic. We attribute some of the stability to the actions taken by Health Home program staff to support Leads and Care Coordinators in maintaining engagement with beneficiaries. These actions include, but are not limited to…

1) A remote version of the required 2-day Health Home Care Coordinator Basic Training was created and began being provided to new Care Coordinators in mid-March.

2) Additional free webinars and resources on COVID-19 and self-care have been made available to Care Coordinators, including webinars developed by a cross-agency workgroup between the Department of Health, the Health Care Authority, and the Department of Social and Health Services, created to support the community based workforce. 3) Care Coordination services began to be allowed over the phone, and beneficiaries were provided with mobile phones when needed to maintain engagement. Other Notes  Rate increases for the three tiers of Health Home services went into effect on July 1st, 2020.

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 2 1. Overall Summary January 14, 2021

As of December 2020 ELIGIBILITY  29,565 dual beneficiaries were eligible for the duals demonstration (including those who have chosen not to participate). ENROLLMENT  37% (10,930) of eligible dual beneficiaries were enrolled with a Health Home Lead Entity.  33% (9,747) of eligible dual beneficiaries chose not to participate in the program.  The remaining 30% (8,888) of eligible dual beneficiaries have not yet been enrolled.  A total of 60,213 eligible dual beneficiaries have been enrolled at least one month at some point in the life of the program.

HIGHLIGHTS ENGAGEMENT  45% (5,033) of dual beneficiaries enrolled in September 2020 (when engagement records are more complete) had received one or more Health Home services since their initial enrollment.

This report provides a month-by-month look at dual Medicare-Medicaid beneficiaries' eligibility, enrollment, and engagement in Washington State's Duals Demonstration and Health Home program. A few things to note:  Dual beneficiaries identified as "already aligned" with another Medicare shared savings program have been removed.  Health Home engagement is based on accepted encounters which can take 3 months to receive.

NOTES  Beginning in January 2017, enrolled beneficiaries who chose not to participate have been dropped from enrollment (a change in policy).  Enrollment dropped beginning in October 2018 due to the withdrawal of Optum as a Health Home Lead. Most actively participating beneficiaries were moved to other Health Home Leads, keeping their Care Coordinator intact.

Overall Eligibility, Enrollment, and Engagement Detail (previous 15 Months) Chose Not to Eligible Enrolled Engaged in Month Engaged Ever Participate % OF % OF % OF NEWLY ENROLLED IN % OF NO LONGER NUMBER0 NUMBER NUMBER NUMBER ELIGIBLE ELIGIBLE ENROLLED ENGAGED MONTH ENROLLED ENROLLED OCT 30,926 6,871 22% 12,298 40% 4,260 35% 106 5,538 45% 8,565 NOV 30,684 7,068 23% 12,094 39% 4,114 34% 74 5,472 45% 8,722 DEC 30,539 7,037 23% 12,161 40% 3,985 33% 65 5,465 45% 8,803 2020 JAN 30,844 7,463 24% 11,949 39% 4,077 34% 97 5,416 45% 8,959 FEB 29,867 7,483 25% 11,652 39% 3,901 33% 82 5,286 45% 9,182 MAR 29,248 7,755 27% 11,056 38% 3,906 35% 75 5,109 46% 9,454 APR 28,774 7,978 28% 10,844 38% 3,936 36% 89 5,073 47% 9,595 MAY 28,610 8,019 28% 11,057 39% 3,895 35% 74 5,093 46% 9,658 JUN 29,262 8,363 29% 10,785 37% 3,821 35% 87 4,994 46% 9,854 JUL 29,432 8,696 30% 11,134 38% 3,860 35% 86 5,064 45% 9,874 AUG 28,584 8,631 30% 11,099 39% 3,857 35% 87 5,031 45% 10,000 SEP 28,952 8,931 31% 11,101 38% 3,623 33% 75 5,033 45% 10,078 OCT 29,111 9,386 32% 10,751 37% pending - pending pending - pending NOV 28,055 9,152 33% 10,625 38% pending - pending pending - pending DEC 29,565 9,747 33% 10,930 37% pending - pending pending - pending

Overall Eligibility, Enrollment, and Engagement (July 2013 - Present) In December 2020 40,000 Eligible, Chose Not to Participate King and Snohomish Counties added April 2017  33% of eligible dual 35,000 Eligible, Not Yet Enrolled Engaged in Month beneficiaries chose Eligible and Enrolled Enrolled & Engaged Ever not to participate. 30,000

 37% of eligible dual 25,000 23 counties added beneficiaries were October 2013 Optum ended 20,000 enrolled. participation Dec 2018 15,000 In September 10,000  45% of enrolled dual beneficiaries 5,000 had received at 0 least one

engagement since

JUL JUL JUL JUL JUL JUL JUL JUL

APR APR APR APR APR APR APR

OCT OCT OCT OCT OCT OCT OCT

OCT initial enrollment.

2014 JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 3 2. Additional Eligibility, Enrollment, and Engagement Details

As of December 2020  98% of eligible dual beneficiaries remained eligible from the prior month.  94% of enrolled dual beneficiaries remained enrolled from the prior month.  Beneficiaries who drop Health Homes eligibility/enrollment may return as newly eligible/enrolled in a later month.

NOTES  71% (3,557) of dual beneficiaries enrolled and ever engaged in September 2020 (when engagement records are more complete) had received 13 or more Health Home services since their initial enrollment. Health Home Dual Beneficiary Eligibility Status Eligible Newly Eligible Eligibility Kept Eligibility Dropped Eligibility Status NUMBER0 NUMBER0 PERCENT1 NUMBER0 PERCENT2 NUMBER0 PERCENT2 Eligibility Dropped OCT 30,926 973 3% 29,953 96% 1,147 4% 40,000 Newly Eligible NOV 30,684 732 2% 29,952 97% 974 3% Eligibility Kept DEC 30,539 608 2% 29,931 98% 753 2% 2020 JAN 30,844 1,149 4% 29,695 97% 844 3% FEB 29,867 680 2% 29,187 95% 1,657 5% MAR 29,248 610 2% 28,638 96% 1,229 4% APR 28,774 712 2% 28,062 96% 1,186 4% MAY 28,610 742 3% 27,868 97% 906 3% JUN 29,262 1,702 6% 27,560 96% 1,050 4% JUL 29,432 825 3% 28,607 98% 655 2% AUG 28,584 71 0% 28,513 97% 919 3% SEP 28,952 1,308 5% 27,644 97% 940 3% 0

OCT 29,111 960 3% 28,151 97% 801 3%

JUL JUL JUL JUL JUL JUL JUL JUL

APR APR APR APR APR APR APR

OCT OCT OCT OCT OCT OCT OCT NOV 28,055 84 0% 27,971 96% 1,140 4% OCT

DEC 29,565 2,132 7% 27,433 98% 622 2%

2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN

ENROLLMENT DETAIL Health Home Dual Beneficiary Enrollment Status Enrolled Newly Enrolled Enrollment Kept Enrollment Dropped Enrollment Status NUMBER0 NUMBER0 PERCENT1 NUMBER0 PERCENT2 NUMBER0 PERCENT2 Enrollment Dropped OCT 12,298 789 6% 11,509 94% 741 6% 40,000 Newly Enrolled NOV 12,094 529 4% 11,565 94% 733 6% Enrollment Kept DEC 12,161 492 4% 11,669 96% 425 4% 2020 JAN 11,949 593 5% 11,356 93% 805 7% FEB 11,652 820 7% 10,832 91% 1,117 9% MAR 11,056 315 3% 10,741 92% 911 8% APR 10,844 620 6% 10,224 92% 832 8% MAY 11,057 706 6% 10,351 95% 493 5% JUN 10,785 544 5% 10,241 93% 816 7% JUL 11,134 941 8% 10,193 95% 592 5% AUG 11,099 445 4% 10,654 96% 480 4% SEP 11,101 710 6% 10,391 94% 708 6% 0

OCT 10,751 478 4% 10,273 93% 828 7%

JUL JUL JUL JUL JUL JUL JUL JUL

APR APR APR APR APR APR APR

OCT OCT OCT OCT OCT OCT OCT NOV 10,625 323 3% 10,302 96% 449 4% OCT

DEC

2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN 10,930 969 9% 9,961 94% 664 6% 2014 JAN

ENGAGEMENT DETAIL Health Home Dual Beneficiary Engagement Counts 1 Engagement 2-6 Engagements 7-12 Engagements 13+ Engagements Enrolled and Ever Engaged NUMBER0 PERCENT1 NUMBER0 PERCENT1 NUMBER0 PERCENT1 NUMBER0 PERCENT1 13+ Engagements OCT 205 4% 934 17% 822 15% 3,577 65% 7,500 7-12 Engagements NOV 172 3% 900 16% 825 15% 3,575 65% 2-6 Engagements DEC 161 3% 873 16% 818 15% 3,613 66% 1 Engagement 2020 JAN 177 3% 834 15% 815 15% 3,590 66% FEB 167 3% 759 14% 837 16% 3,523 67% MAR 147 3% 712 14% 781 15% 3,469 68% APR 156 3% 679 13% 765 15% 3,473 68% MAY 139 3% 694 14% 751 15% 3,509 69% JUN 143 3% 667 13% 713 14% 3,471 70% JUL 144 3% 677 13% 720 14% 3,523 70% AUG 143 3% 670 13% 667 13% 3,551 71% SEP 139 3% 678 13% 659 13% 3,557 71% 0

OCT pending - pending - pending - pending -

JUL JUL JUL JUL JUL JUL JUL JUL

APR APR APR APR APR APR APR

OCT OCT OCT OCT OCT OCT NOV pending - pending - pending - pending - OCT

DEC

2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN pending - pending - pending - pending - 2014 JAN 1Denominator is the current month’s Health Home eligible/enrolled dual beneficiaries. 2Denominator is the previous month’s Health Home eligible/enrolled dual beneficiaries.

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 4 3. Identifying Target Population of Those Not Yet Enrolled

 While a goal of the program is to increase enrollment and engagement, a particular subgroup of those not enrolled are the highest priority. This Target Population of Those Not Yet Enrolled excludes • Beneficiaries eligible for their first month (a month enrollment lag is required to meet 30 day notification requirements). • Beneficiaries with a PRISM Risk Score less than 1.5 (an unofficial policy used to manage capacity ).

NOTES • American Indian and Alaska Native Beneficiaries (not passively enrolled per official policy ).  Given the exclusions, the Target Population of Those Not Yet Enrolled has consistently been on a downward trend after each expansion noted in the plot below (initial program rollout, expansion to King/Snohomish Counties, end of Optum's participation in program).

Target Population of Those Not Yet Enrolled Eligible, Demonstration Target Population Not Yet Target Population Eligible Initial Program Rollout (Jul-Oct 2013) Enrolled 14,000 Optum ended participation NUMBER0 NUMBER0 PERCENT NUMBER0 NUMBER0 PERCENT in December 2018 OCT 30,926 6,963 23% 11,757 6,963 59% 12,000 NOV 30,684 6,922 23% 11,522 6,922 60% DEC 30,539 6,779 22% 11,341 6,779 60% 10,000 King and Snohomish Counties began in April 2017 2020 JAN 30,844 6,802 22% 11,432 6,802 59% 8,000 FEB 29,867 6,195 21% 10,732 6,195 58% MAR 29,248 3,763 13% 10,437 3,763 36% 6,000 APR 28,774 3,635 13% 9,952 3,635 37% 4,000 MAY 28,610 3,369 12% 9,534 3,369 35% JUN 29,262 5,548 19% 10,114 5,548 55% 2,000 JUL 29,432 5,543 19% 9,602 5,543 58% AUG 28,584 5,213 18% 8,854 5,213 59% 0

SEP 28,952 5,232 18% 8,920 5,232 59%

JUL JUL JUL JUL JUL JUL JUL JUL

APR APR APR APR APR APR APR

OCT OCT OCT OCT OCT OCT OCT OCT 29,111 5,254 18% 8,974 5,254 59% OCT

NOV

2015 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 28,055 4,840 17% 8,278 4,840 58% JAN 2014 DEC 29,565 4,972 17% 8,888 4,972 56% Target Population of Those Not Yet Enrolled Target Population of Those Not Yet Enrolled, by Residential County

Total Count of Target Population of Those Not Yet Enrolled, December 2020 Top 10 Counties RANK COUNTY Count 1 KING 1,664 501 - 1,664 2 THURSTON 579 251 - 500 3 GRAYS HARBOR 435 101 - 250 4 KITSAP 430 11 - 100 5 CLALLAM 265 0 - 10 6 MASON 258 7 LEWIS 233 8 PIERCE 226 9 SNOHOMISH 189 10 PACIFIC 140

Target Population of Those Not Yet Enrolled as Percent of Demonstration Eligible Beneficiaries, December 2020 Top 10 Counties RANK COUNTY % OF ELIGIBLE 1 THURSTON 62.3% 50.1% - 63.0% 2 MASON 61.4% 30.1% - 50.0% 3 LEWIS 58.8% 20.1% - 30.0% 4 PACIFIC 51.7% 10.1% - 20.0% 5 KITSAP 49.3% 0.0% - 10.0% 6 GRAYS HARBOR 40.7% 7 CLALLAM 39.3% 8 JEFFERSON 37.7% 9 KING 26.7% 10 WASHINGTON OTHER 20.0%

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 5 4. Geographic Detail

 Health Homes was implemented in 14 counties in July 2013, 23 additional counties were added in October 2013.  Health Homes was implemented in the remaining 2 counties (King and Snohomish) in April 2017.

NOTES  Due to 30 day notification requirements, newly eligible dual beneficiaries wait one month before passive enrollment.

Eligibility, Enrollment, and Engagement Detail (Initial 37 Counties vs. King and Snohomish Counties) Initial 37 Counties King and Snohomish Counties Chose Not to Chose Not to Eligible Enrolled Engaged Eligible Enrolled Engaged Participate Participate NUMBER0 NUMBER0 PERCENT10 NUMBER0 PERCENT1 NUMBER0 PERCENT2 NUMBER0 NUMBER0 PERCENT1 NUMBER0 PERCENT1 NUMBER0 PERCENT2 OCT 22,073 5,740 26% 8,576 39% 3,575 42% 8,848 1,130 13% 3,719 42% 684 18% NOV 21,893 5,857 27% 8,399 38% 3,488 42% 8,787 1,210 14% 3,692 42% 625 17% DEC 21,791 5,791 27% 8,440 39% 3,381 40% 8,744 1,244 14% 3,719 43% 603 16% 2020 JAN 22,021 6,139 28% 8,226 37% 3,416 42% 8,819 1,322 15% 3,721 42% 660 18% FEB 21,311 6,003 28% 8,210 39% 3,268 40% 8,551 1,478 17% 3,440 40% 632 18% MAR 20,839 6,162 30% 7,805 37% 3,234 41% 8,404 1,591 19% 3,249 39% 672 21% APR 20,502 6,271 31% 7,730 38% 3,231 42% 8,266 1,705 21% 3,112 38% 704 23% MAY 20,400 6,267 31% 7,932 39% 3,190 40% 8,204 1,750 21% 3,122 38% 704 23% JUN 20,851 6,571 32% 7,669 37% 3,094 40% 8,405 1,790 21% 3,113 37% 727 23% JUL 20,990 6,819 32% 7,985 38% 3,139 39% 8,436 1,875 22% 3,146 37% 721 23% AUG 20,429 6,718 33% 7,988 39% 3,123 39% 8,150 1,912 23% 3,108 38% 734 24% SEP 20,754 6,966 34% 8,020 39% 2,873 36% 8,193 1,964 24% 3,078 38% 749 24% OCT 20,898 7,189 34% 7,892 38% pending - 8,208 2,195 27% 2,857 35% pending - NOV 20,166 7,024 35% 7,795 39% pending - 7,884 2,126 27% 2,828 36% pending - DEC 21,234 7,324 34% 8,214 39% pending - 8,326 2,421 29% 2,714 33% pending - 1Denominator is Health Home eligible dual beneficiaries. 2Denominator is the Health Home enrolled dual beneficiaries.

Eligible, Chose Not to Participate Eligible, Not Yet Enrolled Eligible and Enrolled Engaged in Month

30,000 Initial 37 Counties 12,000 King and Snohomish

25,000 10,000

20,000 8,000

15,000 6,000

10,000 4,000

5,000 2,000

0 0

JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL

APR APR APR APR APR APR APR APR APR APR APR APR APR APR

OCT OCT OCT OCT OCT OCT OCT OCT OCT OCT OCT OCT OCT OCT OCT OCT

2020 2020 JAN 2014 JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN

Enrolled Health Home Dual Beneficiaries Ever Engaged by Residential County

Percent of Enrolled Dual Beneficiaries who were Ever Engaged September 2020 Top 10 Counties 68.1% - 100.0% RANK COUNTY % EVER ENGAGED 59.9% - 68.0% 1 PACIFIC 78.9% 52.9% - 59.8% 2 COWLITZ 78.2% 38.0% - 52.8% 3 COLUMBIA 72.2% 28.3% - 37.9% 4 WAHKIAKUM 72.2% 5 KITTITAS 71.6% 6 CLARK 69.6% 7 WHATCOM 68.5% 8 SKAGIT 68.1% 9 JEFFERSON 67.9% 10 CHELAN 66.1%

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 6 5. Lead Entity Detail

• Health Home dual beneficiaries are enrolled with one of the twelve Health Home Lead Entities. • There are three types of Health Home Lead Entities. • Area Agencies on Aging (AAA) • Community-Based Organizations (CBO)

NOTES • Managed Care Organizations (MCO) • Optum stopped participation in the Health Home program in December 2018.

Health Home Lead Entity Coverage Area Map for Dual Beneficiaries HH Start HH Coverage Area Type Lead Entity Date 1 2 3 4 5 6 7 Health Home Coverage Areas AAA Northwest Regional Council AAA OCT 2013 Olympic AAA FEB 2019 * Pierce County AAA DEC 2018 Southeast WA Aging and LTC AAA JUL 2013 Southwest AAA DEC 2018

CBO Community Choice OCT 2013 Full Life Care APR 2017 Elevate Health Aug 2019

MCO Community Health Plan of Washington JUL 2013 Coordinated Care JAN 2018 Molina JUL 2016 United Health Care Community Plan JUL 2013 *partial coverage area Health Home Dual Beneficiary Enrollment and Engagement Summary by Lead Entity Enrollment Summary Engagement Summary September 2020 September 2020

% OF TOTAL % OF ENROLLED % OF TOTAL Type Lead Entity ENROLLED ENROLLED BY RANK ENGAGED ENGAGED IN ENGAGED BY RANK LEAD MONTH LEAD

AAA Northwest Regional Council AAA 1,939 17% 3 791 41% 22% 1 Olympic AAA 411 4% 8 153 37% 4% 6 Pierce County AAA 554 5% 7 pending - - - Southeast WA Aging and LTC AAA 1,369 12% 4 610 45% 17% 4 Southwest AAA 1,147 10% 5 684 60% 19% 2

CBO Community Choice 2,064 19% 2 644 31% 18% 3 Full Life Care 2,098 19% 1 518 25% 14% 5 Elevate Health 709 6% 6 pending - - -

MCO Community Health Plan of Washington 391 4% 9 57 15% 2% 9 Coordinated Care1 <11 - 11 0 - - - Molina 156 1% 11 79 51% 2% 8 United Health Care Community Plan 261 2% 10 81 31% 2% 7 1Coordinated Care only serves Fee-for-Service Duals under special circumstances. Distribution of Distribution of Enrolled Dual ENROLLED Enrolled Dual ENGAGED Beneficiaries SEP 2020 Beneficiaries SEP 2020 by Lead Entity by Lead Entity

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 7 Health Home Dual Beneficiary Enrollment and Engagement by Lead Entity

Northwest Regional Council AAA Olympic AAA Pierce County AAA ENROLLED ENGAGED PERCENT ENROLLED ENGAGED PERCENT ENROLLED ENGAGED PERCENT OCT 2,040 872 43% 440 163 37% 673 240 36% NOV 1,987 820 41% 405 171 42% 684 248 36% DEC 1,952 796 41% 397 178 45% 691 223 32% 2020 JAN 1,982 822 41% 380 174 46% 673 238 35% FEB 1,952 798 41% 450 150 33% 622 238 38% MAR 1,833 794 43% 432 151 35% 613 231 38% APR 1,798 806 45% 438 151 34% 608 246 40% MAY 1,811 798 44% 425 144 34% 594 248 42% JUN 1,819 795 44% 422 146 35% 579 237 41% JUL 1,912 811 42% 449 144 32% 621 243 39% AUG 1,929 804 42% 445 151 34% 592 232 39% SEP 1,939 791 41% 411 153 37% 554 pending - OCT 1,963 pending - 403 pending - 552 pending - NOV 1,930 pending - 395 pending - 548 pending - DEC 2,001 pending - 391 pending - 531 pending -

3,000 500 800 2,500 700 400 600 2,000 300 500 1,500 400 200 1,000 300 100 200 500 100

0 0 0

JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL

2017 2017 JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN 2014 JAN 2015 JAN 2016 JAN 2018 JAN 2019 JAN 2020 JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN

Enrolled (through December 2020) Engaged in Month (through September 2020)

Southeast WA Aging and LTC AAA Southwest AAA Community Choice ENROLLED ENGAGED PERCENT ENROLLED ENGAGED PERCENT ENROLLED ENGAGED PERCENT OCT 1,160 736 63% 1,135 815 72% 2,572 716 28% NOV 1,159 697 60% 1,162 798 69% 2,462 698 28% DEC 1,180 681 58% 1,198 784 65% 2,468 642 26% 2020 JAN 1,090 695 64% 1,147 782 68% 2,459 663 27% FEB 1,107 665 60% 1,149 787 68% 2,329 610 26% MAR 1,045 634 61% 1,014 756 75% 2,258 654 29% APR 1,156 624 54% 989 732 74% 2,154 663 31% MAY 1,193 617 52% 1,066 746 70% 2,177 621 29% JUN 1,092 556 51% 1,070 739 69% 2,067 632 31% JUL 1,271 576 45% 1,094 739 68% 1,989 629 32% AUG 1,328 580 44% 1,099 705 64% 2,021 646 32% SEP 1,369 610 45% 1,147 684 60% 2,064 644 31% OCT 1,343 pending - 1,087 pending - 2,052 pending - NOV 1,323 pending - 1,064 pending - 2,076 pending - DEC 1,449 pending - 1,092 pending - 2,230 pending -

4,000 1,400 4,000 3,500 1,200 3,500 3,000 1,000 3,000 2,500 800 2,500 2,000 2,000 1,500 600 1,500 1,000 400 1,000 500 200 500

0 0 0

JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL

2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN

Enrolled (through December 2020) Engaged in Month (through September 2020)

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 8 Health Home Dual Beneficiary Enrollment and Engagement by Lead Entity (cont.)

Full Life Care Elevate Health Community Health Plan of Washington ENROLLED ENGAGED PERCENT ENROLLED ENGAGED PERCENT ENROLLED ENGAGED PERCENT OCT 2,411 482 20% 303 pending - 527 69 13% NOV 2,404 441 18% 307 pending - 514 77 15% DEC 2,477 431 17% 299 pending - 511 80 16% 2020 JAN 2,515 480 19% 306 pending - 484 61 13% FEB 2,398 460 19% 475 pending - 450 57 13% MAR 2,212 484 22% 539 pending - 417 53 13% APR 2,145 499 23% 546 pending - 406 59 15% MAY 2,158 505 23% 636 pending - 401 60 15% JUN 2,147 505 24% 639 pending - 401 61 15% JUL 2,201 510 23% 732 pending - 404 61 15% AUG 2,119 511 24% 731 pending - 396 62 16% SEP 2,098 518 25% 709 pending - 391 57 15% OCT 1,913 pending - 714 pending - 394 pending - NOV 1,902 pending - 680 pending - 385 pending - DEC 1,736 pending - 771 pending - 381 pending -

3,500 11,000 800 3,000 Elevate Health is in the 700 800 2,500 1 process of submitting 600 2,000 600 500 1 historical Health Home 400 1,500 400 service claims. 300 1,000 0 200 200 500 100

0 0 0 0

JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL

0 JUL

2017 2017 JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN 2014 JAN 2015 JAN 2016 JAN 2018 JAN 2019 JAN 2020 JAN

Enrolled (through December 2020) Engaged in Month (through September 2020)

Coordinated Care Molina United Health Care Community Plan ENROLLED ENGAGED PERCENT ENROLLED ENGAGED PERCENT ENROLLED ENGAGED PERCENT OCT <11 0 - 172 78 45% 864 89 10% NOV <11 0 - 173 81 47% 836 83 10% DEC <11 0 - 173 84 49% 814 86 11% 2020 JAN <11 0 - 183 81 44% 729 80 11% FEB <11 0 - 177 58 33% 542 77 14% MAR <11 0 - 160 67 42% 532 81 15% APR <11 <11 - 154 73 47% 447 81 18% MAY <11 0 - 160 72 45% 433 81 19% JUN <11 0 - 162 71 44% 385 75 19% JUL <11 0 - 167 85 51% 292 56 19% AUG <11 0 - 164 81 49% 273 79 29% SEP <11 0 - 156 79 51% 261 81 31% OCT <11 pending - 152 pending - 176 pending - NOV <11 pending - 146 pending - 174 pending - DEC <11 pending - 169 pending - 177 pending -

10 Coordinated Care only serves 200 1,400 1,200 8 Fee-for-Service Duals under 150 1,000 6 special circumstances. 800 100 4 600 400 2 50 200

0 0 0

JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL JUL

2014 2014 JAN 2016 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN 2014 JAN 2015 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN 2014 JAN 2015 JAN 2016 JAN 2017 JAN 2018 JAN 2019 JAN 2020 JAN

Enrolled (through December 2020) Engaged in Month (through September 2020)

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 9 6. Government Accountability Office (GAO) Measure Tracking and Results

 The tracking grid below reflects the status of the GAO Measure Collection Lists returned by each Health Home Lead.  The Measure Results reflect GAO Measure 4 as calculated on the Final GAO Results Lists distributed to the Health Home Leads.  For Demonstration Year 5 (the period of November 2017 through October 2018), the state is deemed to pass the quality performance goal if NOTES all Health Home Leads report their GAO measure. For Demonstration Year 6, the benchmark for GAO Measures is 63% for Assessment Completed, and 44% for Care Plan Completed.

Health Home Lead Entity GAO Measure Collection List Tracking Demonstration Year 7 Demonstration Year 8 2020 2021 Type Lead Entity MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY AAA Northwest Regional Council AAA Olympic AAA Pierce County AAA Southeast WA Aging and LTC AAA Southwest AAA

CBO Community Choice Full Life Care Elevate Health

MCO Community Health Plan of Washington Coordinated Care Molina United Health Care Community Plan

N/A - No Collection List sent to HH Lead Entity Collection List Completed and Collection List Not Yet Returned (no new enrollees/not yet created ) Returned

Health Home Lead Entity GAO Measure Results (Demonstration Year 5, and Year 6 Results) GAO Measure 4: The percentage of Demonstration eligible Medicare-Medicaid enrollees who are willing to participate and could be reached, or who had fewer than 3 documented outreach attempts within 90 days, who had a health action plan completed within 90 days of initial enrollment.

Demonstration Year 5 (Nov 2017 - Oct 2018) Demonstration Year 6 (Nov 2018 - Oct 2019) Type Lead Entity NUMERATOR DENOMINATOR RATE NUMERATOR DENOMINATOR RATE AAA Northwest Regional Council AAA 126 622 20.3% 140 347 40.3% Olympic AAA - - - <11 65 - Pierce County AAA - - - 27 91 29.7% Southeast WA Aging and LTC AAA 180 525 34.3% 76 118 64.4% Southwest AAA - - - 99 134 73.9%

CBO Community Choice 141 543 26.0% 52 356 14.6% Full Life Care 227 1,047 21.7% 180 507 35.5% Elevate Health - - - 0 107 0.0% Optum (ended participation in Dec 18 ) 119 1,658 7.2% - - -

MCO Community Health Plan of Washington <11 69 - 0 <11 - Coordinated Care 0 0 - 0 0 - Molina 0 <11 - <11 <11 - United Health Care Community Plan 33 489 6.7% <11 100 -

TOTAL 832 4,957 16.8% 589 1,830 32.2%

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 10 7. Demographic Details and Serious Mental Illness

 A Minority Engagement Workgroup made up of staff from the Health Care Authority, the Department of Social and Health Services, and the Health Home Leads has been created to address engaging clients from underserved communities (including those with Serious Mental Illness).

NOTES  Demographic information is obtained from the ProviderOne (Medicaid) database.  Any Minority includes any category besides Non-Hispanic White (including Hispanic, Other, and Unknown/Not Provided).

Demographic Breakdown of Engaged Dual Beneficiaries, September 2020

Male Non-Hispanic White 63% Female 35% Any Minority 37% 65%

AGE 62% 65+

38% lt 65

2,000 1,500 1,000 500 0 500 1,000 1,500 2,000

The percentage of *Female, **Non-Hispanic White Dual Beneficiaries, and *Age 65+ are higher in the Engaged population than in the Eligible, or Enrolled populations in September 2020 (*p<0.001; **p<0.05).

Eligible Enrolled Engaged in Month 0.75 0.65 *65% **63% 0.55 61% 61% 62% 61% 59% 59% *62% 0.45 0.35 0.25 % Female % Non-Hispanic White % Age 65+

The percentage of Dual Beneficiaries with an indication of Serious Mental Illness in the last 15 months are higher* in the Engaged population than in the Eligible, or Enrolled populations in September 2020 (*p<0.001). This trend has held since January 2018 when Serious Mental Illness Indication was first tracked.

50%  Serious Mental Illness is indicated by a diagnosis in the 48% CDPS psychiatric risk groups characterized by the following 46% representative conditions: schizophrenia and related 44% psychotic disorders; mania and bipolar disorders; major 42% recurrent depression.

40% NOTES

 The indication of SMI is based on Medicaid and Medicare

JUL JUL JUL

SEP SEP SEP NOV

NOV data, and has been extracted from PRISM beginning in

MAY MAY MAY

MAR MAR MAR

2018.

2018 JAN 2018 JAN 2019 JAN 2020

Prepared by DSHS Research and Data Analysis Division in collaboration with HCA Page 11