Community Health Plan of Washington started out rather modestly, with about 44,000 Medicaid members. Twenty-five years later, it serves 300,000 members in Medicaid and Medicare programs through a network of 20 federally qualified health centers. Leanne Berge has led the organization since 2016. She's bullish on the plan's efforts to integrate behavioral and physical care, but says much more needs to be done to coordinate care for low-income and vulnerable populations. She recently spoke with Modern Healthcare public health reporter Steven Ross Johnson. The following is an edited transcript.
Modern Healthcare: Earlier this year, CHPW celebrated its 25th anniversary. Could you tell us the story of its growth over that time?
Leanne Berge: We are a unique organization as a local not-for-profit, a Washington state-governed organization that serves the Medicaid population, primarily, and also the Medicare population. We were started in 1992 as a subset of the community health centers in Washington that recognized the benefits of having greater control over the financing of the Medicaid program in order to provide a more integrated care model and move away from fee-for-service episodic care.
We first had a contract in 1994 called Healthy Options. It was traditional Medicaid, with about 44,000 members. We were all over the state. In 1997, we held a direct contract with the state. So prior to that, we were also basing our health insurance license on a contract with an existing insurer. That's the way a lot of health plans begin; they partner with other insurance companies to have the money and reserves to start building the infrastructure. By 2003, we had about 100,000 members, and that was just in the basic plan. We had a program here that was equivalent to the Medicaid expansion population. They called it Basic Health. The other managed-care organizations were not interested, actually, in enrolling this population because it was high-risk people who had previously been uninsured and didn't qualify for Medicaid. That was the program that we were recruited by the state to take on. We also took on all kinds of special populations over the years and were responsible for leading a number of innovative programs, including what we called the Mental Health Integration Program. It was really in the forefront of integrating mental health services with the physical services. We did this in partnership with the University of Washington.
We started our Medicare program in 2010. We had significant growth in a very short period of time. We were also one of the first to contract with the state for a fully integrated managed-care program in the southwest region of Washington.
MH: Given the organization's history of taking on riskier populations, to what do you attribute your success?
Berge: It all goes back to the fact that our mission and that of our primary delivery system is so intertwined; it's about serving the communities and all of the population in those communities who would not otherwise be able to access services. In many cases, these same individuals are already known to our delivery system and need support, so we had the advantage of already having a culturally sensitive and integrated care model, seeing individuals who may previously have been in the margins and uninsured.
MH: What do you see as some of your bigger opportunities for future growth?
Berge: We've been expanding our Medicare product again. We actually had to take a more strategic approach and not be quite as expansive as we were earlier. We're focusing on the special needs plan and looking at those parts of our population that are served primarily by the community health centers and where the intersections of the economic and social determinant issues are most acute and really impact people's health. We're also taking full advantage of the innovation that the state is pursuing around behavioral health integration with physical health. That's given us an opportunity to play a bigger role across the population, including people who have serious mental illness. It's still carved out in a number of regions within the state, so we're participating in a leadership role in that movement to bring behavioral health services and physical health services together in an integrated fashion.
We're also taking advantage of the fact that about 60% of the dental services to adults in the Medicaid population are provided through the community health center system, so we are working to leverage that and ensure that we have an integrated approach that also includes oral health.
MH: A number of health centers across the country have been talking about potential service cuts that they would have to institute if they did not receive federal funding at a certain point. Where do you see your health centers?
Berge: We're all concerned about the funding. We're hopeful that will be extended because it's truly supported from a bipartisan perspective. I've never met any politician who does not agree that the role of community health centers is an essential one, particularly when there are cuts to other areas of healthcare or other social programs.
I haven't heard any controversy over the importance of this funding mechanism. That said, the politics of Washington, D.C., right now are anything but predictable and smooth, so it's been challenging to work through this particularly uncertain time. We are in constant discussions about what the consequences might be. On the positive front, the community health centers in Washington state are somewhat less impacted by this funding mechanism than in other states. As a Medicaid expansion state, there's a very low uninsured rate, so they're not as affected in terms of needing funds from other sources to cover uncompensated care. But there is still a portion of the population that needs services. Immigrants are a big number, particularly undocumented immigrants, who may not have healthcare coverage. Our community health centers serve them. They would never turn anyone away.
MH: Outside of funding, what do you see as some of the major challenges you've experienced in the past year?
Berge: Certainly the funding challenge with the Affordable Care Act has been our biggest advocacy effort and we will continue to take a leadership role around the benefits of Medicaid and how we should be working to support the Medicaid program. I think it still comes down to delivery system transformation and being part of a broader collaborative movement that goes beyond the work that we're doing, but that crosses and bridges the silos across the delivery systems. Again, we have good partnerships in the state around these new accountable communities of health that recognize the importance of working with partners that we might not have traditionally worked with. The behavioral health agencies and community-based organizations are probably the best example of that. We can be more effective if we partner across these previously unconnected sectors. It's also looking at housing, transportation, other community-based organizations and faith-based organizations. There are opportunities to make a difference by eliminating barriers and creating connections.
It will take time and it's certainly a challenge, and it means finding additional resources where today there may not be any. For example, mental health providers are in short supply in this state and across the country and we have to invest more in outpatient mental healthcare. We also need more psychiatric beds. We have a homeless population that is, in part, a result of that. The work we can do together is our best opportunity to see improvement, and that's the challenge that we're all quite excited about tackling together.
MH: What's the status of opioid crisis in the state of Washington?
Berge: It's as serious in Washington, I think, as it is across the country. We've seen exponential growth in deaths due to opioid overdose and, if I understand it, it's really the leading cause of accidental death in nearly every part of the state. It surpassed motor vehicle deaths and firearm-related deaths. So it's a huge problem and one that we all recognize the need to be working together to address. Gov. Jay Inslee issued his own executive order to bring together state agencies, local health organizations, law enforcement, tribal governments, all kinds of state and local partners, to work together.
MH: What do you see as your role in those efforts?
Berge: It's many-fold. Supporting the community health centers, for example. They have a very critical role at the community level in integrating the services that are essential in addressing the ongoing victims of the crisis. And they've been involved in medication-assisted treatment. They've been on the forefront of bringing together the behavioral health and substance-abuse disorder services and the physical services. We partner with them around providing support—care coordination, pharmacy data support, support relating to activity in emergency rooms. So it's both a matter of providing very direct support on the ground and analytic support with information that will help identify opportunities for interventions. That's a big piece of what we're doing.