Transcript Empowerment: From Evidence to Practice WIN Navigating to Health Mike Maples, Assistant Commissioner, Mental Health and Substance Abuse Services Texas Department of State Health Services.

Empowerment:
From Evidence to Practice
WIN
Navigating to Health
Mike Maples, Assistant Commissioner,
Mental Health and Substance Abuse Services
Texas Department of State Health Services
What is MIPCD?
• Medicaid Incentives for Prevention of Chronic Disease
• Competitive five year federal grant opportunity from Centers for
Medicare and Medicaid Services (CMS). No state match required.
• Funds demonstration projects that use evidence-based incentives to
help Medicaid clients adopt healthy behaviors, improve outcomes
• Projects must address at least one of the following goals:
—
tobacco cessation,
—
controlling or reducing weight,
—
lowering cholesterol,
—
lowering blood pressure, or
—
avoiding onset of diabetes or improving management of diabetes.
MIPCD Today
• 10 State grants were awarded 09/2012.
• All projects have rigorous scientific designs (such as
randomized, controlled trials) to assess effectiveness.
• Projects target Medicaid clients with or at significant risk
for developing chronic health conditions.
• Two states, Texas and New Hampshire, are focusing on
individuals with behavioral health conditions.
MIPCD State Projects
STATE
TOBACCO
CESSATION
CA
X
CT
X
HI
X
WEIGHT
LOSS
LOWERING
CHOLESTEROL
LOWERING
BLOOD
PRESSURE
DIABETES
MANAGEMENT
OR
PREVENTION
X
X
MN
X
X
MO
X
X
NV
X
NH
X
NY
X
TX
X
WI
X
X
X
X
X
X
X
X
X
X
X
What is WIN?
• Wellness Incentives and Navigation (WIN) – The Texas
MIPCD Project
• $9.9 million grant
• Randomized Controlled Trial
• Partnership: DSHS MHSA & Medicaid (HHSC)
• Site: Harris Managed Care Delivery Area
• Recruitment begins 04/2012
• Recruitment goal: 1,000 to 1,250 participants
• Services end 12/31/2015
Target Population
• Medicaid Managed Care (STAR+PLUS)
members, ages 21 – 55 who:
—Live in the Harris service delivery area
(Harris, Austin, Waller, Fort Bend,
Montgomery, Wharton, Brazoria, Galveston
and Matagorda Counties)
—Are not receiving Medicare
—Have either –
•serious mental illness, OR
•behavioral + chronic health conditions
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WIN Interventions
• Person-centered wellness planning with professional
health navigators, who are trained in Motivational
Interviewing (MI) techniques.
• Flexible wellness account to support specific health goals
defined by the participant in the individual wellness
plan. ($1150 / yr, administered through the navigator)
• Wellness Recovery Action Planning training (WRAP) to
enable participants with more severe mental illnesses to
take full advantage of person-centered wellness
planning.
Why WIN?
•Risk - People with behavioral health conditions are
significantly more likely to suffer chronic physical disease,
and to die at a younger age. (In Texas, 29 years earlier than
the population as a whole.)
•Cost – Behavioral health conditions contribute
significantly to higher medical costs (readmissions, ER
visits, etc.)
•Opportunity - STAR+PLUS is Texas Medicaid’s dominant
health care delivery system for adults with disabilities.
Significant potential for large scale change, if successful.
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