Healthier Washington A View from Above the Details Andrew Busz, Policy Director, Finance Washington State Hospital Association Future of Healthcare Conference March 24, 2016

Objectives Provide an overview of the State’s Healthier Washington Initiative Understand how it will impact efforts for value-based purchasing and health care transformation Understand some of the challenges that will need to be overcome for a transformed health care system

Washington’s Healthier Washington Initiative

Healthier Washington resources/videos/

5 Global Medicaid Transformation Waiver

Healthier Washington Integrating behavioral and physical health services Fully integrate the financing and delivery of physical health, mental health and chemical dependency services in Medicaid through MCOs by 2020 SW WA is an early adopter  working to fully integrate coverage by 4/1/2016 Building Accountable Communities of Health To find regional solutions to regional health issues Supporting clinical practice transformation Providing training and technical assistance to providers Promoting people’s involvement in their health

Healthier Washington Developing value based payment strategies Four payment models are being designed One model involves the FQHCs, RHCs and CAH To move away from encounter based reimbursement and introduce financial flexibility in how care is delivered Consistency measure performance to improve quality and lower costs Governor’s Performance Measures Coordinating Committee and their 52 core measures (clinical measures) 5732/1519 Cross-Systems measures w/ 51 recommendations in (1) quality of life; (2) criminal justice; (3) health/wellness, utilization and disparities; and (4) employment, education, housing Mandate that the 5732/1519 measures are integrated in contracts with RSNs, MCOs, AAAs

Value-Based Purchasing Currently done in a somewhat proprietary manner Inconsistency in assignment and measurement of quality metrics Little standardization of payment mechanisms Often driven from individual purchaser viewpoint rather than one of community access sustainability

Care Delivery Transformation Involves new services that are not currently covered Replaces services that are currently covered by insurance benefit plans Payment must ultimately support service delivery changes

Value-based Purchasing Criteria Fair (ex. Is there adjustment for Socio-economic factors for readmissions?) Accurate (ex. Stratification of hip replacement cases) Impact on Payor Mix (Centers of Excellence approach) CMS and PEBB approaches to hip and knee replacements If done well: Opportunity for quality and value increases for broad spectrum of providers and facilities If done poorly: Providers and facilities may be forced to be selective of patients served or services offered

All-Payer Claims Database Identify differences in cost of services/ (purchaser benefit) Identify reasons driving variation / (public health benefit)

Accountable Communities of Health Funding mechanism for needs outside of traditional health care services and insurance benefits Mechanism for identifying regional needs and priorities May be used to identify quality measures for arrangements between purchasers and providers

Questions? Comments? Andrew Busz Policy Director, Finance, WSHA  206/ Thank You!