Alignment across GCACH Demonstration Projects Cathy Kaufmann, Cathy Homkey July 20, 2017

Importance of Alignment Today’s Discussion Importance of Alignment Review of demonstration projects across 3 key areas: Target population(s) Metrics Strategies / Tactics Breakout discussions on increasing alignment and maximizing GCACH’s impact Identifying needed backbone supports shared across projects Agree on next steps

Strong alignment across projects strengthens scores in: Project Evaluation Criteria Alignment is an underlying component of the Project Evaluation Criteria Strong alignment across projects strengthens scores in: Support & collaboration (linkages) Impact Sustainability ROI Workforce

Cohesive Project Portfolio Why alignment matters Alignment across projects not only makes for a strong project portfolio, it helps create a stronger region. Cohesive Project Portfolio Targeted Resources Outcome Metrics Sustainability Strongest applications will demonstrate alignment and shared framework Focused rather than scatter shot approach makes successful implementation easier to achieve Aligning along populations and metrics increases likelihood GCACH will meet performance targets in later years Strong alignment builds strong foundation for sustainability in year 6

The whole is greater than the sum of its parts.

Alignment Questions in Demonstration Project Plan Template How has GCACH leveraged whole-population vision for health system transformation to inform its project selection & planning? Which interventions, resources and infrastructure will be shared across its portfolio of projects, and how will they be shared? Describe how, through these projects, the ACH plans to improve region-wide health outcomes for Medicaid and non-Medicaid populations. Describe how, through these projects, the ACH plans to improve region-wide quality, efficiency and effectiveness of care processes. Describe how, through these projects, the ACH plans to advance equity in its community. Describe how, through these projects, the ACH plans to demonstrate a role and business model for a structured community collaboration and action mechanism (i.e., ACH) as an integral sustainable part of the regional health system.

GCACH Vision and Mission Vision: The Greater Columbia Region is a vibrant, healthy community in which all individuals, regardless of their circumstances, have the ability to achieve their highest potential. Mission: To advance the health of our population by decreasing health disparities, improving efficiency of health care delivery, and empowering individuals and communities through collaboration, and community engagement.

Assessment findings

Some alignment clearly identified: Commonalities Across Projects (based on Project Reports) Some alignment clearly identified: All projects focused on all counties Some alignment on target populations Some limited alignment on outcomes Some shared tactics/ strategies Opportunity to build a strong unifying framework / cohesive portfolio Note that the following assessment captures what we saw in project reports – further alignment may already exist.

Children / teens most common target population (5 projects) Target Populations Children / teens most common target population (5 projects) Some projects mentioned possibility of targeting or inclusion of children/teens with other populations General Medicaid population (4 projects) Not identified as sole target population for any project Beneficiaries with Complex Health Needs (3 projects) Chronic disease (3 projects) AI/AN, Latino/Hispanic and Women also included in target populations of more than 1 project (but not more than 2) Use this slide for smart art / charts / or screenshot images

Target Populations Matrix BH Integration 2B: Care Coordination 2C: Transitional Care 2D: Diversion 3A: Opioid Use 3B: MCH 3C: Oral Health 3D: Chronic Disease TOTAL Children/teens 1 5 General Medicaid Population 4 High Risk High Utilizers 3 People with SPMI 2 Latino Women/ Maternal Health AI / AN At-risk at Transition from Hospital People with SUD Use this slide for smart art / charts / or screenshot images

Outpatient ED Visits (3 projects) Outcome Metrics Substance use disorder (SUD) treatment penetration (adults) identified by 4 of 9 project initiatives Outpatient ED Visits (3 projects) Follow-up after discharge from ED for MH or SUD (3 projects) MH Treatment penetration - broad (3 projects) All other metrics identified are shared by 2 projects or only identified for one project Use this slide for smart art / charts / or screenshot images

Outcome Metrics Matrix Toolkit Metrics 2A BH Integration 2B Care Coordination 2C: Transitional Care 2D: Diversion 3A: Opioid Use 3B: MCH 3C: Oral Health 3D: Chronic Disease TOTALS SUD Tx penetration (adults) 1 4 F/U after discharge from ED for MH or SUD 3 MH Tx penetration (broad) Outpatient ED Visits per 1k member months F/U after hospitalization for mental illness 2 Plan All-Cause Readmission Rate (30 Days) Adult access to preventive/ambulatory care Non-fatal overdose involving Rx opioids Well-child visits in first 15 months MH Tx penetration (children) Inpatient Hospital Utilization Percent Homeless (Narrow definition) Potentially avoidable ED visits Opioid related deaths per 100k Prenatal care in 1st trimester Childhood immunication status Unintended pregnancies Contraceptive care (effective, LARC, pospartum) # of dental sealants Rate of untreated tooth decay Adult dental exams Adult oral health preventive services Child & Adolescent access to PCPs Comprehensive diabetes care: eye exam/neuropathy Comprehensive diabetes care: blood pressure control Adult BMI Well-child visits 3rd - 6th years of life Use this slide for smart art / charts / or screenshot images

6 projects call for use of Community Health Workers as a key strategy Strategies / Tactics 6 projects call for use of Community Health Workers as a key strategy Strong alignment! But need for coordination here is critical Projects call out need for cultural competency training 5 projects identify health homes or PCPs as part of intervention 4 projects identify care coordination as part of intervention 4 projects identify hospitals as part of intervention 4 projects mention screening for social determinants of health Use this slide for smart art / charts / or screenshot images

Strategies Matrix Strategies/Tactics 2A: BH Integration 2B: Care Coordination 2C: Transitional Care 2D: Diversion 3A: Opioid Use 3B: MCH 3C: Oral Health 3D: Chronic Disease TOTALS CHWs 1 6 Cultural Compt training 5 Health Homes/ PCPs Screen for SDOHs 4 Care Coordination/ Case Mngmnt Hospitals BH Providers 3 RNs Provider/Clincian Training Social Workers 2 Community Paramedicine Needs Gap Assessment VBP Health promotion Marketing / outreach Dental hygenists Use this slide for smart art / charts / or screenshot images

Breakout Discussion

Discussion should be specific and concrete Breakout Discussion Questions Questions: What areas of alignment did this analysis miss? How can projects increase alignment on target populations? How can projects increase alignment on metrics? How can projects increase alignment on strategies/tactics? Discussion should be specific and concrete Use this slide for smart art / charts / or screenshot images

Form into smaller groups (max about 10 people) Breakout Discussion Groups Form into smaller groups (max about 10 people) Very important for each group to have a mix of project teams represented HMA or GCACH staff person will sit in on discussion to help facilitate (not participate) Groups will discuss questions on reflection handout Be sure to capture group’s responses on the handout (they’ll be collected at the end) Pick a speaker to report back to large group in 20 minutes Use this slide for smart art / charts / or screenshot images

Cohesive Project Portfolio Remember why alignment matters during your discussion Alignment across projects not only makes for a strong project portfolio, it helps create a stronger region. Cohesive Project Portfolio Targeted Resources Outcome Metrics Sustainability Strongest applications will demonstrate alignment and shared framework Focused rather than scatter shot approach makes successful implementation easier to achieve Aligning along populations and metrics increases likelihood GCACH will meet performance targets in later years Strong alignment builds strong foundation for sustainability in year 6

Group Report out

Which areas need further work? Next Steps for alignment discussion HMA will capture and reflect back to the Leadership Council the discussion had today. Which areas need further work? How can teams continue to build on this discussion? What support do teams need for this conversation? Use this slide for smart art / charts / or screenshot images

Next Steps

Project teams have identified some shared needs already: Identifying Backbone Supports With increased alignment, likely to be increased shared need for the same kind of supports from backbone entity (ACH) Project teams have identified some shared needs already: Data/ analytics Training / professional development Learning Collaboratives Technical assistance Communications / marketing & outreach Coordination across projects Identifying regulatory/ administrative barriers Leveraging / connecting to outside resources Research Discussion: Do these make sense? What else? Use this slide for smart art / charts / or screenshot images

Thank you Questions? Comments?