Cascade Pacific Action Alliance Developing the November 2017 Medicaid Transformation Waiver Submission

Welcome & Introductions Introduce yourself: Name, organization, and county WELCOME!

Agenda for Today Review CPAA Vision and the Role of Medicaid Demonstration Projects Workplan for Project Teams Review Metrics and Potential Target Populations Select Target Populations for November Application Next Steps: Live meeting evaluation Determine any necessary next steps

Regional Health Priorities Improve Healthcare Access Improve Care Coordination & Integration Prevent & Manage Chronic Disease Prevent and Mitigate Adverse Childhood Experiences (ACES) Enhance Economic & Educational Opportunities

How Does the Medicaid Demonstration Project Align with the CPAA Vision

How Medicaid Transformation Demonstration Supports Region’s Priorities Medicaid Transformation can support the region’s efforts: New funds to incentivize service delivery improvements Continued funding depends on meeting clinical performance metrics in years 3 – 5 If successful in meeting metrics, region will have the ability to make innovative and strategic community investments beyond clinical needs Support for improving how the parts of the system work together A pathway to investing and sustain changes that can drive towards CPAA vision Note that these changes will benefit the entire system, not just Medicaid

How the Medicaid Demonstration Supports our Vision for Change Meta Goals Improve Health, Whole Person Care, and Smarter Spending Improve health equity and health outcomes for all residents in our communities, with a focus on addressing the social determinants of health. Keep residents healthy as long as possible and address all health needs with a focus on prevention and early interventions. Reduce per-capita health care costs while improving the quality of care provided to residents in our communities. 5 Priorities Care Coordination & Health Integration Chronic Disease Prevention and Management Provider Access & Capacity Adverse Childhood Experiences (ACES) Medicaid Waiver Strategies Outcomes & Measures Bi-Directional Integration of Care & Primary Care Transformation Community Based Care Coordination Transitional Care Diversion Interventions Access to Oral Health Services Draft template to be used for developing logic models Addressing the Opioid Use Public Health Crisis Chronic Disease Prevention and Control Maternal and Child Health & Reproductive Health This is a slightly different version of your compass which really focused on the Medicaid Transformation. Eventually we will populate with the projects and the metrics to begin to show this relationship * Includes Medicaid Waiver Toolkit Projects

How does CPAA earn these dollars?

HCA Toolkit offers Strategies within each Project to Earn Dollars by Achieving Outcomes Note that . . . Every project has a required list of metrics Projects need to show progress in meeting performance metrics to receive funding Regions that successfully achieve metrics will be able to use earned funds flexibly to make innovative and strategic community investments Where there is a discussion about 6-8 projects. Right now, CPAA is pursuing all 8 projects and project teams have been told if they come forward with viable projects, they will be considered. There are some strategic questions around metrics, potential funds to the ACH as well as that addressing some issues within other projects may be a possible strategy.

Toolkit Metrics: Bi-Directional Care Outpatient Emergency Department Visits per 1000 Member Months Mental Health Treatment Penetration (Broad Version) Substance Use Disorder Treatment Penetration Plan All-Cause Readmission Rate (30 Days) Medication Management for People with Asthma (5 – 64 Years) Antidepressant Medication Management Comprehensive Diabetes Care: Hemoglobin A1c Testing Follow-up After Discharge from ED for Mental Health, Alcohol or Other Drug Dependence Follow-up After Hospitalization for Mental Illness Inpatient Hospital Utilization Percent Homeless (Narrow Definition) Child and Adolescents’ Access to Primary Care Practitioners Comprehensive Diabetes Care: Eye Exam (retinal) performed Comprehensive Diabetes Care: Medical Attention for Nephropathy Depression Screening and Follow-up for Adolescents and Adults

Bi-Directional Care Strategies Collaborative Care Bree Recommendations Off-Site, Enhanced Co-located, Enhanced or Co-located, Integrated

Toolkit Metrics & Strategies: Care Coordination Strategy: Pathways Community Hub

Toolkit Metrics & Strategies: Transitional Care Outpatient Emergency Department Visits per 1000 Member Months Plan All-Cause Readmission Rate (30 Days) Inpatient Hospital Utilization Follow-up After Discharge from ED for Mental Health, Alcohol or Other Drug Dependence Follow-up After Hospitalization for Mental Illness Mental Health Treatment Penetration (Broad Version) Percent Homeless (Narrow Definition) Strategies: • Interact 4.0 • Transitional care model • Care transitions intervention

Toolkit Metrics & Strategy: Diversion Outpatient Emergency Department Visits per 1000 Member Months Percent Homeless Percent Arrested Strategy: Community Paramedicine

Toolkit Metrics & Strategy: Chronic Disease and Prevention Outpatient Emergency Department Visits per 1000 Member Months Medication Management for People with Asthma (5 – 64 Years) Child and Adolescents’ Access to Primary Care Practitioners Comprehensive Diabetes Care: Eye Exam (retinal) performed Comprehensive Diabetes Care: Medical Attention for Nephropathy Comprehensive Diabetes Care: Hemoglobin A1c Testing Depression Screening and Follow-up for Adolescents and Adults Statin Therapy for Patients with Cardiovascular Disease (Prescribed) Strategy: Chronic Care Model

November Project Application Section I : ACH Level Regional Health Needs Inventory ACH Theory of Action and Alignment Governance Community & Stakeholder Engagement Tribal Engagement Funds Allocation Required Health System Capacity Council Addressing Section II: Project Level Project Selection and Outcomes Implementation Approach and Timing Partnering Providers Regional Assets, Challenges, Proposed Solutions Monitoring and Continuous Improvement Project Sustainability Project Teams Addressing

Project Level Workplan August 29 (Today): Review Strategies, Metrics and Data to Identify Target Populations September: Discuss Providers & Domain 1 Investments to support successful project (share with Council, Support team, etc.) Develop Strawman Proposal October: Refine/Revise Strawman proposal Review Workplan October 23: Final Project Application to Council

Today: Identifying Target Populations

Today’s Task: Selecting Target Populations Looking across all of the metrics (see handout), there appear to be over a dozen target groups to focus on Matrix shows subregions or subgroups where CORE has identified substantial variation. These subpopulations may deserve special consideration. Today’s task: review and do initial selection of potential target populations Metrics drive the selection of target populations Need to include subregions and subpopulations identified by CORE.

Next Steps & Closing Next meeting: Any additional next steps Tuesday September 26, 2017 Location: TBD – Will send email update when available Any additional next steps