GCACH Demographics and Health Measures SE WA GCACH Demographics and Health Measures BFCHA Governing Board Meeting April 24 2017

Objectives It is only through the clear presentation of data that health policy can be developed. State of Reform Understand the state of socio-economic and physical health of those residing within the GCACH Identify where there are gaps Develop clear thinking on where to focus and where not to focus our resources Guide the policy discussion going forward

Data Sources Used Regional Health Needs Inventory (RHNI Phase 2) We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics There are 60 measures or more that we are being held accountable to. Some are still under development and some will be hard to assess (e.g. ROI) Data Sources Used Regional Health Needs Inventory (RHNI Phase 2) Healthier WA Dashboard RWJF County Health Rankings WA Health Alliance Community Checkup DSHS Research and Data Analysis (RDA) Community Commons HCA Data & Reports And more!

Demographics & Health Coverage We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics Demographics & Health Coverage Concentrations of Hispanics, Native-American Indians: Franklin, Yakima: ~50% Hispanic Rural Areas: Garfield 100% Rural ↓Income, ↑Unemployment, ↑% children in Poverty ↓Homeless, ↑physical inactivity, ↓exercise opportunities ↑Uninsured: Undocumented, ineligible Higher % of CHIP coverage vs. WA State: Young families MCO Coverage: Molina, Coordinated Care, CHPW (80%) ↓ Provider ratios (PCPs, Dentists, BHS), ↓% people with personal provider

We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics Project Categories Chronic Disease: ↑Adult obesity, ↑Diabetes but good monitoring and testing: blood sugar, eyes, kidney Concentrations: Yakima, SE WA corner Other: ↓Asthma, ↓depression Mental Health: Average % adults with poor mental health ↓Mental health, CD/SA treatment penetration ↓ Psychiatric inpatient readmission (30-day) Dental: ↑people receiving dental services Gaps: Whitman Health Network

Project Categories ↑Contraception coverage (including LARC) We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics Project Categories ↑Contraception coverage (including LARC) Very high STD rates: Chlamydia ↑Teen pregnancy: Cultural? ↓Well-child visits ↑childhood immunization rates Some overuse of antibiotics in children Opioid Abuse: Significant problem ↑chronic users across age, gender, and ethnicity ↑MAT with Buprenorphine

We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics Project Categories Biggest overall concern: ↑ ED visits and ↑ potentially avoidable ED visits Some of the highest rates in WA State Across all age groups ↑Preventable hospital days ↓All-cause inpatient readmission (30-day)

Summary Biggest areas of concern: We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics Summary Biggest areas of concern: ED visits and potentially avoidable ED visits Chronic opioid abuse Mental health and CD/SA penetration Well-child visits High teen pregnancy and STD rates Preventable inpatient hospital days

Re-Formation of Priority Work Groups into Project Teams GCACH Priority Work Group MTP Project Team Project Behavioral Health Bi-Direction Integration of Care & Primary Care Transformation 32% Addressing Opioid Use Public Health Crisis 4% Care Coordination Care Coordination (Pathways Hub) 22% Transitional Care 13% Diversion Interventions Healthy Youth & Equitable Communities Reproductive and Maternal/Child Health 5% Oral Health Access to Oral Health Services 3% Diabetes/Obesity Chronic Disease Prevention and Control 8%

Project Objective/Goal MTP Project Team Project Project Objective/Goal MTP Weight Bi-Direction Integration of Care & Primary Care Transformation Example: Team Based model that adds a behavioral health care manager and a psychiatric consultant to support the primary care provider’s mgmt. of individual patients’ behavioral health needs 2A Project Objective: Through a whole‐person approach to care, address physical and behavioral health needs in one system through an integrated network of providers, offering better coordinated care for patients and more seamless access to the services they need. This project will support and advance Healthier Washington’s initiative to bring together the financing and delivery of physical and behavioral health services, through MCOs, for people enrolled in Medicaid. Required 32% Addressing Opioid Use Public Health Crisis Example: AMDG’s Interagency Guideline on Prescribing Opioids for Pain, CDC Guideline for Prescribing Opioids for Chronic Pain, Substance Use during Pregnancy: Guideline for Screening and Management 3A Overarching Goal: Support the achievement of the state’s goals to reduce opioid‐related morbidity and mortality through strategies that target prevention, treatment, and recovery supports. 4% Care Coordination (Pathways Hub) https://innovations.ahrq.gov/sites/default/files/Guides/CommunityHubManual.pdf 2B Project Objective: Promote care coordination across the continuum of health for Medicaid beneficiaries, ensuring those with complex health needs are connected to the interventions and services needed to improve and manage their health. Optional 22% Transitional Care Example: A nurse led model of transitional care for high-risk older adults that provides comprehensive in-hospital planning and home follow-up Diversion Interventions Example: A systematic approach to re-directing and managing persons who present at the ED nor non-emergency conditions, which may be oral health, general physical health, and/or behavioral health conditions. 2C 2D Overarching goals: Improve transitional care services to reduce avoidable hospital utilization and ensure beneficiaries are getting the right care in the right place. Overarching Goal: Implement diversion strategies to promote more appropriate use of emergency care services and person‐centered care through increased access to primary care and social services, especially for medically underserved populations. 13% Reproductive and Maternal/Child Health Example: Nurse Family Partnership, Early Head Start 3B Overarching goal: Ensure that women have access to high quality reproductive health care throughout their lives and promote the health and safety of Washington’s children. 5% Access to Oral Health Services Example: Mobile/Portable Dental Care 3C Overarching goal: Increase access to oral health services to prevent or control the progression of oral disease and ensure that oral health is recognized as a fundamental component of whole‐person care. 3% Chronic Disease Prevention and Control Example: Stanford Chronic Disease Self-Mgmt Program 3D Overarching Goal: Integrate health system and community approaches to improve chronic disease management and control. 8%

Medicaid Transformation Project Certification & Application process for ACHs March RHNI Data Provided and HW Data Website Created STATE/PARTNERS ACH/REGIONAL March Certification Requirements Complete March/April VBP Taskforce July Project Application Template April DSRIP TA Starts May Certified Phase 1 Aug Certified Phase 2 Aug Dec 2017 Applications Approved Dec March Apr May June July Oct Jan March ACH Transition Plan in Place May 15th Certification Phase 1 Due June 30th Update SIM Budget Aug 14th Certification Phase 2 Due Jan Project Implementation Oct Oct 31st SIM Narrative Report Project Plan Applications Due Project Plan Development Q1 2017 Q2 2017 Q3 2017 Q4 2017 Jan 2018

Project Selection Process Timeline Project Selection Process April 20 – May 3 Leadership Council Meeting Re-form 5 Priority Work Groups into 7 Project Teams Confirm/Select Project Team Facilitator Review MTD Approaches/Strategies Review Data Community Asset Inventory Assess Subject Matter Expertise on Team May 4 - 11 Conference Call Project Team Facilitators (PTF) Review Preliminary Regional Survey Results Project Team Facilitators Discuss Measures of Commonality between projects Determine 2-3 Approaches/Strategies for each Project Category May 18 Receive Regional Survey Results Receive Report from Project Facilitators Breakout into Project Teams to determine 2 Project Approaches/Strategies Develops/Modifies Evaluation Criteria for Scoring final projects May 18 Board of Directors Approves Project approaches/Strategies from Project Teams May 19 - June 15 (PTF) Finalizes evaluation criteria for scoring final projects May 22 – June 16 World Cafés to showcase local programs to Public June 22 Project Team Facilitators recommend projects for full application process Leadership Council recommends application template for approval Leadership Council recommends projects to Board June 22 Board of Directors Board approves projects to move to full application process Board approves application template July ? Letters of Application Due July 20 Board Meeting Board approves final projects for Project Plan Application July - October Obtain attestations with organization, Write Project Plan Application

Questions? For more information: Carol Moser cmoser@greatercolumbiaach.org Wes Luckey wluckey@greatercolumbiaach.org Aisling Fernandez afernandez@greatercolumbiaach.org Website: www.greatercolumbiaach.org Thank you for the opportunity to discuss Healthier WA with you today, and we look forward to a continued partnership as Healthier WA further develops throughout the state. Thank you!