Benton-Franklin Health District Board of Directors July 26, 2017 SE WA Benton-Franklin Health District Board of Directors July 26, 2017 Greater Columbia ACH Transformation Demonstration Update

Certification Phase 1 - May GCACH Milestones

Medicaid Transformation Objectives through services that improve health outcomes and reduce the rate of growth in the overall cost of care such as acute care hospitals, nursing facilities, psychiatric hospitals, traditional long-term services and supports, and jails using payment methods that take the quality of services and other measures of value into account prevention and management of diabetes, cardiovascular disease, mental illness, substance use disorders, oral health and more Medicaid Transformation Objectives Improve population health Reduce avoidable use of intensive services and settings Accelerate the transition to value-based payment Ensure that Medicaid cost growth is 2% below national trends

Greater Columbia by County Population & Medicaid %**   County Population Healthier WA Dashboard % of County Population Population on Medicaid** % on Medicaid Asotin 22,138 3% 6,863 31% Benton 188,474 26.5% 58,427 Columbia 4,058 .6% 1,177 29% Franklin 88,239 12.5% 36,178 41% Garfield 2,216 0.3% 665 30% Kittitas 43,483 6% 10,436 24% Walla Walla 61,268 8.6% 17,155 28% Whitman 46,622 6.6% 8,392 18% Yakima 252,463 35.6% 116,133 46% GCACH Population 708,961 100% 255,326 36% WA State Population 7,170,351 1,909,374  26.6% ** https://fortress.wa.gov/t/51/views/HealthierWashingtonDashboard/PopulationExplorer - measurement period 10-1-2015 to 9-30-2016

Benton & Franklin in top 5 for Potentially Avoidable ED Visits

Disparities of Greater Columbia ACH

Percentage of uninsured population has declined since 2013

Initiative Funds will flow to Participants through Several Distinct “Pools”

$119 Million in Provider Incentives Bi-Directional Integration of Physical & Behavioral Health $38M Community-Based Care Coordination $26.2M Domain 2: Care Delivery Redesign Transitional Care $15.4M Diversions Interventions $15.4M Addressing the Opioid Use Public Health Crisis $4.7M Reproductive and Maternal and Child Health $5.9M Domain 3: Prevention and Health Promotion Access to Oral Health Services $3.6M Chronic Disease Prevention and Control $9.5M

Benton & Franklin Counties have many measures worse than the State Average Washington Health Alliance Community Check-up 2016

Source: RWJF County Health Rankings 2A: Bi-Directional Integration of Physical and Behavioral Health through Care Transformation (Required)

Bi-Directional Goals FIMC 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) Bi-Directional Goals Goal 2 FIMC Increase access to integrated primary care-behavioral health services by maximizing tenants of the Bree Collaborative (increasing access) Collaborative Care Model (maximizing patient tracking), internal and external co-location. Goal 4 Goal 1 Goal 3 Identify a regional approach to data collection / registries to improve population health (PHQ-9, SBIRT, PAM). Fully integrate physical health, mental health, and substance use services in order to provide the right care, in the right place, at the right time. Increase interoperability between providers and systems to increase efficiencies, improve communication, and reduce redundancies.

Integrated managed care is evolving and spreading!

3A: Addressing the Opioid Use Public Health Crisis (Required) 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) 3A: Addressing the Opioid Use Public Health Crisis (Required) Goal: To reduce opioid-related morbidity and mortality through strategies that target prevention, treatment, and recovery.

Opiate Related Deaths: 1999-2015 WA State Dept. of Health, Center for Health Statistics Opiate Related Deaths: 1999-2015

2012-2015: Deaths per County (opioid related) 2012-2015: Rate per 100,000 population Asotin 12 10.8 Benton 84 9.3 Columbia 2 too few to calc. Franklin 17 4.4 Garfield Kittitas 9.1 Walla Walla 25 8.5 Whitman 13 8.1 Yakima 65 5.5 From 2002 to 2013 publicly funded treatment admissions involving an opioid, statewide, went up 196.5%. Three counties in the GCACH increased over 250%.* *http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2015-01.pdf

Project Selection Process

Five Conditions of Collective Impact Collective Impact is a framework to tackle deeply entrenched and complex social problems. It is an innovative and structured approach to making collaboration work across government, business, philanthropy, non-profit organisations and citizens to achieve significant and lasting social change. The Collective Impact approach is premised on the belief that no single policy, government department, organisation or program can tackle or solve the increasingly complex social problems we face as a society.  The approach calls for multiple organisations or entities from different sectors to abandon their own agenda in favour of a common agenda, shared measurement and alignment of effort. Unlike collaboration or partnership, Collective Impact initiatives have centralised infrastructure – known as a backbone organisation – with dedicated staff whose role is to help participating organisations shift from acting alone to acting in concert Five Conditions of Collective Impact

Questions? For more information: Carol Moser, ED cmoser@greatercolumbiaach.org Wes Luckey, PM wluckey@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!