Budget and Funds Flow Committee Retreat October 9, 2017

B&FF Committee Goals: Level Setting Understand GCACH’s role in Healthier Washington Better understanding of the Mission and Vision of Greater Columbia ACH Understanding the foundational principles driving the Project Plan Scoring Understand Funds Flow from the State Understand role of the Budget and Funds Flow Committee to the success of the Demonstration. Come to an agreement on a Funds Flow Distribution to Partner Organizations Understand the target population Have a quick look at potential partnering providers

Better Health, Better Care, Lower Costs

Healthier Washington recognizes that health is more than health care. - Health systems transformation is not just health care reform--this really is about all the systems that affect health, not just medical care. - The current system: - Separates the “head” from the “body” —no integration between services for physical health, mental health and chemical dependency. - Focuses on volume of services provided, not quality of outcomes. - Is expensive, and getting more so, without producing better results. Health is more than health care. HW is grounded in an understanding that health is more than health care – that 80% of the factors that affect a person’s health occur outside of the health care system. Improving people’s health outcomes (and lowering costs) will depend on addressing those factors and linking supports for them to the health care delivery system. - Health encompasses community (nutritious food, housing, public health), system supports (measurement, consumer engagement, workforce development) and health & recovery efforts (mental health, long-term care, oral health). Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper, State Quality Improvement Institute.. Minnesota. 3 Better Health, Better Care, Lower Costs

ACHs are a forum for regional collaborative decision making

Systems Collaboration and Integration Foundational to Budget and Funds Flow

Dorothy Teeter, State of Reform, 2015 “Truisms” HCA North Star: Better Health, Better Care, Lower Costs (Triple Aim) Use dollars in the best way you know. There is an 80% overlap in delivery system partners, so the potential for savings is the integration of systems. Build your healthcare delivery system around the measures. ."

MTD Toolkit: Pay for Performance Metrics

GCACH Guiding Principles Create Equitable Communities (Improve Health Disparities) Integrate Systems (Behavioral, Dental, Primary Care, Social Services) Cross Sector Collaboration (Clinical-Community Linkages) No wrong door Reinvest savings for sustainability Build around measures Try to keep everyone whole and shift dollars Scalability and spread of programs

Vision & Mission of Greater Columbia Adopted March 19, 2015, Leadership Council Vision Statement The Greater Columbia Region is a vibrant, healthy community in which all individuals, regardless of circumstance, have the ability to achieve their highest potential. Mission Statement The Mission of the Greater Columbia ACH is to advance the health of our population by decreasing health disparities, improving efficiency of health care delivery, and empowering individuals and communities through collaboration, innovation, and engagement.

Population & Medicaid # by County OFM 4-1-16 Population on Medicaid* % of Population on Medicaid % of GCACH Pop on Medicaid   Asotin 22,150 6,863 31% 2.7% Benton 190,500 58,427 22.9% Columbia 4,050 1,177 29% 0.5% Franklin 88,670 36,178 41% 14.2% Garfield 2,200 665 30% 0.3% Kittitas 43,710 10,436 24% 4.1% Walla Walla 60,730 17,155 28% 6.7% Whitman 47,940 8,392 18% 3.3% Yakima 250,900 116,133 46% 45.5% Population GCACH 710,850 255,426 35.9% 100% Population WA 7,183,700 1,909,374 26.6% ** https://fortress.wa.gov/t/51/views/HealthierWashingtonDashboard/PopulationExplorer

Regional Needs Assessment Measures for which all counties in the region had outcomes worse than the state Access to dentists Access to exercise opportunities Access to mental health providers Children in poverty Healthy community design Median household income Poor academic performance

Data looked at Medical & Social Needs

High-cost, high-utilizing patients our target population

What was Medicaid Thinking?

Medicaid Transformation Distribution Robert Wood Johnson Foundation County Health Rankings: “Clinical care is only one fifth of the factors determining health. Healthy Behaviors (e.g. tobacco use, diet and exercise, alcohol and drug use, sexual activity) comprises 30% of factors determining good health Social and Economic Behaviors (e.g. education, employment, income, family and social support, & community safety) comprise 40% of factors determining good health. Physical environment (e.g. air & water quality, housing & transit) comprises 10% of the factors determining good health. Healthy People 2020  developed a “place-based” organizing framework for SDOH Economic Stability Education Social and Community Context Health and Health Care Neighborhood and Built Environment

Social Service Spending Comparisons

DSRIP Calculator provides risk assessment tool

Risks can be assessed across all Metrics

Carol Moser, Executive Director: cmoser@greatercolumbiaach.org Wes Luckey, Program Manager: wluckey@greatercolumbiaach.org