Medicaid Transformation Project Demonstration SE WA Medicaid Transformation Project Demonstration Benton county Democratic Central Committee July 19, 2017

Apple Health Overview 1,905,946 Washingtonians enrolled in Washington Apple Health (Medicaid) through Health Care Authority (HCA) Approximately 85% (1,619,830) are enrolled in managed care through five MCOs HCA Purchasing Goals (2021): 90% of state-financed health care and 50% of commercial health care will be in value-based payment arrangements (measured at the provider/practice level). Washington’s annual health care cost growth will be below the national health expenditure trend.

Ensuring health care focuses on the whole person Healthier WA: Regional partnerships involving hospitals, public health organizations, non-profits, social service agencies and more. Whole Person: Outcomes will be focused not just on healthcare delivery but also on what has been called the social determinants of health, which include homelessness, incarceration rates, employment and more. All of these fit in together to determine overall population health. Payment: Driving this will be a re-alignment of incentives toward value-based payment. Washington State vision for creating healthier communities and a more sustainable health care system by: Building healthier communities through a collaborative regional approach Ensuring health care focuses on the whole person Improving how we pay for services Better Health, Better Care, Lower Costs

Moving Toward Value Reward patient-centered, high quality care “Triple Aim”: Improving the patient experience of care (including quality and satisfaction); Improving the health of populations; and. Reducing the per capita cost of health care Moving Toward Value Reward patient-centered, high quality care Reward health plan and system performance Align payment and reforms with CMS Improve outcomes Drive standardization Increase sustainability of state health programs Achieve Triple Aim

Healthier Washington recognizes that health is Ignoring genetic factors, research has shown that what affects health and mortality is driven more by societal factors and health behaviors. Not just smoking and poor diet but also employment, safe housing, transportation and more have an affect on our health. Healthier Washington recognizes that health is more than health care. Health Care 20% Socio-economic Factors 40% Physical Environment 10% Health Behaviors 30% Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper, State Quality Improvement Institute.. Minnesota. Better Health, Better Care, Lower Costs 3

ACHs are a forum for regional collaborative decision making

Accountable Communities of Health A volunteer association of independent stakeholders focused on developing and implementing a shared action agenda established by consensus (collective impact) with the goal of improving health within a region. - A foundational element of Washington state’s transformation strategy is the development of regionally based, voluntary collaborative called “Accountable Communities of Health” (ACHs) to drive integrated delivery of health and social services and improve population health. - ACHs will provide the forum, organizational support, and State-community partnership to achieve transformative results through collaboration. Within regions, and across the state, ACHs represent collaborative decision-making across multiple sectors and systems to align actions to achieve healthy communities and populations. ACHs are the accelerator/coordinator of regional best practices, lessons learned and shared challenges to drive health systems transformation focusing on population health, social determinants of health, clinical-community linkages and whole person care. Community and regional impact, including regional purchasing strategies, starting with Medicaid. - ACH infrastructure and governance grounded in the “collective impact” model - Collective Impact structure: common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support - Collective Impact is the commitment of a group of important actors from different sectors to a common agenda for solving a specific social problem. A Healthier WA will see engaged communities focused on community health and wellness, whole person care, and partnering with the state delivery system improvement, including value based purchasing. Timeline: Iterative development process over the entirety of the SIM grant. Goal for statewide designation for all ACHs by the end of 2015. We’re well into ACH design and implementation, but early in the four-year process. We still have a lot to learn in partnership with our communities. COH Planning (2572) in 2014 provided a very valuable learning opportunity for the state and for communities as they consider the newly established RSAs and future ACH development. COH planning regions informed the competitive selection of two pilot regions based on maturity and identification of regional pilot projects. Two Pilots were selected (2572) in 2015 and these two regions just recently achieved official ACH designation (North Sound and Cascade Pacific Action Alliance) Seven Design regions, of which SWWA is one, are working on the following: Governance and Organizational Structure Community Engagement and Multi-sector Representation Regional assessment and asset inventories Better Health, Better Care, Lower Costs

MTP: Up to $1.125 Billion Over 5 Years ACHs will receive a share of waiver dollars ACHs will select transformation activities aligned with Regional Health Improvement Plan ACHs will coordinate regional transformation activities ACHs will distribute funding to partners to carry out transformation activities ACHs will monitor impact Improve Health Outcomes

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

Initiative 1: What Will Be the Role of ACHs? Coordinating Medicaid Projects at the Regional Level 11

Greater Columbia by County Population & Medicaid %**   County Population OFM 4-1-16 % GCACH Pop Population on Medicaid* % of GCACH Pop on Medicaid Asotin 22,150 3% 6,497 2.6% Benton 190,500 26% 55,853 22.0% Columbia 4,050 1% 1,145 0.5% Franklin 88,670 12% 34,916 13.8% Garfield 2,200 0.3% 599 0.2% Kittitas 43,710 6% 9,974 3.9% Klickitat 21,270 6,588 Walla Walla 60,730 8% 16,568 6.5% Whitman 47,940 7% 7,822 3.1% Yakima 250,900 34% 113,780 44.8% Total GCACH Pop  732,120 100% 253,742 Comparison to WA State 13.9% Comparison to GCACH Population 34.7% ** https://fortress.wa.gov/t/51/views/HealthierWashingtonDashboard/PopulationExplorer The GCACH has a much larger share of its population on Medicaid than the state overall

The GCACH Medicaid population faces many socio-economic hurdles Greater Columbia ACH   Characteristics Statewide GCACH Rural 18% 23.3% Hispanic/Latino 11.2% 26.4% American Indian/Alaska Native 1.2% 14.3% Less than high school graduate 10% 19.2% Non Citizen 7.1% 10.0% Limited English proficient 7.9% 13.5% Migrant Seasonal Farmworker 4.1% 19.6% Uninsured 18.2% Medicaid Insured 26% 34.7% Below Poverty 12.9% 19.5% The GCACH Medicaid population faces many socio-economic hurdles

Regional Needs Assessment

Initiative 1: What is the Work? Regional VBP Transition Plan Workforce Action Plan Systems for Population Health Management Transformation Plan Domain 1: Health & Community Systems Capacity Building Bi-Directional Integration of Behavioral Health & Primary Care Community-Based Care Coordination Transitional Care Diversion Interventions Domain 2: Care Delivery Redesign Addressing Opioid Use Public Health Crisis Maternal & Child Health Access to Oral Health Services Health Equity through Chronic Disease Prevention & Control Domain 3: Health Equity Through Prevention & Health Promotion 10

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) Emphasis (80%) on funding programs that lead to integration, coordination of care and reduction of institutional services Estimated Potential Annual Funding Earned are subject to modification based on Project Plan scorning performance and HCA revision

STATE/PARTNERS ACH/REGIONAL Q1 2017 Q2 2017 Q3 2017 Q4 2017 Jan 2018 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 April 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 Planning Oct 12th Nov 16 Project Plan Application Due Participating Provider LOIs/RFQs due Project Plan Development Q1 2017 Q2 2017 Q3 2017 Q4 2017 Jan 2018

Questions? For more information: Carol Moser cmoser@greatercolumbiaach.org Website: www.greatercolumbiaach.org Thank you! 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.