Update on Greater Columbia ACH SE WA Sunnyside Hospital Update on Greater Columbia ACH 6-20-17

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

Disparities of Greater Columbia ACH

Transition to Project Teams

General Roles of the Project Teams Bring voice to various sectors represented within our region Act as advisory to the Board of Directors Inform the Leadership Council Represent subject matter expertise (SME) and acquire new SME where appropriate Review data & evidence-based approaches in the Medicaid Demonstration Toolkit Determine community alignment with approaches Possibly interact with outside consultants and have a role in ongoing project performance monitoring

Project Selection Process

Governor Kitzhaber’s Theory of Change Incentive payments VBP

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

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

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

Potentially avoidable ER visits, Mental Health services for Adults and Children, Adolescent well-care visits, Antidepressant medication, worse than State average. Washington Health Alliance Community Check-up 2016

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.

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, state wide, went up 196.5%. Three counties in the GCACH increased over 250%. http://adai.uw.edu/p ubs/infobriefs/ADAI- IB-2015-01.pdf

Behavioral health care is evolving!

How do we get there? Conduct a regional assessment of capacity and gaps of integration. Target areas in ACH with significant capacity gaps. Conduct county-level focus groups, discussing results of each county’s assessment. Strategize need for integration expansion. Begin discussion about data collection and interoperability. Conduct a financial analysis of the Collaborative Care Model inclusive of FQHCs, BHO providers, hospitals and hospital-owned practices, private practices to determine current interest in expanding integration.

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 William Van Noy, CFO wvannoy@greatercolumbiaach.org Wes Luckey, PM wluckey@greatercolumbiaach.org Aisling Fernandez, AA/CC 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!