Building Accountable Communities of Health Washington State of Reform Health Policy Conference January 8, 2015, 2:15 – 3:00 pm Representative Laurie Jinkins, Member, Healthcare and Wellness Committee, Washington State House of Representatives Carol Moser, Executive Director, Benton-Franklin Community Health Alliance Dr. Elya Moore, PhD, Deputy Director, Whatcom Alliance for Health Advancement, Supporting the North Sound Accountable Community of Health

Session agenda Brief overview of Accountable Communities of Health (ACH) (5 minutes) Presentations from panelists on plans to implement the ACH model (25 minutes) Questions from the audience (15 minutes)

Washington State Health Care Innovation Plan (SHCIP) 1.Improve how we pay for services –e.g., value-based purchasing 2.Ensure health care focuses on the whole person –e.g., integration of physical health, mental health, and chemical dependency care 3.Build healthier communities through a broad collaborative regional approach –e.g., Accountable Communities of Health

4 Washington’s Goals for ACHs  ACHs are formal entities – regionally governed, public private partnership organizations  Provide a multi-sector voice for delivery system reform, shared health improvement goals, and regional purchasing strategies  Serve as a forum for regional collaborative decision-making to accelerate health system transformation, focusing on social determinants of health, clinical-community linkages, and whole person care  Accelerate physical and behavioral health care integration through financing and delivery system adjustments, starting with Medicaid.

Pilot ACHs 5 Complete a “startup initiative” to demonstrate the valuable role of ACHs Test and inform ACH designation criteria, to be finalized by the end of 2015 Provide learning opportunities as a peer leader to Design communities Inform the statewide ACH evaluation design, including rapid-cycle learning and improvement

Two Selected Pilot ACHs 1.North Sound Accountable Community of Health, supported by Whatcom Alliance for Health Advancement. The North Sound Accountable Community of Health serves the North Sound Regional Service Area: Whatcom, Skagit, Island, San Juan and Snohomish Counties. 2.Cascade Pacific Action Alliance, supported by CHOICE Regional Health Network. The Cascade Pacific Action Alliance serves the Timberlands and Thurston-Mason Regional Service Areas: Cowlitz, Grays Harbor, Lewis, Mason, Pacific, Thurston and Wahkiakum Counties.

Design Communities 7 Leverage the planning process, including the newly developed Community Health Plans Respond to lessons learned during the planning process Focus on capacity building, building on lessons learned from the Pilots

Where the Health Care Authority (HCA) sees ACH’s going

Representative Laurie Jinkins Member, Healthcare and Wellness Committee, Washington State House of Representatives

Health Info Tech Collective Impact Respect | Innovation | Collaboration | Leadership Collective Impact Respect | Innovation | Collaboration | Leadership Integration Quality Measures Flexible Model for Reducing Chronic Disease Improve Diabetes and Depression ACHIEVE TRIPLE AIM Health Info Exchange Comm Health Workers and Care Coordinators Learning Culture

Health Info Technology and Exchange Data sharing agreements Shared EMR’s, care plans & progress notes Shared “health” port Provider prompts Auto-alerts Work flow processes Primary Interventions and Potential Strategies VISION Healthy, vibrant people and communities achieving their full potential. MISSION To improve the health of our community by collaboratively delivering integrated and cost-effective healthcare and human service solutions across Pierce County. VALUES Respect | Innovation | Collaboration | Leadership Community Health Workers and Care Coordinators Standard SOW Communication with providers (tech) Provider referral Education Home visits Service delivery Care Coordination Integration Early identification IMPACT model Screening Health action plans Mobile BH and PC Tele-counseling Service co-location Quality Measures CTP Measures Diabetes and depression measures Consistent across organizations Implemented thru Health Info Tech Learning Culture Data & info sharing Training Shared learning Evidence based practices

PIERCE COUNTY ACCOUNTABLE COMMUNITIES OF HEALTH Board of Directors Health Innovation Partnership Community Coalition (TBD) Health Equity & Other Advisory Groups Ad Hoc CommitteesCommunity Forums Vision: TBD (e.g. Healthy People in Healthy Communities) Priorities: Mental Health | Chronic Disease Prevention| Access to Care Coalitions Comm. Orgs. Workgroups Providers Payers Workgroups ClinicalCommunity Improve Care Quality & Reduce Costs Prevention & Root Causes of Health Governing Body: 501(c)3 12/4/2014 HEALTH EQUITY Citizen’s Review Panel

Carol Moser Executive Director, Benton-Franklin Community Health Alliance

GREATER COLUMBIA COMMUNITY OF HEALTH Presented by Carol Moser, Executive Director Benton-Franklin Community Health Alliance January 8, 2015

The Greater Columbia Basin

Tri-City Hospitals (Kennewick General, Lourdes Health Network, Kadlec Regional Medical Center) build Tri-Cities Cancer in 1992

Foresight of Community Leaders The mission of BFCHA: To bring the community and healthcare providers together to: Work cooperatively Foster community-wide stewardship Assess community health needs and facilitate long-term, comprehensive, community wide solution that achieve affordable, high quality wellness and accessible health care for all residents of the Mid-Columbia

SE Washington Community of Health #6

Top AreaCountyAsotinBentonColumbiaFranklinGarfieldWallaWA State Data Driving Decisions

RSA Designations made us Greater!

Collective Impact Model Driving Governance, Committee Structure

Finding Alignment looks promising

Elya Moore, PhD Deputy Director, Whatcom Alliance for Health Advancement Alliance Supporting the North Sound Accountable Community of Health

4 North Sound ACH, 1 of the 2 Pilot ACHs

Our Common Agenda A coalition with the triple aim of transforming the health system:  to improve the health of our communities and our people  to improve the experience of care and access to care  and to lower per capita health care costs in Snohomish, Skagit, San Juan, Island and Whatcom counties

Our Guiding Principles  We can accomplish more together than we can individually  Trust, respect, transparency, continuous learning, and data- driven decision-making  Collaboration between sectors is key  Communities must be engaged to shape strategies  The way care is currently organized and delivered will not be effective in achieving our shared aim  To improve overall community health we need to go upstream

Our Process  Build on the strengths, experiences and successes  Align efforts with existing state, county or local priorities, outcomes, strategies and metrics.  Create measurable goals, and ensure accountability towards outcomes  Ensure that our plan is clear, robust, well-researched, inclusive and actionable, yet practical

CASE Initiative: Coordinate, Align, Standardize, Enhance, and Expand care coordination programs in our region  Highest utilizers of jails, EMS, and EDs  Coordinate existing efforts to achieve better results and more savings among those currently served  Scale up to achieve maximum effect  Produce a North Sound ACH regional care coordination operations manual and a mini-business plan using findings from the CASE Initiative.

The North Sound ACH Commitment To succeed 1 st with a short-term initiative that can demonstrate significant progress and cost savings in the 1 st 6 months. We are motivated by, and committed to, long term, sustainable, health improvement, and capturing and reinvesting shared savings to address upstream, root causes of health, with a focus on prevention. The CASE Initiative is an essential stepping stone to reaching this goal. By coming together around the CASE Initiative, we will continue to build trust, while also demonstrating the collective impact of working together.

North Sound ACH governance model Adding first responders in 2015 (EMS, fire, or police)

Follow the North Sound ACH Online: Receive our the NSACH newsletter or come to a meeting or event:

Questions

Questions to run on 1.How will ACHs inform, support, and advise Medicaid purchasing? 2.How should the ACHs be organizing to guarantee ability to capture and reinvest shared savings to address upstream determinants of health? 3.How will the ACHs advise and collaborate with the Behavioral Health Organization on behavioral health integration (chemical, mental, and physical), both in terms of service delivery and financing? 4.What is the nature of the relationship between ACHs and health plans? How is it defined? Managed? 5.What keeps you up at night when you think of the proverbial rubber hitting the road?