1. Accountable Community of Health Design: Getting Grounded Accountable Community of Health Interim Leadership Council May 7, 2015

2. 1.What’s behind the Accountable Community of Health initiative? 2.What might happen with an ACH partnership that otherwise would not? 3.What’s this ACH design year about and why am I here? Three questions

3. What’s behind the Accountable Community of Health Initiative? ❶

4. By 2020, the people of King County will experience significant gains in health and well-being because our community worked collectively to make the shift from a costly, crisis-oriented response to health and social problems, to one that focuses on prevention, embraces recovery, and eliminates disparities. 4 King County Health and Human Services Transformation Plan, 2013

5. Rethinking system “edges” Primary care Specialty care Behavioral health Oral health Employers / business / workplaces Housing Schools Transportation Social / human services Public health Health plans Neighborhood organizations; faith communities Parks Long-term services & supports Based on graphic from Institute for Healthcare Improvement Government

6. To succeed, must apply the “Triple Aim” Framework 6 The IHI Triple Aim framework was developed by the Institute for Healthcare Improvement in Cambridge, Massachusetts (www.ihi.org).”www.ihi.org Better health of populations Lower per capita health care costs Better care for individuals System designs that simultaneously improve three dimensions

7. Meanwhile, down in Olympia – a Health Innovation Plan is crafted (and funded) Build healthier communities through a broad, collaborative regional approach (Accountable Communities of Health) Ensure health care focuses on the whole person (focus on physical/ behavioral health integration) Improve how we pay for services (pay for value, not volume) Through combined savings and avoided costs, adjusting health system can save $1.05 billion over 5 years 7

8. 8 Clinical Community ACHs Accountable Community of Health Defined: A regionally governed, public-private collaborative or structure tailored by the region to align actions and initiatives of a diverse coalition of participants in order to achieve healthy communities and populations

9. What will ACHs do? 9 Facilitate collaborative decision-making across multiple sectors and systems, focusing on social determinants of health, clinical-community linkages, and whole person care. Bring together all sectors that contribute to health to develop shared priorities and strategies for population health, including improved delivery systems, coordinated initiatives, and value based payment models. Drive physical and behavioral health care integration by informing financing and delivery system adjustments, starting with Medicaid. Engage in state-community partnership to achieve results.

10. Accountable Community of Health Boundaries

11. Washington’s Accountable Community of Health Initiative Timeline 11

12. What might happen with an ACH partnership that otherwise would not? ❷

13. How an ACH Partnership can drive toward prevention and equity 13 1. Plan: Develop common agenda (regional health improvement plan) 2. Do: Carry out strategies to increase health & equity; reduce costs 3. Study: Show improved health & social outcomes 4. Act: Capture & reinvest portion of savings + align other $$ → for next cycle Adapted from “Closing the Loop” – The Prevention Institute Governance structure that’s accountable for the results of this cycle Convening, data, shared measurement system, engagement & communication to support this cycle (“backbone” functions)

14. Different kinds energy are needed to propel the ACH 14 4. Act: Capture & reinvest portion of savings + align other $$ → for next cycle

15. Transformative Energy Management 15 4. Act: Capture & reinvest portion of savings + align other $$ → for next cycle Gas - examples Local government funding Federal grants State grants Hospital community benefit Philanthropy support Regenerated energy - examples Social impact bonds / pay for success Shared savings with health care Global Medicaid waiver investments Changes in policies, purchasing, and contracting strategies

16. What’s this ACH design year about and why am I here? ❹

17. Design Year Deliverables – Path to ACH “Designation” 17 1. Plan: Develop common agenda (regional health improvement plan) 2. Do: Carry out strategies to increase health & equity; reduce costs 3. Study: Show improved health & social outcomes 4. Act: Capture & reinvest portion of savings + align other $$ → for next cycle Convening, data, shared measurement system, engagement & communication to support this cycle Figure out an approach to this Work on an initial path for sustainability Governance structure that’s accountable for the results of this cycle Formalize this And formalize this.. all against a backdrop of “doing”

18. Physical/ Behavioral Health Integration Committee Familiar Faces (jail high users) Housing-health partnership Communities of Opportunity The Plan for 2015 Learn / support / test Create Interim ACH Leadership Council Partner with equity network/ coalition Performance measurement Regional health improvement plan approach Sustainability Work groups for cross-cutting issues.. Backdrop of “doing” (some existing shared priority initiatives)

19. Partnership with an equity network/coalition Interim ACH Leadership Council Network representation Public Sector Reps Private Sector Reps Community “Public Shareholders” Equity network/ coalition

20. Develop partnership with equity networks/coalitions Design elements of ACH Readiness Proposal: - Approach to future regional health improvement plan - Approach to sustainability - Governance model - Backbone functions (measurement, communications, convening, etc.) Take actions as appropriate to support success of the four initiatives of focus, and learn from them to inform ACH design. Endorse model of care for full integration of physical/behavioral health, developed via the committee. Provide feedback to state/county on ACH-related matters throughout the year. Help figure out responses to new opportunities if they arise in 2015. Roles of Interim ACH Leadership Council

21. Coming Up in the Near Term (May/June) Exploring equity network connection & capacity: With leadership of Regional Equity Network, Healthy King County Coalition, and Wendy Watanabe Work groups launch: 1.Performance measures work group – Eli Kern 2.Regional Health Improvement plan work group – Gloria Albetta 3.[Sustainability work group – ??] Physical / behavioral health integration committee: Susan McLaughlin, King County Dept of Community and Human Services May 11 Familiar Faces Guidance Team: Will be discussing link to ACH May 21 King County Board of Health: Briefings on ACH and the joint Community Health Needs Assessment by KC Hospitals for a Healthier Community Engagement with State partners: Continued participation in ACH Advisory Committee and ACH gatherings Expecting May 15 release of designation criteria

22. Interested parties who want to join King County ACH stakeholder list can write to: hhstransformation@kingcounty.govhhstransformation@kingcounty.gov King County ACH Website: http://www.kingcounty.gov/exec/HHStransformation/ach.aspx http://www.kingcounty.gov/exec/HHStransformation/ach.aspx Washington State ACH Website: http://www.hca.wa.gov/hw/Pages/communities_of_health.aspx http://www.hca.wa.gov/hw/Pages/communities_of_health.aspx Resources This project is supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies