1. Washington State Hospital Association
Accountable Communities of Health Advisory Group Update
by Edward Miles, VP Integration & Business Development, Memorial

2. Overview
Health Care Authority (HCA) has divided the state into nine local regions.
Each ACH should be or has developed a governing entity
Responsible for designing projects funded by the waiver
State asked for $3 billion
Support the ACH work
Other initiatives
State will provide a portion to sustain the administrative functions of the ACH
Vast majority of funds will flow to local providers
Not grant funds
Funds awarded when project meets pre-set goals.
The state may allow projects to have process goals and milestones

3. ACH Organizational Structure
ACH needs to be a legal contracting entity
Able to receive and approve local project ideas and contract with local providers for the work
Required to have cross-representation from different sectors
At least 50% of the decision-making body must be represented by non-clinical, non-payer participants
Need to have financial and management capacity
Oversight of operating budget
Reporting requirements
Executing agreements
Developing budgets and funds flow plans for distribution of incentive payments for projects
Maintaining communication with partners and stakeholders

4. Project Work
HCA and CMS will agree to a list of project categories eligible for funding
i.e. a transformation project tool kit
HCA will develop a project application and scoring guide
HCA has specified project areas:
Health system capacity building
Care delivery redesign
Prevention and health promotion

5. State Contracted Organizations
HCA to issue two Request for Proposals (RFP) to help with fund distribution and project approvals
Independent Assessor
Create the application and review tool
Create process for review and approval of all proposed project plans that come from ACH
Financial Executor
Disburses funds to project participants
Submit reports to HCA on distribution of project payments, fund balances, distribute budget and expense reports

6. Funding the Non-Federal Share
Medicaid as a matching program needs to have state and local funds to draw down federal waiver payments under the waiver. The state will generate most of the match funds by counting state expenditures from “Medicaid-like” programs that improve health, but currently receive no federal match. The federal government is also insisting the state use intergovernmental transfers with local public organizations to fund a portion, potentially a significant share of the total funds. To fulfill the obligations on local match partnerships, HCA will be soliciting funding and proposals for projects from local public entities, including hospitals and hospital districts. These projects will need to follow the same process as all other provider proposals.

7. Value Based Purchasing
HCA goal – 90% of state health care purchased from Medicaid and public employees be value based by 2021

8. Roles in Values-Based Purchasing
MCO
2017 incentives – MCO will have 1% withhold based on their performance on core quality measures
ACH
Parallel with MCO incentives (if more than 30% of providers participate in VBP arrangements in 2017, incentives are awarded)
Provider
Funds flow based on outcomes

9. Bundles, Capitation & Other
Public Employees Benefit Board Program
Jan 2016, they signed with two networks for capitation
Puget Sound Accountable Care Plan
Puget Sound High Value Network
Geographic expansion planned in the coming years
Virginia Mason
Awarded a payment bundle for total hip and knee
Alternative Payment Models
Exploration occurring for rural health and safety net providers

10. Recommendations
Focus on “process” for receiving, deciding, and supporting submissions
Develop infrastructure for monitoring/measuring submissions

11. Process chart for GCACH project funding
Entity has idea
Entity writes up business plan
Entity submits plan to ACH for approval
Step 1
Program application/submission to GCACH
ACH reviews program app/submission
ACH approves
ACH requests $$ from 3rd party Escrow
ACH writes a check to Entity (per business plan)
Step 2 Program approval
Entity submits periodic audit/monitoring of idea to ACH
ACH submits periodic audit/monitoring of all ideas to DOH
Step 3 Audit/Monitoring

15. Concerns
What happens if an ACH does not prioritize one of its member’s strategic initiatives?
Example: Memorial submitted highest # of LOI’s in the state (12). The state accepted 10 and Memorial is prepared to execute on all 10.
If the ACH focuses on “community gardens” as a diabetes/obesity prevention initiative, how would Memorial participate? Note: Memorial currently has a robust diabetes and childhood obesity program(s) that have been very successful and are a part of its strategic plan. Neighborhood gardens are not part of those programs.
Memorial would look to the state to help fund those programs that have been successful but are not currently funded.