1. Alignment across GCACH Demonstration Projects
Cathy Kaufmann, Cathy Homkey July 20, 2017

2. Importance of Alignment
Today’s Discussion
Importance of Alignment
Review of demonstration projects across 3 key areas:
Target population(s)
Metrics
Strategies / Tactics
Breakout discussions on increasing alignment and maximizing GCACH’s impact
Identifying needed backbone supports shared across projects
Agree on next steps

3. Strong alignment across projects strengthens scores in:
Project Evaluation Criteria
Alignment is an underlying component of the Project Evaluation Criteria
Strong alignment across projects strengthens scores in:
Support & collaboration (linkages)
Impact
Sustainability
ROI
Workforce

4. Cohesive Project Portfolio
Why alignment matters
Alignment across projects not only makes for a strong project portfolio, it helps create a stronger region.
Cohesive Project Portfolio
Targeted Resources
Outcome Metrics
Sustainability
Strongest applications will demonstrate alignment and shared framework
Focused rather than scatter shot approach makes successful implementation easier to achieve
Aligning along populations and metrics increases likelihood GCACH will meet performance targets in later years
Strong alignment builds strong foundation for sustainability in year 6

5. The whole is greater than the sum of its parts.

7. Alignment Questions in Demonstration Project Plan Template
How has GCACH leveraged whole-population vision for health system transformation to inform its project selection & planning?
Which interventions, resources and infrastructure will be shared across its portfolio of projects, and how will they be shared?
Describe how, through these projects, the ACH plans to improve region-wide health outcomes for Medicaid and non-Medicaid populations.
Describe how, through these projects, the ACH plans to improve region-wide quality, efficiency and effectiveness of care processes.
Describe how, through these projects, the ACH plans to advance equity in its community.
Describe how, through these projects, the ACH plans to demonstrate a role and business model for a structured community collaboration and action mechanism (i.e., ACH) as an integral sustainable part of the regional health system.

8. GCACH Vision and Mission
Vision: The Greater Columbia Region is a vibrant, healthy community in which all individuals, regardless of their circumstances, have the ability to achieve their highest potential.
Mission: To advance the health of our population by decreasing health disparities, improving efficiency of health care delivery, and empowering individuals and communities through collaboration, and community engagement.

9. Assessment findings

10. Some alignment clearly identified:
Commonalities Across Projects (based on Project Reports)
Some alignment clearly identified:
All projects focused on all counties
Some alignment on target populations
Some limited alignment on outcomes
Some shared tactics/ strategies
Opportunity to build a strong unifying framework / cohesive portfolio
Note that the following assessment captures what we saw in project reports – further alignment may already exist.

11. Children / teens most common target population (5 projects)
Target Populations
Children / teens most common target population (5 projects)
Some projects mentioned possibility of targeting or inclusion of children/teens with other populations
General Medicaid population (4 projects)
Not identified as sole target population for any project
Beneficiaries with Complex Health Needs (3 projects)
Chronic disease (3 projects)
AI/AN, Latino/Hispanic and Women also included in target populations of more than 1 project (but not more than 2)
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12. Target Populations Matrix
BH Integration
2B:
Care Coordination
2C: Transitional
Care
2D: Diversion
3A:
Opioid Use
3B:
MCH
3C:
Oral Health
3D:
Chronic Disease
TOTAL
Children/teens 1 5
General Medicaid Population 4
High Risk High Utilizers 3
People with SPMI 2
Latino
Women/ Maternal Health
AI / AN
At-risk at Transition from Hospital
People with SUD
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13. Outpatient ED Visits (3 projects)
Outcome Metrics
Substance use disorder (SUD) treatment penetration (adults) identified by 4 of 9 project initiatives
Outpatient ED Visits (3 projects)
Follow-up after discharge from ED for MH or SUD (3 projects)
MH Treatment penetration - broad (3 projects)
All other metrics identified are shared by 2 projects or only identified for one project
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14. Outcome Metrics Matrix
Toolkit Metrics 2A
BH Integration 2B
Care Coordination
2C:
Transitional Care
2D:
Diversion
3A:
Opioid Use
3B: MCH
3C:
Oral Health
3D:
Chronic Disease
TOTALS
SUD Tx penetration (adults) 1 4
F/U after discharge from ED for MH or SUD 3
MH Tx penetration (broad)
Outpatient ED Visits per 1k member months
F/U after hospitalization for mental illness 2
Plan All-Cause Readmission Rate (30 Days)
Adult access to preventive/ambulatory care
Non-fatal overdose involving Rx opioids
Well-child visits in first 15 months
MH Tx penetration (children)
Inpatient Hospital Utilization
Percent Homeless (Narrow definition)
Potentially avoidable ED visits
Opioid related deaths per 100k
Prenatal care in 1st trimester
Childhood immunication status
Unintended pregnancies
Contraceptive care (effective, LARC, pospartum)
# of dental sealants
Rate of untreated tooth decay
Adult dental exams
Adult oral health preventive services
Child & Adolescent access to PCPs
Comprehensive diabetes care: eye exam/neuropathy
Comprehensive diabetes care: blood pressure control
Adult BMI
Well-child visits 3rd - 6th years of life
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15. 6 projects call for use of Community Health Workers as a key strategy
Strategies / Tactics
6 projects call for use of Community Health Workers as a key strategy
Strong alignment! But need for coordination here is critical
Projects call out need for cultural competency training
5 projects identify health homes or PCPs as part of intervention
4 projects identify care coordination as part of intervention
4 projects identify hospitals as part of intervention
4 projects mention screening for social determinants of health
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16. Strategies Matrix
Strategies/Tactics
2A:
BH Integration
2B:
Care Coordination
2C: Transitional Care
2D: Diversion
3A: Opioid Use
3B: MCH
3C:
Oral Health
3D:
Chronic Disease
TOTALS
CHWs 1 6
Cultural Compt training 5
Health Homes/ PCPs
Screen for SDOHs 4
Care Coordination/ Case Mngmnt
Hospitals
BH Providers 3
RNs
Provider/Clincian Training
Social Workers 2
Community Paramedicine
Needs Gap Assessment
VBP
Health promotion
Marketing / outreach
Dental hygenists
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17. Breakout Discussion

18. Discussion should be specific and concrete
Breakout Discussion Questions
Questions:
What areas of alignment did this analysis miss?
How can projects increase alignment on target populations?
How can projects increase alignment on metrics?
How can projects increase alignment on strategies/tactics?
Discussion should be specific and concrete
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19. Form into smaller groups (max about 10 people)
Breakout Discussion Groups
Form into smaller groups (max about 10 people)
Very important for each group to have a mix of project teams represented
HMA or GCACH staff person will sit in on discussion to help facilitate (not participate)
Groups will discuss questions on reflection handout
Be sure to capture group’s responses on the handout (they’ll be collected at the end)
Pick a speaker to report back to large group in 20 minutes
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20. Cohesive Project Portfolio
Remember why alignment matters during your discussion
Alignment across projects not only makes for a strong project portfolio, it helps create a stronger region.
Cohesive Project Portfolio
Targeted Resources
Outcome Metrics
Sustainability
Strongest applications will demonstrate alignment and shared framework
Focused rather than scatter shot approach makes successful implementation easier to achieve
Aligning along populations and metrics increases likelihood GCACH will meet performance targets in later years
Strong alignment builds strong foundation for sustainability in year 6

21. Group Report out

22. Which areas need further work?
Next Steps for alignment discussion
HMA will capture and reflect back to the Leadership Council the discussion had today.
Which areas need further work?
How can teams continue to build on this discussion?
What support do teams need for this conversation?
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23. Next Steps

24. Project teams have identified some shared needs already:
Identifying Backbone Supports
With increased alignment, likely to be increased shared need for the same kind of supports from backbone entity (ACH)
Project teams have identified some shared needs already:
Data/ analytics
Training / professional development
Learning Collaboratives
Technical assistance
Communications / marketing & outreach
Coordination across projects
Identifying regulatory/ administrative barriers
Leveraging / connecting to outside resources
Research
Discussion: Do these make sense? What else?
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25. Thank you
Questions? Comments?