1. Cascade Pacific Action Alliance
Developing the November 2017 Medicaid Transformation Waiver Submission

2. Welcome & Introductions
Introduce yourself: Name, organization, and county
WELCOME!

3. Agenda for Today
Review CPAA Vision and the Role of Medicaid Demonstration Projects
Workplan for Project Teams
Review Metrics and Potential Target Populations
Select Target Populations for November Application
Next Steps:
Live meeting evaluation
Determine any necessary next steps

4. Regional Health Priorities
Improve Healthcare Access
Improve Care Coordination & Integration
Prevent & Manage Chronic Disease
Prevent and Mitigate Adverse Childhood Experiences (ACES)
Enhance Economic & Educational Opportunities

5. How Does the Medicaid Demonstration Project Align with the CPAA Vision

6. How Medicaid Transformation Demonstration Supports Region’s Priorities
Medicaid Transformation can support the region’s efforts:
New funds to incentivize service delivery improvements
Continued funding depends on meeting clinical performance metrics in years 3 – 5
If successful in meeting metrics, region will have the ability to make innovative and strategic community investments beyond clinical needs
Support for improving how the parts of the system work together
A pathway to investing and sustain changes that can drive towards CPAA vision
Note that these changes will benefit the entire system, not just Medicaid

7. How the Medicaid Demonstration Supports our Vision for Change
Meta Goals
Improve Health, Whole Person Care, and Smarter Spending
Improve health equity and health outcomes for all residents in our communities, with a focus on addressing the social determinants of health.
Keep residents healthy as long as possible and address all health needs with a focus on prevention and early interventions.
Reduce per-capita health care costs while improving the quality of care provided to residents in our communities.
5 Priorities
Care Coordination & Health Integration
Chronic Disease Prevention and Management
Provider Access & Capacity
Adverse Childhood Experiences (ACES)
Medicaid Waiver Strategies
Outcomes & Measures
Bi-Directional Integration of Care & Primary Care Transformation
Community Based Care Coordination
Transitional Care
Diversion Interventions
Access to Oral Health Services
Draft template to be used for developing logic models
Addressing the Opioid Use Public Health Crisis
Chronic Disease Prevention and Control
Maternal and Child Health & Reproductive Health
This is a slightly different version of your compass which really focused on the Medicaid Transformation. Eventually we will populate with the projects and the metrics to begin to show this relationship
* Includes Medicaid Waiver Toolkit Projects

8. How does CPAA earn these dollars?

9. HCA Toolkit offers Strategies within each Project to Earn Dollars by Achieving Outcomes
Note that . . .
Every project has a required list of metrics
Projects need to show progress in meeting performance metrics to receive funding
Regions that successfully achieve metrics will be able to use earned funds flexibly to make innovative and strategic community investments
Where there is a discussion about 6-8 projects. Right now, CPAA is pursuing all 8 projects and project teams have been told if they come forward with viable projects, they will be considered. There are some strategic questions around metrics, potential funds to the ACH as well as that addressing some issues within other projects may be a possible strategy.

10. Toolkit Metrics: Bi-Directional Care
Outpatient Emergency Department Visits per 1000 Member Months
Mental Health Treatment Penetration (Broad Version)
Substance Use Disorder Treatment Penetration
Plan All-Cause Readmission Rate (30 Days)
Medication Management for People with Asthma (5 – 64 Years)
Antidepressant Medication Management
Comprehensive Diabetes Care: Hemoglobin A1c Testing
Follow-up After Discharge from ED for Mental Health, Alcohol or Other Drug Dependence
Follow-up After Hospitalization for Mental Illness
Inpatient Hospital Utilization
Percent Homeless (Narrow Definition)
Child and Adolescents’ Access to Primary Care Practitioners
Comprehensive Diabetes Care: Eye Exam (retinal) performed
Comprehensive Diabetes Care: Medical Attention for Nephropathy
Depression Screening and Follow-up for Adolescents and Adults

11. Bi-Directional Care Strategies
Collaborative Care
Bree Recommendations
Off-Site, Enhanced
Co-located, Enhanced or Co-located, Integrated

12. Toolkit Metrics & Strategies: Care Coordination
Strategy: Pathways Community Hub

13. Toolkit Metrics & Strategies: Transitional Care
Outpatient Emergency Department Visits per 1000 Member Months
Plan All-Cause Readmission Rate (30 Days)
Inpatient Hospital Utilization
Follow-up After Discharge from ED for Mental Health, Alcohol or Other Drug Dependence
Follow-up After Hospitalization for Mental Illness
Mental Health Treatment Penetration (Broad Version)
Percent Homeless (Narrow Definition)
Strategies:
• Interact 4.0
• Transitional care model
• Care transitions intervention

14. Toolkit Metrics & Strategy: Diversion
Outpatient Emergency Department Visits per 1000 Member Months
Percent Homeless
Percent Arrested
Strategy: Community Paramedicine

15. Toolkit Metrics & Strategy: Chronic Disease and Prevention
Outpatient Emergency Department Visits per 1000 Member Months
Medication Management for People with Asthma (5 – 64 Years)
Child and Adolescents’ Access to Primary Care Practitioners
Comprehensive Diabetes Care: Eye Exam (retinal) performed
Comprehensive Diabetes Care: Medical Attention for Nephropathy
Comprehensive Diabetes Care: Hemoglobin A1c Testing
Depression Screening and Follow-up for Adolescents and Adults
Statin Therapy for Patients with Cardiovascular Disease (Prescribed)
Strategy: Chronic Care Model

16. November Project Application
Section I : ACH Level
Regional Health Needs Inventory
ACH Theory of Action and Alignment
Governance
Community & Stakeholder Engagement
Tribal Engagement
Funds Allocation
Required Health System Capacity Council Addressing
Section II: Project Level
Project Selection and Outcomes
Implementation Approach and Timing
Partnering Providers
Regional Assets, Challenges, Proposed Solutions
Monitoring and Continuous Improvement
Project Sustainability Project Teams Addressing

17. Project Level Workplan
August 29 (Today):
Review Strategies, Metrics and Data to Identify Target Populations
September:
Discuss Providers & Domain 1 Investments to support successful project (share with Council, Support team, etc.)
Develop Strawman Proposal
October:
Refine/Revise Strawman proposal
Review Workplan
October 23:
Final Project Application to Council

18. Today: Identifying Target Populations

19. Today’s Task: Selecting Target Populations
Looking across all of the metrics (see handout), there appear to be over a dozen target groups to focus on
Matrix shows subregions or subgroups where CORE has identified substantial variation. These subpopulations may deserve special consideration.
Today’s task: review and do initial selection of potential target populations
Metrics drive the selection of target populations
Need to include subregions and subpopulations identified by CORE.

20. Next Steps & Closing Next meeting: Any additional next steps
Tuesday September 26, 2017
Location: TBD – Will send update when available
Any additional next steps