1. Benton and Franklin Counties
SE WA
League of Women Voters
Benton and Franklin Counties
April 6, 2017

2. Apple Health Overview
1,905,946 Washingtonians enrolled in Washington Apple Health (Medicaid) through Health Care Authority (HCA)
Approximately 85% (1,619,830) are enrolled in managed care through five MCOs
HCA Purchasing Goals (2021):
90% of state-financed health care and 50% of commercial health care will be in value-based payment arrangements (measured at the provider/practice level).
Washington’s annual health care cost growth will be below the national health expenditure trend.

3. Moving Toward Value Reward patient-centered, high quality care
“Triple Aim”: Improving the patient experience of care (including quality and satisfaction); Improving the health of populations; and. Reducing the per capita cost of health care
Moving Toward Value
Reward patient-centered, high quality care
Reward health plan and system performance
Align payment and reforms with CMS
Improve outcomes
Drive standardization
Increase sustainability of state health programs
Achieve Triple Aim

4. Ensuring health care focuses on the whole person
Healthier WA: Regional partnerships involving hospitals, public health organizations, non-profits, social service agencies and more.
Whole Person: Outcomes will be focused not just on healthcare delivery but also on what has been called the social determinants of health, which include homelessness, incarceration rates, employment and more. All of these fit in together to determine overall population health.
Payment: Driving this will be a re-alignment of incentives toward value-based payment.
Washington State vision for creating healthier communities and a more sustainable health care system by:
Building healthier communities through a collaborative regional approach
Ensuring health care focuses on the whole person
Improving how we pay for services
Better Health, Better Care, Lower Costs

5. Healthier Washington recognizes that health is
Ignoring genetic factors, research has shown that what affects health and mortality is driven more by societal factors and health behaviors. Not just smoking and poor diet but also employment, safe housing, transportation and more have an affect on our health.
Healthier Washington recognizes that health is
more than health care.
Health Care 20%
Socio-economic Factors
40%
Physical Environment 10%
Health Behaviors 30%
Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper, State Quality Improvement Institute.. Minnesota.
Better Health, Better Care, Lower Costs 3

6. ACHs are a forum for regional collaborative decision making

7. Accountable Communities of Health
- A foundational element of Washington state’s transformation strategy is the development of regionally based, voluntary collaborative called “Accountable Communities of Health” (ACHs) to drive integrated delivery of health and social services and improve population health.
- ACHs will provide the forum, organizational support, and State-community partnership to achieve transformative results through collaboration. Within regions, and across the state, ACHs represent collaborative decision-making across multiple sectors and systems to align actions to achieve healthy communities and populations. ACHs are the accelerator/coordinator of regional best practices, lessons learned and shared challenges to drive health systems transformation focusing on population health, social determinants of health, clinical-community linkages and whole person care. Community and regional impact, including regional purchasing strategies, starting with Medicaid.
- ACH infrastructure and governance grounded in the “collective impact” model
- Collective Impact structure: common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support
- Collective Impact is the commitment of a group of important actors from different sectors to a common agenda for solving a specific social problem.
A Healthier WA will see engaged communities focused on community health and wellness, whole person care, and partnering with the state delivery system improvement, including value based purchasing.
Timeline: Iterative development process over the entirety of the SIM grant. Goal for statewide designation for all ACHs by the end of 2015.
We’re well into ACH design and implementation, but early in the four-year process. We still have a lot to learn in partnership with our communities.
COH Planning (2572) in 2014 provided a very valuable learning opportunity for the state and for communities as they consider the newly established RSAs and future ACH development. COH planning regions informed the competitive selection of two pilot regions based on maturity and identification of regional pilot projects.
Two Pilots were selected (2572) in 2015 and these two regions just recently achieved official ACH designation (North Sound and Cascade Pacific Action Alliance)
Seven Design regions, of which SWWA is one, are working on the following:
Governance and Organizational Structure
Community Engagement and Multi-sector Representation
Regional assessment and asset inventories
A volunteer association of independent stakeholders
focused on developing and implementing a shared action agenda established by
consensus (collective impact) with the goal of improving health within a region.
Better Health, Better Care, Lower Costs

8. Greater Columbia ACH Medicaid Population*
Summary Group Name
Statewide Total
Adults
Children
Total
AEM Expansion Adults
310 66
Apple Health For Kids
803,828
462
132,464
132,926
Elderly persons
74,292
7,476
Family (TANF) Medical 21 3
Family Planning
12,476
1,833 90
1,923
Former Foster Care Adults
2,154
244 38
282
Foster Care
29,665 41
3,285
3,326
Medicaid CN Caretaker Adults
136,746
18,038
Medicaid CN Expansion Adults
608,433
71,726
Other Federal Programs 18
Partial Duals
61,165
6,936
Persons with disabilities
150,072
14,070
3,489
17,559
Pregnant Womens Coverage
16,703
2,762 5
2,767
1,895,883
123,657
139,371
263,028
Enrollees in Medical Programs By County Report, *

9. Greater Columbia by County Population & Medicaid %**
County Population
OFM
% GCACH Pop
Population on Medicaid*
% of GCACH Pop on Medicaid
Asotin
22,150 3%
6,497
2.6%
Benton
190,500
26%
55,853
22.0%
Columbia
4,050 1%
1,145
0.5%
Franklin
88,670
12%
34,916
13.8%
Garfield
2,200
0.3%
599
0.2%
Kittitas
43,710 6%
9,974
3.9%
Klickitat
21,270
6,588
Walla Walla
60,730 8%
16,568
6.5%
Whitman
47,940 7%
7,822
3.1%
Yakima
250,900
34%
113,780
44.8%
Total GCACH Pop 
732,120
100%
253,742
Comparison to WA State
13.9%
Comparison to GCACH Population
34.7% **
The GCACH has a much larger share of its population on Medicaid than the state overall

10. The GCACH Medicaid population faces many socio-economic hurdles
Greater Columbia ACH
Characteristics
Statewide
GCACH
Rural
18%
23.3%
Hispanic/Latino
11.2%
26.4%
American Indian/Alaska Native
1.2%
14.3%
Less than high school graduate
10%
19.2%
Non Citizen
7.1%
10.0%
Limited English proficient
7.9%
13.5%
Migrant Seasonal Farmworker
4.1%
19.6%
Uninsured
18.2%
Medicaid Insured
26%
34.7%
Below Poverty
12.9%
19.5%
The GCACH Medicaid population faces many socio-economic hurdles

11. Mental Health Provider
Backbone Organization
GCACH
Carol Moser, Executive Director
Aisling Fernandez, Communications Coordinator
Wes Luckey, Program Manager
Eastern WA University
Dr. Patrick Jones, Facilitator
Board of Directors
Local Gov’t
Public Health
Mental Health Provider
Social Services
Hospital
FQHC
Healthcare Provider
CBO/FBO
Columbia County
Meghan Debolt
Yakima Memorial Hospital
Eddie Miles
Tri-Cities Community Health
Martin Valadez, President
Sunnyside Community Hospital
Brian Gibbons, Treasurer
Comprehensive Mental Health
Ed Thornbrugh
Catholic Family and Child Services
Darlene Darnell
SE WA Aging and Long Term Care
Lori Brown
GCBH Executive Director
Ken Roughton
Education
Philanthropy
Managed Care
Housing
Workforce Dev
Tribes
Public Safety
Consumer
Transportation
ESD 123
Les Stahlnecker
Three Rivers Community Foundation
Carrie Green
Yakima Neighborhood Health
Rhonda Hauff, Vice-President
Washington State Allied Health Center of Excellence
Dan Ferguson
Yakama Nation
Frank Mesplie
Kittitas Fire
John Sinclair, Secretary
Northwest Justice Project Jefferson Coulter
People for People
Madelyn Carlson
United Healthcare
Amina Suchoski
Basic Idea: Everyone moving into the same direction at the same time to impact some of our seemingly intractable health issues.
A regional health improvement coalition of independent organizations
An Accountable Community of Health is a group of leaders from a variety of sectors in a given geographic area with a common interest in improving health. Participating, among others, are health and long-term care providers, health insurance companies, public health agencies, school districts, criminal justice agencies, non-profit social service agencies, legal services organizations, tribes, and philanthropic agencies. With support from the state, they are voluntarily organizing to coordinate activities, jointly implement health-related projects, and advise state agencies on how to best address health needs with in their area. They are not intended to duplicate or replace existing services.

12. Regional Needs Assessment

13. Medicaid Transformation
Current System
Transformed System
Fragmented clinical and financial approaches to care delivery
Integrated systems that deliver whole person care
Disjointed care and transitions
Coordinated care and transitions
Disengaged clients
Activated clients
Capacity limits in critical service areas
Optimal access to appropriate
services
Individuals impoverish themselves to access long term services and supports (LTSS)
Timely supports delay or divert need for Medicaid LTSS
Inconsistent measurement of
delivery system performance
Standardized performance measurement with accountability for improved health outcomes
Volume-based payment
Value-based payment 12
Better Health, Better Care, Lower Costs

14. Washington’s Medicaid Transformation Goals
Medicaid Transformation Project (MTP)
Reduce avoidable use of intensive services and
settings
Improve population health
Accelerate the transition to value-based payment
Ensure that Medicaid per-capita cost growth is
below national trends
Better Health, Better Care, Lower Costs 8

15. Medicaid Transformation Project Initiatives
Transformation through Accountable
Communities of Health
Initiative 2
Enable Older Adults to Stay at Home; Delay or
Avoid the Need for More Intensive Care
Initiative 3
Targeted Foundational Community Supports
Delivery System Transformation
Benefit: Medicaid Alternative Care (MAC)
Benefit: Supportive Housing
Medicaid Transformation Project Initiatives
Each region, through its Accountable Community of Health, will be able to pursue projects that will transform the Medicaid delivery system to serve the whole person and use resources more wisely.
Community-based option for Medicaid clients and their families.
Services to support unpaid family caregivers.
Individualized, critical services and supports that will assist Medicaid clients to obtain and maintain housing. The housing-related services do not include Medicaid payment for room and board.
Benefit: Tailored Supports for
Older Adults (TSOA)
Benefit: Supportive Employment
For individuals “at risk” of future Medicaid LTSS not currently meeting Medicaid financial eligibility criteria.
Primarily services to support unpaid family caregivers.
Services such as individualized job coaching and training, employer relations, and assistance with job placement.
Also known as Delivery System Reform Incentive Payments (DSRIP).
Pay for Performance Projects
Medicaid Benefits/Services 9

16. Initiative 1: What is the Work?
Domain 1: Health & Community Systems Capacity Building
Regional VBP Transition Plan
Workforce Action Plan
Systems for Population Health Management Transformation Plan
Bi-Directional Integration of Care & Primary Care
Community-Based Care Coordination
Transition Care
Diversion Interventions
Domain 2: Care Delivery Redesign
Domain 3: Health Equity Through Prevention & Health Promotion
Addressing Opioid Use Public Health Crisis
Maternal & Child Health
Access to Oral Health Services
Health Equity through Chronic Disease Prevention & Control 10

17. Medicaid Transformation 5-Year Demonstration through ACHs
Initiative 1
Health & Community Systems Capacity Building
Domain 1
Financial Sustainability through Value Based Payment
Focus Area #1
Workforce
Focus Area #2
Systems for Population Health Management
Focus Area #3
Care Delivery Redesign
Domain 2
Bi-Directional Integration of Care & Primary Care Transformation
Required Project 2A
Community-Based Care Coordination
Optional Project 2B
Transitional Care
Optional Project 2C
Diversion Interventions
Optional Project 2D
Healthy Equity through Prevention & Health Promotion
Domain 3
Addressing the Opioid Use Public Health Crisis
Required Project 3A
Health Equity through Chronic Disease Prevention & Control
Optional Project 3B
Maternal & Child Health
Optional Project 3C
Access to Oral Health Services
Optional Project 3D
Performance Measurement
System-wide measures for each project
Regional Health Needs Inventory (RHNI)
HCA will provide data & ACHs will fill in gaps using local data sources. Will inform planning of projects.
Statewide VBP Transition Taskforce
Requires ACH participation
Workforce Development Taskforce
Requires ACH Participation
Practice Transformation Support Hub
Will assist providers in ACH regions with transformation efforts
KEY:
Green boxes are required:
Regional Health Needs Inventory
2 taskforces
3 DOMAINS
2 Required projects (green)
2 Optional projects (yellow).
Orange boxes ACH specific
GCACH SIM Project

18. Quality and Outcome Measures
Comprehensive Diabetes Care (CDC) - Hemoglobin A1c (HbA1c) Testing
Comprehensive Diabetes Care (CDC) - Eye Exam (Retinal) Performed
Comprehensive Diabetes Care (CDC) - Medical Attention for Nephropathy
Statin Therapy for Patients with Cardiovascular Disease
Medication Management for People with Asthma (MMA)
Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adult Admissions
Follow-up Care for Children Prescribed ADHD Medication (ADD)
Annual Monitoring for Patients on Persistent Medications (MPM) - ACE/ARB
Medication Adherence: Proportion of Days Covered (3 Rates by Therapeutic Category)
Medications: Generic Prescribing Rate
Use of Imaging Studies for Low Back Pain (LBP)
Appropriate Testing for Children with Pharyngitis (CWP)
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)
Potentially Avoidable Use of the Emergency Room
Plan All-Cause Readmissions (PCR)
Childhood Immunization Status (CIS) Combination 10
Immunizations for Adolescents (IMA)
Immunization for Influenza
Pneumococcal Vaccination Status for Older Adults (PNU)
Children and Adolescents' Access to Primary Care Practitioners (CAP)
Oral Health: Primary Caries Prevention Offered by Primary Care
Audiological Evaluation No Later Than 3 Months of Age
Well Child Visits in the First Fifteen Months of Life (W15)
Well Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)
Adults Access to Preventive/ Ambulatory Health Services (AAP)
Adult Tobacco Use
Breast Cancer Screening (BCS)
Cervical Cancer Screening (CCS)
Chlamydia Screening in Women (CHL)
Colorectal Cancer Screening (COL)
Adult Mental Health Status
Mental Health Service Penetration (Broad Version)
Substance Use Disorder Service Penetration
Antidepressant Medication Management (AMM)

19. Initiative 1: What Will Be the Role of ACHs?11

20. STATE/PARTNERS ACH/REGIONAL Q1 2017 Q2 2017 Q3 2017 Q4 2017 Jan 2018
March
RHNI Data Provided and HW Data Website Created
STATE/PARTNERS
ACH/REGIONAL
March Certification Requirements Complete
March/April
VBP Taskforce
July Project Application Template
April DSRIP TA
Starts
May Certified Phase 1
Aug Certified Phase 2
Aug
Dec 2017
Applications Approved
Dec
March
April
May
June
July
Oct
Jan
March
ACH
Transition
Plan in Place
May 15th Certification Phase 1 Due
June 30th Update SIM Budget
Aug 14th Certification Phase 2 Due
Jan
Project Implementation
Oct
Oct 31st
SIM Narrative Report
Project Plan Applications Due
Project Plan Development
Q1 2017
Q2 2017
Q3 2017
Q4 2017
Jan 2018

21. MTP: Up to $1.125 Billion Over 5 Years
ACHs will receive a share of waiver dollars
ACHs will select transformation activities aligned with Regional Health Improvement Plan
ACHs will coordinate regional transformation activities
ACHs will distribute funding to partners to carry out
transformation activities
ACHs will monitor impact
Improve Health Outcomes

22. Questions?
For more information: Carol Moser Wes Luckey Aisling Fernandez Website:
Thank you for the opportunity to discuss Healthier WA with you today, and we look forward to a continued partnership as Healthier WA further develops throughout the state.
Thank you!