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SE WA Aging and Long Term Care Council of Governments
Governing Board Meeting April 6, 2017
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Ensuring health care focuses on the whole person
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
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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
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ACHs are a forum for regional collaborative decision making
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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
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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 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. United Healthcare Amina Suchoski
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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, *
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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% **
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Greater Columbia ACH Characteristics Statewide GCACH Rural 18% 23.3%
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%
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Regional Needs Assessment
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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
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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
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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
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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
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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
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Initiative 1: What Will Be the Role of ACHs?
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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
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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
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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!
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