1. GCACH Demographics and Health Measures
SE WA
GCACH Demographics and Health Measures
BFCHA Governing Board Meeting
April

2. Objectives
It is only through the clear presentation of data that health policy can be developed.
State of Reform
Understand the state of socio-economic and physical health of those residing within the GCACH
Identify where there are gaps
Develop clear thinking on where to focus and where not to focus our resources
Guide the policy discussion going forward

3. Data Sources Used Regional Health Needs Inventory (RHNI Phase 2)
We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics
There are 60 measures or more that we are being held accountable to. Some are still under development and some will be hard to assess (e.g. ROI)
Data Sources Used
Regional Health Needs Inventory (RHNI Phase 2)
Healthier WA Dashboard
RWJF County Health Rankings
WA Health Alliance Community Checkup
DSHS Research and Data Analysis (RDA)
Community Commons
HCA Data & Reports
And more!

4. Demographics & Health Coverage
We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics
Demographics & Health Coverage
Concentrations of Hispanics, Native-American Indians:
Franklin, Yakima: ~50% Hispanic
Rural Areas: Garfield 100% Rural
↓Income, ↑Unemployment, ↑% children in Poverty
↓Homeless, ↑physical inactivity, ↓exercise opportunities
↑Uninsured: Undocumented, ineligible
Higher % of CHIP coverage vs. WA State: Young families
MCO Coverage: Molina, Coordinated Care, CHPW (80%)
↓ Provider ratios (PCPs, Dentists, BHS), ↓% people with personal provider

5. We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics
Project Categories
Chronic Disease: ↑Adult obesity, ↑Diabetes but good monitoring and testing: blood sugar, eyes, kidney
Concentrations: Yakima, SE WA corner
Other: ↓Asthma, ↓depression
Mental Health: Average % adults with poor mental health
↓Mental health, CD/SA treatment penetration
↓ Psychiatric inpatient readmission (30-day)
Dental: ↑people receiving dental services
Gaps: Whitman Health Network

6. Project Categories ↑Contraception coverage (including LARC)
We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics
Project Categories
↑Contraception coverage (including LARC)
Very high STD rates: Chlamydia
↑Teen pregnancy: Cultural?
↓Well-child visits
↑childhood immunization rates
Some overuse of antibiotics in children
Opioid Abuse: Significant problem
↑chronic users across age, gender, and ethnicity
↑MAT with Buprenorphine

7. We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics
Project Categories
Biggest overall concern: ↑ ED visits and ↑ potentially avoidable ED visits
Some of the highest rates in WA State
Across all age groups
↑Preventable hospital days
↓All-cause inpatient readmission (30-day)

8. Summary Biggest areas of concern:
We’ve extracted data from a lot of places but we still have not come up with data on all of the MTD metrics
Summary
Biggest areas of concern:
ED visits and potentially avoidable ED visits
Chronic opioid abuse
Mental health and CD/SA penetration
Well-child visits
High teen pregnancy and STD rates
Preventable inpatient hospital days

9. Re-Formation of Priority Work Groups into Project Teams
GCACH Priority Work Group
MTP Project Team
Project
Behavioral Health
Bi-Direction Integration of Care &
Primary Care Transformation
32%
Addressing Opioid Use Public Health Crisis 4%
Care Coordination
Care Coordination (Pathways Hub)
22%
Transitional Care
13%
Diversion Interventions
Healthy Youth & Equitable
Communities
Reproductive and Maternal/Child Health 5%
Oral Health
Access to Oral Health Services 3%
Diabetes/Obesity
Chronic Disease Prevention and Control 8%

10. Project Objective/Goal
MTP Project Team
Project
Project Objective/Goal
MTP
Weight
Bi-Direction Integration of Care &
Primary Care Transformation
Example: Team Based model that adds a behavioral health care manager and a psychiatric consultant to support the primary care provider’s mgmt. of individual patients’ behavioral health needs 2A
Project Objective: Through a whole‐person approach to care, address physical and behavioral health needs in one system through an integrated network of providers, offering better coordinated care for patients and more seamless access to the services they need. This project will support and advance Healthier Washington’s initiative to bring together the financing and delivery of physical and behavioral health services, through MCOs, for people enrolled in Medicaid.
Required
32%
Addressing Opioid Use Public Health Crisis Example: AMDG’s Interagency Guideline on Prescribing Opioids for Pain, CDC Guideline for Prescribing Opioids for Chronic Pain, Substance Use during Pregnancy: Guideline for Screening and Management 3A
Overarching Goal: Support the achievement of the state’s goals to reduce opioid‐related morbidity and mortality through strategies that target
prevention, treatment, and recovery supports. 4%
Care Coordination (Pathways Hub) 2B
Project Objective: Promote care coordination across the continuum of health for Medicaid beneficiaries, ensuring those with complex health needs are connected to the interventions and services needed to improve and manage their health.
Optional
22%
Transitional Care Example: A nurse led model of transitional care for high-risk older adults that provides comprehensive in-hospital planning and home follow-up
Diversion Interventions Example: A systematic approach to re-directing and managing persons who present at the ED nor non-emergency conditions, which may be oral health, general physical health, and/or behavioral health conditions. 2C 2D
Overarching goals: Improve transitional care services to reduce avoidable hospital utilization and ensure beneficiaries are getting the right care in the right place.
Overarching Goal: Implement diversion strategies to promote more appropriate use of emergency care services and person‐centered care through increased access to primary care and social services, especially for medically underserved populations.
13%
Reproductive and Maternal/Child Health Example: Nurse Family Partnership, Early Head Start 3B
Overarching goal: Ensure that women have access to high quality reproductive health care throughout their lives and promote the health and safety
of Washington’s children. 5%
Access to Oral Health Services Example: Mobile/Portable Dental Care 3C
Overarching goal: Increase access to oral health services to prevent or control the progression of oral disease and ensure that oral health is recognized as a fundamental component of whole‐person care. 3%
Chronic Disease Prevention and Control Example: Stanford Chronic Disease Self-Mgmt Program 3D
Overarching Goal: Integrate health system and community approaches to improve chronic disease management and control. 8%

11. Medicaid Transformation Project
Certification & Application process for ACHs
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
Apr
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

12. Project Selection Process
Timeline
Project Selection Process
April 20 – May 3
Leadership Council Meeting
Re-form 5 Priority Work Groups into 7 Project Teams
Confirm/Select Project Team Facilitator
Review MTD Approaches/Strategies
Review Data
Community Asset Inventory
Assess Subject Matter Expertise on Team
May Conference Call Project Team Facilitators (PTF)
Review Preliminary Regional Survey Results
Project Team Facilitators Discuss Measures of Commonality between projects
Determine 2-3 Approaches/Strategies for each Project Category
May 18
Receive Regional Survey Results
Receive Report from Project Facilitators
Breakout into Project Teams to determine 2 Project Approaches/Strategies
Develops/Modifies Evaluation Criteria for Scoring final projects
May 18 Board of Directors
Approves Project approaches/Strategies from Project Teams
May 19 - June 15 (PTF)
Finalizes evaluation criteria for scoring final projects
May 22 – June 16
World Cafés to showcase local programs to Public
June 22
Project Team Facilitators recommend projects for full application process Leadership Council recommends application template for approval
Leadership Council recommends projects to Board
June 22 Board of Directors
Board approves projects to move to full application process
Board approves application template
July ?
Letters of Application Due
July 20 Board Meeting
Board approves final projects for Project Plan Application
July - October
Obtain attestations with organization, Write Project Plan Application

13. 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!