1. Council Meeting Winfried Danke, CEO MARCH 8th, 2018

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

3. CPAA Mission Statement
CPAA is improving community health and safety while advancing the Triple Aim: improving health equity, promoting whole person care, and reducing per-capita health care costs while improving the quality of care.

4. Proposed Agenda Items
Review Payment Portal Registration and Capacity Assessment Letters
Appoint new MCO Board Director
Debrief Meeting with Tribal Health Directors
Check in with Work Groups and Advisory Committees
Learn about CPAA’s Participant Survey & Identify Next Steps for Improvement
Update on IGT and Shared Domain 1 Investments &
Board Business
Shared Learning: Care Integration

5. Payment Portal Registration & Capacity Assessment Letter
What are these letters?
What do you want me to do?
Who can help me if I have questions?

6. MCO Board Director Appointment
Resignation received, effective March 30
Randy Barker, Molina
Review application received
Kat Ferguson-Mahan Latet, CHPW
Election Process
Majority vote of sector members
Nomination and Appointment
MCO representatives vote

7. Meeting With Tribal Health Directors (2/21)
Tribal Health Directors in Attendance:
Denise Walker, Confederated Tribes of the Chehalis
Kay. A. Culbertson, Cowlitz Indian Tribe
Kim Zillyett-Harris, Shoalwater Bay Tribe
Aliza Brown, Quinault Indian Nation

8. Meeting With Tribal Health Directors
Main Outcomes:
CPAA will visit with each tribe to develop a customized plan for transformation participation
CPAA tribal engagement goals being adjusted based on input from tribal Health Directors
Tribal Health Directors agreed to meet every other month with CPAA to identify and assess tribal implications of CPAA actions
Funding to be distributed equally among tribes
Kay A. Culbertson, Cowlitz Indian Tribe Health Director, will help with final interviews for CPAA Community and Tribal Liaison position

9. Work Group Check-in Met February 27th and 28th Discussed:
ACEs Work Group
Pathways Work Group
Met February 27th and 28th
Webinar – Pathways
In-Person – ACEs Work Group
Discussed:
Day in the life of a care coordinator
Forming Core Planning Team
Logic Models
Metrics
Next work group meetings:
Pathways – March 27th
ACEs – March 28th

10. Work Group Check-in Bi-Directional Care Integration Care Transitions
Chronic Disease
Opioid Response
Welcome - Alexandra Toney
Met February 27th and 28th via webinar
Discussed:
Domain 1 Strategies
Education Campaigns
Next milestones
Next work group meetings:
Opioid – March 21st
Others – March 27th

11. Advisory Committee Check-in
Clinical Provider Advisory Committee
Meets March 20th
Consumer Advisory Committee
February 13th at Great Wolf Lodge
Reviewing ACH Assessment

12. ACH Participant Survey
Lisa Schafer, CCHE
Michelle Chapdelaine, CCHE

13. Shared Domain 1 Investments
Update on meeting with IGT Contributors/ACHs

14. Meeting with IGT Contributors 2/14/18
In Attendance:
ACHs
Association of WA Public Hospital Districts (AWPHD)
UW Medicine
Main Outcomes:
Value-based care alliance b/w UW Med/AWPHD (80/20)
AWPHD: 45% of IGT incentive payments for Move to Value Fund
UW: Facilitating access to expertise but ACHs have to pay for services (e.g., AIM Center)
No “menu of services”
Identify common gaps across the state and work together to address gaps?

15. Board Action Items (3/8/18)
Approval of Previous Meeting Minutes
Officer Elections
Approval of first round of IGT Partnering Provider Payments per Provider Achievement Report for a total of $4,096,090
Approval of CEO Performance Evaluation Process, Timeline and Evaluation Form
For complete agenda, see staff.

17. Oral Health Integration
David Meyers, DDS
Cowlitz Family Health Center Dental Director

18. Integrated SYSTEMS OF CARE (Part 2) March 8th , 2018

19. Agenda
General overview of Project 2A: Bi-Directional Integration of Care
Integration of Project Areas
Group Discussion on care integration

20. Bi-Directional Integration of Care Overview
Objective: Through a whole person approach to care, address physical and behavioral health needs in one system through an integrated network of providers, better coordinated care, and better access to services
Six levels on integration
Coordinated
Co-located
Integration
Two primary evidence based approaches used
Collaborative Care Model (CoCM)
Bree Collaborative
Discussed Strategies
Implement screening tools
New team roles
Quality Measure
Medication adherence

21. Systems of Integrated Care
Domain 2: Care Delivery Redesign
2A: Bi-directional integration of care
Kyle Roesler
2B: Community-based care coordination
Michael O’Neill
2C: Transitional Care
Alexandra Toney
Domain 3: Prevention and Health Promotion
3A: Addressing the opioid use public health crisis
Malika Lamont
3B: Maternal and child health
Jennifer Brackeen
3D: Chronic disease prevention and control
Alexandra Toney
CPAA decided on six project areas which are listed on the slide along with the Program Managers.
Bi-Directional Care can be viewed as the cornerstone of all the project areas.
It is a required project by HCA
Primary care setting
Includes medical and behavioral health resources
But we must be sure not to silo the projects because many of the project metrics can be addressed in one appointment, by one provider, using screening and assessment tools.
We want providers to think about how they can change several areas at one time
Making changes at a clinic level
In my experience, a lot of changes can be made during initial screening or assessment of the patient before doctor every sees them
Adding the PHQ-9 to every screening in Primary Care
nurse take blood pressure and documents BMI before every psychiatry appointment
Sharing of care plans
I want us start thinking about how the six projects are connected.
Next Slide

22. Care Integration Challenges Several payers Data sharing
Numerous Project Managers
Opportunities
Address several areas in one visit
Overlapping target populations
Shared metrics
When we start to think about the project areas as one integrated portfolio, there are some challenges we need to overcome, but also many opportunities.
Several payers
MCOs
BHOs
Data Sharing
Interoperability EHRs
42 CFR which restricts certain information being shared (without consent)
Shared care plans not only clinically but with Community Based Organizations
Even with our own structuring of project implementation
Program Managers for specific areas
Good because they can become a SME, but naturally creates silos
Work Groups – invaluable input but only focus on the needs of that one project area
Plan itself – we had to write a proposals and implementation plan for project specific areas
We have to be mindful to talk to each other and combine efforts when we can
Despite the challenges there is tremendous opportunities for us to transform health care into a whole-person approach by integrating the project areas.
Ability to address multiple metrics in one visit
Patient walks into primary care and nurse brings up the template
Patient filled out the PHQ-9 (depression screening complete)
Nurse completes the medication reconciliation
Nurse can review the master problem list
Last time A1C complete?
Review the Asthma Care plan?
Immunizations up to date?
Is a well-visit due?
Make appropriate referrals
Patients walks into Behavioral Health Clinic
Same principals
Record BMI, Blood Pressures
Medication Reconciliation
Required screenings
This is why interoperability of BH and medical records are important
Overlapping Target Population
In all project areas, we are looking at the highest risk patients
Dual diagnosis is not uncommon
High utilizers are shared between all projects areas
Shared Metrics
ED Utilization is a metric is all projects areas
In our small group discussions we will look at shared metrics and how to maximize impact
Next Slide

23. Shared Project P4P Metrics (1/1)
October 2017 Medicaid Transformation Project Toolkit Metrics (updated Dec 19, 2017)
Measure Name
2a: Integration
2b: Care Coordination
2c: Transitional Care
3a: Opioids
3b: Reproductive / MCH
3d: chronic disease prevention
Follow-up After Hospitalization for Mental Illness x
Inpatient Hospital Utilization
Mental Health Treatment Penetration (broad)
Outpatient Emergency Department Visits per 1000 Member Months
Plan All-Cause Readmission Rate (30 Days)
Follow-up After Discharge from ED for Mental Health, Alcohol or Other Drug Dependence
Substance Use Disorder Treatment Penetration
Percent Homeless (Narrow Definition)
Comprehensive Diabetes Care: Eye Exam (retinal) performed
Child and Adolescents’ Access to Primary Care Practitioners
Medication Management for People with Asthma (5 – 64 Years)
Comprehensive Diabetes Care: HbA1c Testing
Comprehensive Diabetes Care: Medical attention for nephropathy
These are the metrics out of the October 2017 toolkit including the updates from December 2017 where a few metrics were removed. This is the oversimplified version, it doesn’t go into P4R or P4P and years to start reporting, but a good place to start.
Lines highlighted in orange share 3 or more metrics.
Lines below share two metrics.
13 measures are shared between projects areas, with 7 in at least 3 project areas.
ED utilizations is in all project areas
Inpatient hospitalization is in 5 of the 6
When you look vertically, Integration is in almost all the shared metrics, again why this project is so important.
Questions or comments on this slide?
Next Slide

24. Single Project P4P Metrics (2/2)
October 2017 Medicaid Transformation Project Toolkit Metrics (updated Dec 19, 2017)
Measure Name
2a: Integration
2b: Care Coordination
2c: Transitional Care
3a: Opioids
3b: Reproductive / MCH
3d: chronic disease prevention
Antidepressant Medication Management x
Childhood Immunization Status
Chlamydia Screening in Women Ages 16 to 24
Contraceptive Care – Most & Moderately Effective Methods
Prenatal care in the first trimester of pregnancy
Statin Therapy for Patients with Cardiovascular Disease (Prescribed)
Patients on high-dose chronic opioid therapy by varying thresholds (Measure specification in development)
Patients with concurrent sedatives prescriptions (Measure specification in development)
Substance Use Disorder Treatment Penetration (Opioid) (Measure specification in development)
Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life
Well-Child Visits in the First 15 Months of Life
This slide demonstrates metrics that are not shared between two or more project areas.
11 total
Previous slide

25. Small Group Discussions
How are projects connected?
Work flow
Shared metrics
Target Population
What opportunities do you see?
How can you mitigate challenges?
Who will you need to partner with to be successful?
What support will you need from CPAA to be successful?
2A: Bi-Directional Integration of Care
2B: Community-Based Organizations
2C: Transitional Care
3A: Opioid Response
3B: Maternal and Child Health
3D: Chronic Disease
I’m really trying to get everyone thinking about how these project areas are connected, and not stand alone ideas.
In small groups, I would like for you to start discussion on integrated systems of care, and connecting all six project areas.
READ Slide
Project areas are listed on the right for you to reference.
If each table could please identify a spokesperson to present your groups ideas at the end.
SMALL GROUP DISCUSSION
Would wants to summarize what was discussed in their groups?
I hope this helped you start thinking about integrated care and the goals of the Transformation, and what role you can play as we move forward to implementation.
And to carry that discussion forward even more, I want to welcome Jennifer to discuss the Natural Communities of Care concept.

26. Natural Communities of Care
How do we work together collaboratively to develop an integrated system of care that improves population health outcomes?
Working together cross-functionally and locally to improve population health.
Improve Population Health
Bi-Direction of Care
Pathways
Transitional Care
Opioid Response
Rep.
Maternal Child Health
Chronic Care Model
Share information, leverage and expand workforce, while creating sustainability
Public Health, Hospitals, Primary Care, Behavioral Health, Community Based Organizations, Education, EMS/Fire/Law Enforcement, MCOs, and Tribes

27. Review of Shared Learning
General overview of Project 2A: Bi-Directional Integration of Care
Group Discussion on Care Integration
Questions
Feedback? Did this work for you?

28. Summary and Next Steps
Main meeting outcomes
What worked? What can we do better next time? What do we need to bring to our local forums?
Next Council Meeting:
Thursday, April 12, 2018, 12:00-3:00 PM Great Wolf Lodge Conference Center Old Hwy 99 SW, Grand Mound, WA 98531