1. Using NCACH Project Metrics to determine our Collective Impact
Chelan-Douglas CHI
May 9, 2018

2. NCACH has selected 6 Medicaid Transformation Projects to implement across Chelan, Douglas, Grant, and Okanogan counties
These projects are all held accountable by metrics issued by the HCA
NCACH, its partnering providers, and members of the community all have a role to play in achieving these metrics
All projects and funding are aimed at supporting Medicaid beneficiaries, with the assumption that by improving quality of care and access to services for low-income and underserved populations will in turn improve quality of care and access to services for all through a strengthened system

3. Project Objective Bi-Directional Integration of Care
Through a whole-person approach to care, address physical and behavioral health needs in one system through an integrated network of providers
Community-Based Care Coordination (aka Pathways Community HUB)
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 their health
Transitional Care
Improve transitional care services to reduce avoidable hospital utilization and ensure beneficiaries are getting the right care in the right place
Diversion Intervention
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
Addressing the Opioid Use Public Health Crisis
Support the achievement of the state’s goals to reduce opioid-related morbidity and mortality through strategies that target prevention, treatment, and recovery supports
Chronic Disease (e.g. cardiovascular, respiratory, diabetes, obesity, stroke, arthritis, etc) Prevention and Control
Integrate health system and community approaches to improve chronic disease management and control

4. HCA Performance Metrics
2A: Integration
2B: Pathways
2C: Transitional
2D: Diversion
3A: Opioid
3D: Chronic
Total
Outpatient Emergency Department Visits per 1000 Member Months 1 6
Inpatient Hospital Utilization 5
Follow-up After Discharge from ED for Mental Health 3
Follow-up After Discharge from ED for Alcohol or Other Drug Dependence
Follow-up After Hospitalization for Mental Illness
Percent Homeless (Narrow Definition)
Plan All-Cause Readmission Rate (30 Days)
Substance Use Disorder Treatment Penetration 2
Mental Health Treatment Penetration (Broad Version)
Child and Adolescents' Access to Primary Care Practitioners
Comprehensive Diabetes Care: Eye Exam (Retinal) Performed
Comprehensive Diabetes Care: Hemoglobin A1c Testing
Comprehensive Diabetes Care: Medical Attention for Nephropathy
Medication Management for People with Asthma (5-64 years)
Substance Use Disorder Treatment Penetration (Opioid)
Antidepressant Medication Management
Patients on high-dose chronic opioid therapy by varying thresholds
Patients with concurrent sedatives prescriptions
Percent Arrested
Statin Therapy for Patients with Cardiovascular Disease (Prescribed)

5. HCA Performance Metrics - Unpacked
2A: Integration
2B: Pathways
2C: Transitional
2D: Diversion
3A: Opioid
3D: Chronic
TotalR
Reduce Outpatient Emergency Department Visits incl. visits for mental health & chemical dependency 1 6
Reduce Inpatient Hospital Utilization 5
Reduce number of follow-up visits/hospitalization within 30-days by beneficiaries who had were hospitalized 3
“^” After Discharge from ED for Alcohol or Other Drug Dependence
“^” Follow-up After Hospitalization for Mental Illness
Reduce rate of beneficiaries who experience homelessness ≥ 1 month (excludes “homeless with housing”)
Reduce readmission (within 30 days) rates to hospital to those who have been discharged
Ensure that those who need SUD services and treatment get them 2
Ensure that those who need mental health services get them
Ensure that children and adolescents receive annual visits with a primary care provider
Ensure that clients with diabetes are receive a retinal/dilated eye exam by eye care professional
Reduce number of clients with diabetes whose last A1c Hemoglobin test was recorded > 9% (poor control)
Ensure that clients with diabetes are screened for nephropathy (kidney function test)
Ensure that clients with asthma are dispensed and have access to appropriate medications and treatment
Ensure that clients identified with a SUD for opioids receive SUD treatment and support
Ensure that clients with a diagnosis of major depression and were newly treated with depression meds stay on them
Monitor and reduce number of Patients on high-dose chronic opioid therapy by varying thresholds
Monitor and reduce number of Patients with concurrent sedatives prescriptions
Reduce Percentage of Medicaid enrollees Arrested
Ensure that clients with ACSVD (heart disease) are dispensed appropriate medications and treatment

6. Unpacking the Metrics
Symptoms of the problem
PROBLEM
Root Causes

7. Unpacking the Metrics
Medication Management for People with Asthma ages
More hospital (ED) visits for asthma related issues (e.g. attacks)
Lower population health
Increased financial burden on families managing asthma
Lower life expectancy
Poor academic or job performance from absences, etc
More use of EMS (e.g. ambulance called for asthma attack)
ASTHMA MEDICATION MANAGEMENT
Links between agricultural operations and chronic respiratory illnesses
Socioeconomic status = living conditions +/- likely to experience asthma
Lack of health literacy around individual asthma management
Transportation may create barriers to accessing care or pharmacy
Costs of medications may cause barriers or hardship
Employment may make it hard to get to regularly scheduled appointments
Limited non-clinical support to help with disease education and management
Overburdened medical system – hard to get in with PCP or in some cases find one

8. Prevention Strategies
5 Levels of Prevention for Health Issues or Conditions:
Primordial – Addressing known factors that are a threat to population health (e.g. banning cigarettes or seatbelt laws)
Primary – Level of prevention at which health promotion measures are taken before clinical intervention (e.g. receiving vaccinations, eating nutritious meals, exercise, reproductive health education & services)
Secondary – Taken after one is exposed to illness (e.g. screening tests for common risks, like colonoscopies, blood pressure, or mammograms; BH services for those who may be at risk of suicide); used to detect at early stage to avoid more costly measures
Tertiary – Lifestyle of person after developing disease – maximize longevity or quality of life (e.g. insulin for diabetes management; SUD services and support)
Quaternary – Keeping people from at risk from over-medication or unnecessary or excessive intervention from health system (e.g. protecting homeless or elderly from over-diagnosis or being excessively medicated; palliative care; support services for those with life-long disabilities)

9. + Medicaid Project Objectives
Small group exercise:
NCACH Project Metrics
+ Medicaid Project Objectives
+ Chelan-Douglas Goals Identified in March
X Prevention Strategies
= Our Collective Impact

10. ROOT CAUSE AND SYSTEMIC EVALUATION
PREVENTATIVE STRATEGIES & PARTNERSHIP OPPORTUNITIES FOR: (WRITE METRIC BELOW)
ROOT CAUSE AND SYSTEMIC EVALUATION
What sequence of events lead to the problem?
What conditions allow the problem to occur?
What other problems surround the occurrence of the central problem?
PREVENTION
PRIMORDIAL & PRIMARY PREVENTION STRATEGIES
(How do we stop this problem from occurring in the first place?)
SECONDARY PREVENTION
(What do we do now that this problem exists?)
TERTIARY & QUATERNARY PREVENTION
(What long term responses can we take to mitigate and manage this problem and its affects?)
What can your client do?
What can CBOs and other non-clinical partners do?
What can clinical partners do?
Opportunities for Partnership or Collaboration?
What outside funding opportunities exist to support these strategies?
Which of the goals identified during the March 2018 meeting align with these strategies?

11. Resources:
HCA Healthier Washington Dashboard - dashboards
HCA Medicaid Transformation Project Metrics - guide.pdf