1. Medicaid Transformation Project Demonstration
SE WA
Medicaid Transformation Project Demonstration
Benton county Democratic Central Committee
July 19, 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. 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

4. 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

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 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.
- 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
Better Health, Better Care, Lower Costs

8. 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

9. Medicaid Transformation Objectives
Improve population health—prevention and management of diabetes, cardiovascular disease, mental illness, substance use disorders, oral health and more
Reduce avoidable use of intensive services and settings—such as acute care hospitals, nursing facilities, psychiatric hospitals, traditional long- term services and supports, and jails
Accelerate the transition to value-based payment—using payment methods that take the quality of services and other measures of value into account
Ensure that Medicaid cost growth is 2% below national trends—through services that improve health outcomes and reduce the rate of growth in the overall cost of care
Provide flexibility to fund traditional and non-traditional services for targeted populations

11. Initiative 1: What Will Be the Role of ACHs?
Coordinating Medicaid Projects at the Regional Level 11

12. 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

13. 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

14. Regional Needs Assessment

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

16. 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)
Emphasis (80%) on funding programs that lead to integration, coordination of care and reduction of institutional services
Estimated Potential Annual Funding Earned are subject to modification based on Project Plan scorning performance and HCA revision

17. 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
Planning
Oct 12th
Nov 16
Project Plan Application Due
Participating Provider LOIs/RFQs due
Project Plan Development
Q1 2017
Q2 2017
Q3 2017
Q4 2017
Jan 2018

18. Questions?
For more information: Carol Moser Website:
Thank you!
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.