1. Washington State Health Care Innovation A Five-Year Plan
Health Care Innovation Planning
Washington State Health Care Innovation A Five-Year Plan
Northwest Portland Area Indian Health Board Consultation
October 23, 2013

2. State Health Care Innovation Planning
Introductions
Karen Merrikin, Contracted Project Director, State Healthcare Innovation Planning
Jenny Hamilton, Health Care Authority
Aims:
By 2019 , 80 percent of Washington residents and their communities will be healthier
Medicaid clients with physical and behavioral comorbitieis will have improved health outcomes at lower cost
annual state-purchased healthcare cost growth will be 2% less than national health expenditure trend. 12

3. Aims for Transformation
State Health Care Innovation Planning
Aims for Transformation
Aims:
By 2019 , 80 percent of Washington residents and their communities will be healthier
Medicaid clients with physical and behavioral comorbitieis will have improved health outcomes at lower cost
annual state-purchased healthcare cost growth will be 2% less than national health expenditure trend.
Healthy people and communities
Better care
Affordable care 12

4. State Health Care Innovation Planning
Today’s Objectives
Overview of the aims and major proposed innovations of the Innovation Plan
Opportunity to Share Ideas and Insights

5. Adjusted Timeline Context: Not a Testing Grant; a Planning Grant
Possible second-round of Testing Grants in 2014
Adjusted Timeline for Planning Grant:
Draft Plan available end of October
Collect feedback on the Draft Plan through mid- November
Refine plan through early December
Finished plan document due to CMMI by December 31 8

6. 730 Members of the SHCIP Feedback Network
State Health Care Innovation Planning
730 Members of the SHCIP Feedback Network
Executive Oversight
Project
Director
Consultant Team
State Core Team
In-Kind Experts & Staff
The Innovation Planning process has involved hundreds of people from across the state.
-- A dozen leaders from 10 state agencies have met regularly as part of project oversight
-- Consultants from the private sector have convened small groups and conducted surveys. This part of the process has involved a couple of hundred industry leaders from across the state.
-- In addition to this, we’ve communicated with 730 members of the State Health Care Innovation Feedback network and, from that group, we’ve collected over 100 pages of thoughts, ideas, and suggestions for improvements.
Our state team, consultants and stakeholder worked on questions such as these:
--What is the system now?
--What might it be?
--Which good work already under way in our state and evidence-based practices might we build on?
--How will changes we’re considering impact Washington’s heath care system?
--What will the return on investment be?
--What kind of workforce will we need?
Questions like these came from the Feedback Network:
--What about the quality innovations already under way in our state?
--Are we going to focus on whole-person care?
--Are promising practices going to be considered along side best practices?
--What about Behavioral Health, Oral Health and Housing? 9

7. Before we get started, a few definitions
State Health Care Innovation Planning
Before we get started, a few definitions
Accountable Communities of Health – Locally governed, public- private partnership organizations bringing together and supporting communities, sectors, and systems—including health and social service providers, risk-bearing entities, counties, public health and tribes. ACHs link, align and act on achieving community health improvement goals and encourage cross-sector resource sharing.
Fee for Service – Today’s primary payment model – rewards volume.
Integrated Physical and Behavioral Care – A practice team of primary care and behavioral health clinicians working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care (AHRQ lexicon definition)
Value Based Payment – Outcomes based payment model linked to health outcomes, patient experience and utilization effectiveness.
Aims:
By 2019 , 80 percent of Washington residents and their communities will be healthier
Medicaid clients with physical and behavioral comorbitieis will have improved health outcomes at lower cost
annual state-purchased healthcare cost growth will be 2% less than national health expenditure trend. 13

8. The Washington Way: Focus on Health
State Health Care Innovation Planning
The Washington Way: Focus on Health
Washington’s innovation plan focuses not only on achieving better value for medical care, but also strives to better align health systems with community transformation initiatives to support the underpinnings of lifelong health.

9. The Washington Way: Improve Care
State Health Care Innovation Planning
The Washington Way: Improve Care
Change how care is delivered and connected to communities by:
Aligning financial incentives
Using common measures and driving transparency
Enabling practice transformation
Strengthening our health information infrastructure
Modernizing our workforce
Providing people with access to tools and resources for health and wellness
Creating greater local accountability
Not ready for sharing

10. Information Technology
State Health Care Innovation Planning
The Big Picture
Nutritious Food
Education
Employ- ment
Mental Health
Crisis Intervention
Built Environment
Physical Health
Oral Health
Public Health
Family Support
Whole
Person
Housing
Transpor- tation
Criminal
Justice
Substance Abuse
Long-Term Care
Community
Measure-ment
Consumer Engagemt
Financing
& Admin
Health & Recovery
Information Technology
Practice Transfor- mation
Workforce Develop ment
System Supports

11. The Washington Way: Guiding principles
State Health Care Innovation Planning
The Washington Way: Guiding principles
Care is patient centered, equitable, based on evidence*, with a heavy focus on prevention
Payments are based on quality outcomes and value, not volume
A core measure set is used by all payers and purchasers across the community
Delivery system and payer performance is measured, and results are transparent and available to employers/purchasers and consumers
A person’s care is seamless and integrated with community resources, social services and public health
Workforce is effectively trained and efficiently meets demand
Consumers are engaged in their health and the health of the community
Health disparities systematically addressed and health equity promoted
Not ready for sharing

12. Information Technology
State Health Care Innovation Planning
The Big Picture
Nutritious Food
Education
Employ- ment
Mental Health
Crisis Intervention
Built Environment
Public Health
Physical Health
Oral Health
Family Support
Whole
Person
Housing
Transpor- tation
Criminal
Justice
Substance Abuse
Long-Term Care
Community
Measure-ment
Consumer Engagemt
Financing
& Admin
Health & Recovery
Information Technology
Practice Transfor- mation
Workforce Develop ment
System Supports

13. The Washington Way: The Innovation Plan – Health and Recovery
State Health Care Innovation Planning
The Washington Way:
The Innovation Plan – Health and Recovery
Achieve greater accountability for improved health outcomes and total cost of care
Foster strong and efficient primary care
Support effective care management and care transitions
Move care to less costly settings and methods
Reduce unwarranted variation and waste
Better integrate physical and behavioral health services and supports
Support evidence based practice and effective use of technology
Emphasize prevention and effective management of chronic illness
Post reform, Washington state will pay for the care of more residents than any other payor, including Medicare. At least 25% of all state residents, or over 1.5 million individuals.

14. The Washington Way: The Innovation Plan – System Supports
State Health Care Innovation Planning
The Washington Way:
The Innovation Plan – System Supports
Enhance data and information infrastructure
Planned build out of all payer claims database
Common statewide performance measures, transparency sensitive to rural/urban and populations served
Expanded health information exchange & shared care planning capabilities
Elimination or reduction of payment/administrative silos
Innovations in “geomapping” and hotspotting to enable community focus on health inequities and targeted strategies and tactics and measure progress over time
Post reform, Washington state will pay for the care of more residents than any other payor, including Medicare. At least 25% of all state residents, or over 1.5 million individuals.

15. The Washington Way: The Innovation Plan – System Supports
State Health Care Innovation Planning
The Washington Way:
The Innovation Plan – System Supports
Primary Health Regional Extension System
Hub – convener, coordinator, clearinghouse
Spokes within regions – local support for practice transformation and community priorities
Workforce Development & Support
Primary care loan repayment
Career ladder support
Community Health Worker
Telehealth services

16. The Washington Way: The Innovation Plan – System Supports
State Health Care Innovation Planning
The Washington Way:
The Innovation Plan – System Supports
Individuals and Families Activation and Engagement
Community Health Workers – health education, connectors to clinical and community resources
Tools and resources to help individuals make informed, shared decisions about care with providers
Robust wellness programs as part of benefits and linked to community resources
Post reform, Washington state will pay for the care of more residents than any other payor, including Medicare. At least 25% of all state residents, or over 1.5 million individuals.

17. The Washington Way: Getting the Cogs to Move in Alignment
State Health Care Innovation Planning
The Washington Way:
Getting the Cogs to Move in Alignment
Coordinate and integrate the delivery system with community services, social services and public health
Create 7-9 regional service areas
Medicaid procurement moves to these 7-9 regions
Accountable Community of Health organization within each region
Better cross sector alignment on statewide priorities
Local solutions thrive
Regional Extension Center “spoke” within each region
Key state community service supports better aligned with regions over time
Transformation trust fund supports innovation
Post reform, Washington state will pay for the care of more residents than any other payor, including Medicare. At least 25% of all state residents, or over 1.5 million individuals.

18. 7-9 Regional Service Areas (9 region map)
State Health Care Innovation Planning
7-9 Regional Service Areas (9 region map) 34

19. 7-9 Regional Service Areas (7 region map)
State Health Care Innovation Planning
7-9 Regional Service Areas (7 region map) 35

20. State Health Care Innovation Planning
The Washington Way:
Bringing it all together: Physical and Behavioral Health Solutions
Post reform, Washington state will pay for the care of more residents than any other payor, including Medicare. At least 25% of all state residents, or over 1.5 million individuals.

21. State Health Care Innovation Planning
The Washington Way:
Bringing it all together: Physical and Behavioral Health Solutions
Post reform, Washington state will pay for the care of more residents than any other payor, including Medicare. At least 25% of all state residents, or over 1.5 million individuals.

22. We agree The Washington Way:
State Health Care Innovation Planning
The Washington Way:
Bringing it all together: Physical and Behavioral Health Solutions
“The evidence for integrated mental health care is now so extensive that researchers and policy makers urge that efforts be shifted from studying the approach to helping healthcare organizations implement it.”
- University of Washington AIMs Center
We agree
Post reform, Washington state will pay for the care of more residents than any other payor, including Medicare. At least 25% of all state residents, or over 1.5 million individuals.

23. State Health Care Innovation Planning
The Washington Way:
Bringing it all together: Physical and Behavioral Health Solutions
Restructure Medicaid procurement on a phased basis to better support integrated physical, mental health and substance use/abuse treatment & support services
Strengthen Washington’s Accountable Communities of Health infrastructure to support both integration, and upstream prevention
Post reform, Washington state will pay for the care of more residents than any other payor, including Medicare. At least 25% of all state residents, or over 1.5 million individuals.

24. State Health Care Innovation Planning
The Washington Way:
Bringing it all together: Physical and Behavioral Health Solutions
3. Use existing and new state levers to spread and sustain integrated models of physical and behavioral health care
Practice transformation support and resources
Workforce capacity and flexibility
Shared clinical information sharing – new tools, resources and training
Outcome based payments to providers
Post reform, Washington state will pay for the care of more residents than any other payor, including Medicare. At least 25% of all state residents, or over 1.5 million individuals.

25. State Health Care Innovation Planning
Healthy Communities
Today: Health and wellness efforts are not coordinated or integrated, although many communities are taking action as first movers.
Vision: Across the state -
Bring organizations together with common goals for improved health at the local level, and capacity to address local priorities

26. Accountable Communities of Health – The Washington Way
State Health Care Innovation Planning
Accountable Communities of Health – The Washington Way
Philosophy and structure that recognizes the value of collective action and shared responsibility to achieve health
ACHs are formal entities – regionally governed, public private partnership organizations 44

27. Accountable Communities of Health – The Washington Way
State Health Care Innovation Planning
Accountable Communities of Health – The Washington Way
ACH accountabilities
Develop a region wide health needs assessment, set common agenda
Act as the facilitator of learning and continuous quality
Fund manager and broker for aligned community initiatives
“Home” for shared services
Structure, governance and development of ACH model – still many opportunities to shape, public health a key partner 45

28. The Big Picture for Washington
State Health Care Innovation Planning
The Big Picture for Washington
Health Information Exchange & Shared Care Planning
Payment Linked to Outcomes
Healthy Communities
Healthy People
Performance Measurement & Transparency
Practice Transformation Support
Modified from “Framework for DE’s health transformation,” Delaware’s State Health Care Innovation Plan
Workforce Capacity

29. State Health Care Innovation Planning
Next Steps
The Draft Plan will be available October 31: ages/resources_and_document s.aspx
Sign up for the Feedback Network to receive updates:
PLAN

30. Dialogue Whole person care – physical and behavioral health
State Health Care Innovation Planning
Dialogue
Whole person care – physical and behavioral health
Tribal Centric Behavioral Health Plan
Accountable Communities of Health
Regions under consideration – input? Boundaries?
Tribal, AI/AN engagement
Innovative programs and practices
Your advice and guidance to us

31. Thank You Contribute to Innovation Planning:
State Health Care Innovation Planning
Thank You
Contribute to Innovation Planning:
Stay informed via the SHCIP website:
Share your thoughts by ing the SHCIP Help Desk: