1. Behavioral Health Committee Benton-Franklin Community Health Alliance
October 4, 2017

2. ACH “101”Goals for today What is the Healthier Washington Initiative?
Who is Greater Columbia Accountable Community of Health?
What does the region’s health look like?
Behavioral Health data in Benton & Franklin Counties
How much money is dedicated for Transformation?
What projects have been determined through the Project Teams?

3. Better Health, Better Care, Lower Costs

4. Healthier Washington recognizes that health is more than health care.
- Health systems transformation is not just health care reform--this really is about all the systems that affect health, not just medical care.
- The current system:
- Separates the “head” from the “body” —no integration between services for physical health, mental health and chemical dependency.
- Focuses on volume of services provided, not quality of outcomes.
- Is expensive, and getting more so, without producing better results.
Health is more than health care.
HW is grounded in an understanding that health is more than health care – that 80% of the factors that affect a person’s health occur outside of the health care system.
Improving people’s health outcomes (and lowering costs) will depend on addressing those factors and linking supports for them to the health care delivery system.
- Health encompasses community (nutritious food, housing, public health), system supports (measurement, consumer engagement, workforce development) and health & recovery efforts (mental health, long-term care, oral health).
Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper, State Quality Improvement Institute.. Minnesota. 3
Better Health, Better Care, Lower Costs

5. ACHs are a forum for regional collaborative
decision making

6. Nine ACHs in Washington

7. Population & Medicaid # by County
OFM
Population on Medicaid*
% of Population on Medicaid
% of GCACH Pop
on Medicaid
Asotin
22,150
6,863
31%
2.7%
Benton
190,500
58,427
22.9%
Columbia
4,050
1,177
29%
0.5%
Franklin
88,670
36,178
41%
14.2%
Garfield
2,200
665
30%
0.3%
Kittitas
43,710
10,436
24%
4.1%
Walla Walla
60,730
17,155
28%
6.7%
Whitman
47,940
8,392
18%
3.3%
Yakima
250,900
116,133
46%
45.5%
Population GCACH
710,850
255,426
35.9%
100%
Population WA
7,183,700
1,909,374
26.6% **

8. GCACH Differentiations
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
26.6%
35.9%
Below Poverty
12.9%
19.5%

9. Regional Needs Assessment
Measures for which all counties in the region had outcomes worse than the state
Access to dentists
Access to exercise opportunities
Access to mental health providers
Children in poverty
Healthy community design
Median household income
Poor academic performance

10. Medicaid Transformation Demonstration

11. Over $100 million in Provider Incentives

12. Incentive Dollars Bridge to VBP

13. 8 Project Teams formed to study Transformation Projects

14. 6 project areas chosen August 22
Bi-Directional Integration of Physical and Behavioral Health
Community-Based Care Coordination
Transition Care
Diversions Interventions
Addressing the Opioid Crisis
Chronic Disease Prevention and Control

15. 2A: Bi-Directional Integration of Physical and Behavioral Health through Care Transformation (Required)
Source: RWJF County Health Rankings

16. Benton & Franklin Counties have many measures worse than the State Average
Washington Health Alliance Community Check-up 2016

18. Bi-Directional Goals FIMC
Increase access to integrated primary care-behavioral health services by maximizing tenants of the Bree Collaborative (increasing access) Collaborative Care Model (maximizing patient tracking), internal and external co-location.
FIMC
Goal 4
Fully integrate physical health, mental health, and substance use services in order to provide the right care, in the right place, at the right time.
Goal 3
Identify a regional approach to data collection / registries to improve population health (PHQ-9, SBIRT, PAM).
Increase interoperability between providers and systems to increase efficiencies, improve communication, and reduce redundancies.
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)

19. Integrated managed care is evolving and spreading!

20. 3A: Addressing the Opioid Use Public Health Crisis (Required)
Goal: To reduce opioid-related morbidity and mortality through strategies that target prevention, treatment, and recovery.
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)

22. Opiate Related Deaths: 1999-2015
WA State Dept. of Health, Center for Health Statistics

23. 2012-2015: Deaths per County (opioid related)
: Rate per 100,000 population
Asotin 12
10.8
Benton 84
9.3
Columbia 2
too few to calc.
Franklin 17
4.4
Garfield
Kittitas
9.1
Walla Walla 25
8.5
Whitman 13
8.1
Yakima 65
5.5
From 2002 to publicly funded treatment admissions involving an opioid, statewide, went up 196.5%. Three counties in the GCACH increased over 250%.* *

24. MTD Toolkit: Pay for Performance Metrics

25. Carol Moser, Executive Director: cmoser@greatercolumbiaach.org
Wes Luckey, Program Manager: