1. North Sound Accountable Communities of Health Gary Goldbaum, MD, MPH ggoldbaum@snohd.org March 6, 2015

2. North Sound ACH awarded $150,000 Pilot ACH Grant February 9 to June 30, 2015 Cascade Pacific Action Alliance (CHOICE) also awarded pilot grant Additional funding opportunity anticipated Design Grants of $100,000 awarded to 7

3. The Promise of Pilot ACHs 3 Complete a “startup initiative” to demonstrate the valuable role of ACHs Test and inform ACH designation criteria, to be finalized by the end of 2015 Provide learning opportunities as a peer leader to Design communities Inform the statewide ACH evaluation design, including rapid-cycle learning and improvement

4. The Vision of the North Sound ACH A coalition with the triple aim of transforming the health system:  to improve the health of our communities and our people  to improve the experience of care and access to care  and to lower per capita health care costs in Snohomish, Skagit, San Juan, Island and Whatcom counties

5.  We can accomplish more together than we can individually  Trust, respect, transparency, continuous learning, and data-driven decision- making  Collaboration between sectors is key  Communities must be engaged to shape strategies  The way care is currently organized and delivered will not be effective in achieving our shared aim  To improve overall community health we need to go upstream The Guiding Principles of the North Sound ACH

6. The Process for the North Sound ACH  Build on existing strengths, experiences, & successes  Align efforts with existing state, county or local priorities, outcomes, strategies & metrics.  Create measurable goals, & ensure accountability towards outcomes  Ensure that our plan is clear, robust, well-researched, inclusive, & actionable, yet practical

7. The North Sound ACH Commitment To succeed 1 st with a short-term initiative Committed to sustainable, health improvement and capturing and reinvesting shared savings in prevention The CASE Initiative will continue to build trust while demonstrating the collective impact of working together

8. North Sound ACH Pilot Grant Deliverables Governance “Backbone” (also known as administrative organization) development Regional Health Needs Inventory Initial plan for sustainability CASE Initiative

9. 1% of people account for ¼ of costs

10. CASE Initiative: High level overview  Coordinate care coordination programs that target the highest utilizers of jails, EMS, and EDs  Align on outcome measures and processes  Standardize across programs  Enhance & Expand across programs to bring up to best practice standards CASE Initiative: Coordinate, Align, Standardize, Enhance, and Expand care coordination programs in our region

11. CASE Initiative: Tracking A single, shared Performance Measures Dashboard to display performance in four domains:  Improved outcomes  Reduced costs  Process measures  Sustainability CASE Initiative: Coordinate, Align, Standardize, Enhance, and Expand care coordination programs in our region

12. CASE Initiative: Deliverable  By the end of June:  Produce a regional care coordination operations manual that can be supported by the 5 managed Medicaid plans, and  a mini-business plan using findings from the CASE Initiative. CASE Initiative: Coordinate, Align, Standardize, Enhance, and Expand care coordination programs in our region

13. CASE Initiative: Deliverable cont.  Provide care coordination services to ≥ 200 high utilizers in ≥ two counties.  In those enrolled, decrease the ED visit rate by 50% and hospitalization rate by 25%.  Show a minimum net health care savings of $1 million dollars.  Have a process for regularly submitting performance reports for integration into the CASE dashboard. CASE Initiative: Coordinate, Align, Standardize, Enhance, and Expand care coordination programs in our region

14. For more information: Lee Che Leong lpleong@hinet.org

15. Who benefits from care coordination? 1% 4% 15% 80% Utilization of the health care system Well population At-risk population Complex high-users with multiple chronic diseases and behavioral health co- morbidities and social needs Health & public health systems Medical and behavioral health systems EDs, jails, police, housing, community mental health clinics, federally qualified health clinics

16. Care coordination efforts in the North Sound: a snapshot The Community Paramedic Navigator Program in Snohomish has resulted in a 63% reduction in 911 calls and 54% reduction in ED visits in the initial evaluation. Following the launch of Providence’s Care Transitions Program, the readmit rate dropped from 16% to 10%. WAHA’s Intensive Case Management Program has observed a 26% decrease in ED visits, a 51% decrease in hospitalizations, and a 31% decrease in incarcerations.