Building Accountable Communities of Health Washington State of Reform Health Policy Conference...
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Transcript of Building Accountable Communities of Health Washington State of Reform Health Policy Conference...
Building Accountable Communities of Health Washington State of Reform Health Policy ConferenceJanuary 8, 2015, 2:15 – 3:00 pm
Representative Laurie Jinkins, Member, Healthcare and Wellness Committee, Washington State House of Representatives
Carol Moser, Executive Director, Benton-Franklin Community Health Alliance
Dr. Elya Moore, PhD, Deputy Director, Whatcom Alliance for Health Advancement, Supporting the North Sound Accountable Community of Health
Session agenda
Brief overview of Accountable Communities of Health (ACH) (5 minutes)
Presentations from panelists on plans to implement the ACH model (25 minutes)
Questions from the audience (15 minutes)
Washington State Health Care Innovation Plan (SHCIP)
1. Improve how we pay for services– e.g., value-based purchasing
2. Ensure health care focuses on the whole person– e.g., integration of physical health,
mental health, and chemical dependency care
3. Build healthier communities through a broad collaborative regional approach– e.g., Accountable Communities of
Healthhttp://www.hca.wa.gov/hw/Pages/about_the_plan.aspx
4
Washington’s Goals for ACHs
ACHs are formal entities – regionally governed, public private partnership organizations
Provide a multi-sector voice for delivery system reform, shared health improvement goals, and regional purchasing strategies
Serve as a forum for regional collaborative decision-making to accelerate health system transformation, focusing on social determinants of health, clinical-community linkages, and whole person care
Accelerate physical and behavioral health care integration through financing and delivery system adjustments, starting with Medicaid.
Pilot ACHs
5
• 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
Two Selected Pilot ACHs
1. North Sound Accountable Community of Health, supported by Whatcom Alliance for Health Advancement. The North Sound Accountable Community of Health serves the North Sound Regional Service Area: Whatcom, Skagit, Island, San Juan and Snohomish Counties.
2. Cascade Pacific Action Alliance, supported by CHOICE Regional Health Network. The Cascade Pacific Action Alliance serves the Timberlands and Thurston-Mason Regional Service Areas: Cowlitz, Grays Harbor, Lewis, Mason, Pacific, Thurston and Wahkiakum Counties.
Design Communities
7
• Leverage the planning process, including the newly developed Community Health Plans
• Respond to lessons learned during the planning process
• Focus on capacity building, building on lessons learned from the Pilots
Where the Health Care Authority (HCA) sees ACH’s going
Q3 2014
Q4 2014 2015 2016 2017
Two Pilot ACHs
2018
You are here!
Progression through the “ACH Continuum”
Fully developed ACHs by the end of 2018!
COH Planning Grants
Design Communities
Representative Laurie Jinkins
Member, Healthcare and Wellness Committee, Washington State House of Representatives
HEALTHY, VIBRANT PEOPLE AND COMMUNITIES ACHIEVING THEIR FULL POTENTIAL
Hea
lth In
fo T
ech
Collective ImpactRespect | Innovation | Collaboration | Leadership
Inte
grati
on
Qua
lity
Mea
sure
s
Flexible Model for Reducing Chronic Disease
Improve Diabetes and Depression
ACHIEVE TRIPLE AIMH
ealth
Info
Exc
hang
e
Com
m H
ealth
Wor
kers
an
d Ca
re C
oord
inat
ors
Lear
ning
Cul
ture
Health Info Technology and Exchange
Data sharing agreements
Shared EMR’s , care plans & progress notes
Shared “health” port
Provider prompts
Auto-alerts
Work flow processes
Primary Interventions and Potential Strategies
VISIONHealthy, vibrant people and communities achieving their full potential.
MISSIONTo improve the health of our community by collaboratively delivering integrated and cost-effective healthcare and human service solutions across Pierce County.
VALUESRespect | Innovation | Collaboration | Leadership
Community Health Workers and Care Coordinators
Standard SOW
Communication with providers (tech)
Provider referral
Education
Home visits
Service delivery
Care Coordination
Integration
Early identification
IMPACT model
Screening
Health action plans
Mobile BH and PC
Tele-counseling
Service co-location
Quality Measures
CTP Measures
Diabetes and depression measures
Consistent across organizations
Implemented thru Health Info Tech
Learning Culture
Data & info sharing
Training
Shared learning
Evidence based practices
PIERCE COUNTY ACCOUNTABLE COMMUNITIES OF HEALTH
Board of Directors
Health Innovation Partnership
Community Coalition(TBD)
Health Equity & Other Advisory Groups
Ad Hoc CommitteesCommunity Forums
Vision: TBD (e.g. Healthy People in Healthy Communities)
Priorities: Mental Health | Chronic Disease Prevention| Access to Care
Coalitions
Comm. Orgs.
Workgroups
Providers
Payers
Workgroups
ClinicalCommunity
Improve Care Quality & Reduce Costs
Prevention & Root Causes of Health
Governing Body: 501(c)3
12/4/2014
HEALTH EQUITY
Citizen’s Review Panel
Carol Moser
Executive Director, Benton-Franklin Community Health Alliance
GREATER COLUMBIA COMMUNITY OF HEALTH
Presented by Carol Moser, Executive DirectorBenton-Franklin Community Health Alliance
January 8, 2015
The Greater Columbia Basin
Tri-City Hospitals (Kennewick General, Lourdes Health Network, Kadlec Regional Medical Center) build Tri-Cities Cancer in
1992
Foresight of Community Leaders
The mission of BFCHA:To bring the community and healthcare providers together to:• Work cooperatively• Foster community-wide stewardship• Assess community health needs and facilitate
long-term, comprehensive, community wide solution that achieve affordable, high quality wellness and accessible health care for all residents of the Mid-Columbia
SE WashingtonCommunity of Health #6
YPLL Rate 6214 5500 6880 5680 6148 5709
Z-Score -0.19 -0.70 0.28 -0.57 0.00 -0.24
% Fair/Poor 20 13 17 24 19 15 14
Z-Score 0.98 -0.87 0.25 2.33 0.84 -0.17
Physically Unhealthy Days 4.8 3.7 4.1 4.2 4.5 3.3 3.6
Z-Score 1.77 -0.39 0.39 0.59 1.18 -1.18
Mentally Unhealthy Days 3.7 3.1 3.3 2.6 3.8 2.8 3.3
Z-Score 0.51 -0.67 -0.28 -1.65 0.70 -1.25
% LBW 6.3 6.7 6.7 6.0 6.3
Z-Score 0.38 0.89 0.00 0.89 0.00 -0.01
% Smokers 22 15 15 12 17 13 16
Z-Score 1.20 -0.46 -0.59 -1.39 -0.04 -1.08
% Obese 29 32 32 32 34 28 28
Z-Score -0.13 0.77 0.77 0.72 1.13 -0.55
Food Environment Index 8 8 7 7 5 7 8
Z-Score -0.73 -1.28 0.27 0.31 2.82 -0.33
% Physically Inactive 24 20 23 22 27 17 19
Z-Score 0.73 -0.48 0.53 0.26 1.68 -1.31
% With Access 35 66 43 59 46 74 82
Z-Score 1.46 -0.11 1.08 0.23 0.93 -0.54
% Excessive Drinking 16 13 15 14 11 14 17
Z-Score -0.20 -1.16 -0.55 -0.72 -2.42 -0.85
Adult obesity
Food environment index
Physical inactivity
Access to exercise opportunities
Excessive drinking
Low birthweight
Adult smoking
Poor or fair health
Premature death (Years of Potential Life Lost)
Poor physical health days
Poor mental health days
Top Area County Asotin Benton Columbia Franklin GarfieldWalla Walla WA State
Data Driving Decisions
RSA Designations made us Greater!
Collective Impact Model Driving Governance, Committee Structure
Finding Alignment looks promising
Elya Moore, PhD
Deputy Director, Whatcom Alliance for Health Advancement Alliance
Supporting the North Sound
Accountable Community of Health
4
North Sound ACH, 1 of the 2 Pilot ACHs
Our Common Agenda
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 careand to lower per capita health care costs
in Snohomish, Skagit, San Juan, Island and Whatcom counties
Our Guiding Principles 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
Our Process Build on the strengths, experiences and successes Align efforts with existing state, county or local priorities,
outcomes, strategies and metrics. Create measurable goals, and ensure accountability towards
outcomes Ensure that our plan is clear, robust, well-researched, inclusive
and actionable, yet practical
CASE Initiative: Coordinate, Align, Standardize, Enhance, and Expand care coordination programs in our region
Highest utilizers of jails, EMS, and EDs Coordinate existing efforts to achieve better results and more
savings among those currently served Scale up to achieve maximum effect Produce a North Sound ACH regional care coordination
operations manual and a mini-business plan using findings from the CASE Initiative.
The North Sound ACH Commitment
• To succeed 1st with a short-term initiative that can demonstrate significant progress and cost savings in the 1st 6 months.
• We are motivated by, and committed to, long term, sustainable, health improvement, and capturing and reinvesting shared savings to address upstream, root causes of health, with a focus on prevention.
• The CASE Initiative is an essential stepping stone to reaching this goal. By coming together around the CASE Initiative, we will continue to build trust, while also demonstrating the collective impact of working together.
North Sound ACH governance model
Adding first responders in 2015 (EMS, fire, or police)
Follow the North Sound ACHOnline: http://whatcomalliance.org
Receive our the NSACH newsletter or come to a meeting or event: [email protected]
Questions
Questions to run on
1. How will ACHs inform, support, and advise Medicaid purchasing?
2. How should the ACHs be organizing to guarantee ability to capture
and reinvest shared savings to address upstream determinants of
health?
3. How will the ACHs advise and collaborate with the Behavioral
Health Organization on behavioral health integration (chemical,
mental, and physical), both in terms of service delivery and
financing?
4. What is the nature of the relationship between ACHs and health
plans? How is it defined? Managed?
5. What keeps you up at night when you think of the proverbial
rubber hitting the road?