Breanne Laughery - cpaawa.org

Questions?

Breanne LaugheryDirector of Partnerships,

Upstream Washington

(206) 915-1257

[email protected]

mailto:[email protected]

Table Discussion

Questions:

o What improvements could you make in your practice to make it

easier for women to access all methods of contraception, same

day?

o What types of assistance do patients or clients need in order to

access all methods of contraception?

o How can the Technical Assistance from Upstream USA help

CPAA meet their goals? Is this an opportunity for CPAA to pursue?

Cascade Pacific Action AllianceMedicaid Transformation Project Funds Flow Proposal – May 2018

Management & Admin. (10%),

Contingency (5%)

Capacity Building (health systems and

community)

Year 1 Project Funds Flow Chart – Revised, May 2018

Provider Engagement

Provider Engagement -

Tribes

Project Funds$ 11,758,942

8%

2% 3%

15%

Wellness Fund

8%

Special Projects

Capacity Building (health systems &

community) - Tribes

31%

3%

30%

Provider Performance

Wellness Fund


community, including tribes)


Partner Engagement (including special

projects, local forums & tribes)

Partnering Providers (project implementation,

bonus payments & Centers for Transformation)


Approx. 8%Approx. 34% Approx. 12%Approx. 31%


Contingency (5%)

The Big Picture

Plan/Test

2018

• Initial Funds Flow (Engagement)

• Portfolio of coordinated projects (planning)

• Network of partners

• Learning communities

• Formation of Proto Centers for Transformation (C4T)

Implement/Scale

2019/20

• Modified Funds Flow (Performance)

• Project portfolio Implementation

• Deepen learning communities

• Identify C4T Leads

• Align partners w/ C4T

• Meet Pay for Reporting/Pay for Performance goals through C4T

Spread/Sustain

2021+

• Sustainable health delivery system reform > Medicaid Transformation by meeting value-based purchasing goals

• Integrated delivery system to address population health

• Better health in all 7 counties

• Whole person health

• Smarter spending

Medicaid Transformation Project - Funding Principles

• Support sustainability of the project

• Improve health equity/reduce health disparities

• Address social determinants of health to the greatest extent possible

• Provide sufficient incentive for providers (clinical and non-clinical) to participate

• Reward relative contribution to desired outcomes

• Invest in rural and urban areas

• Invest in all seven counties

• Reward truly transformative efforts over marginal improvements

• Establish a regional Wellness Fund (Innovation Fund) to support investments in key health improvement areas

Evolving Funds Flow Emphasis Over Time

Year 1 Provider

Engagement

Year 2+ Provider

PerformanceAchievement

• Engaging Partners• Organizing Projects• Forming C4Ts

• Activating C4Ts• Implementing Projects• Scaling Projects

Centers For Transformation (C4T)

Establish Centers For Transformation that will serve as a cohesive, effective regional framework for population health improvements.

Provisional Definition:

A cluster of independent organizations that agree to work together across community sectors in a given location to advance health system transformation. The Centers for Transformation provide leadership, support, and guidance to help their partners implement best practices and work standards to improve population health. Additionally, through their partners, Centers for Transformation provide well-coordinated population health focused services across sectors.

C4Ts are virtual clusters, not physically integrated or co-located.

Centers for Transformation - Request for Proposals Process

Draft

Medicaid Transformation Project - Year 1 Funds Flow – April DRAFT

37

Use Category Action % $Project Management/Administration Spend 10% 1,175,894 Reserve/Contingency Hold 5% 587,947 Regional Wellness Fund Hold 8% 940,715 Special Projects Fund Disburse 2% 235,179 Sub-Total 25% 2,939,736

Health Systems & Comm. Cap. Bldg (D1) Invest Centrally 31% 3,645,272 Health Systems & Comm. Cap. Bldg (Tribes) Disburse 3% 352,768 Sub-Total 34% 3,998,040

Provider Engagement Disburse 30% 3,527,683 Provider Engagement (Tribes) Disburse 3% 352,768 Provider Performance (Implementation Plan) Disburse 8% 940,715 Sub-Total 41% 4,821,166

Grand Total 100% 11,758,942

NON-TRIBAL PROVIDER ENGAGEMENT 3,527,683 A. Basic Engagement 85% 2,998,530 Base PaymentsAssessment Survey Pre RFP 5% 176,384 Standard Agreement Post RFP 5% 176,384 Project Participation Post RFP 25% 881,921

Bonus PaymentsAttribution (Medicaid Lives Served) Post RFP 30% 1,058,305 Equity Post RFP 10% 352,768 Rural Post RFP 5% 176,384 Local Community Forums Post RFP 5% 176,384

B. Centers of Excellence Hold or Disburse 15% 529,152

PROVIDER PERFORMANCE 940,715

First-Year Funds Flow: Provider Engagement

Provider Engagement

Tribes

Base Pay

Assessment

Agreement

Participation

Bonus Potential

Attribution

Equity

RuralCapacity

Fund

C4T

Local Forums

Items in Green = Determined by Request for Proposals (RFP)

*Earned in 2017, disbursed in 2018

RFP Timeline

Basic Design Approval 5/10

RFP Release 5/30

Letter of Intent Due

6/14

RFP Responses Due 7/15

Network Partners

Selected 8/15

Key RFP Design Consideration

• As simple as possible, yet providing sufficient information to identify the strongest project proposals and applicants.

• One response per partner, i.e., partners address multiple projects in one application and explain how the proposed activities are mutually reinforcing.

• RFP serves to identify strongest possible project designs that will move Medicaid Transformation outcome metrics.

• Once the most capable partners with most effective project designs have been identified through the RFP process, bonus pools (attribution, equity and rural) come into play.

• Preserve flexibility for strategic adjustments to rankings to ensure broad participation across sectors and counties, and ensure key partners for project success are engaged.

Key RFP Design Elements

RFP Sections

Section Subject

Section 1 Information about the Applicant

Section 2 Projects and Interventions (select any of 6 projects)

Section 3 Implementation Readiness (partnership, coordination, etc.)

Section 4 Individuals Served

Section 5 Contribution to Equity

Section 6 Rural Representation

The majority of points are generated in Section 2.

Sections 4-6 are not scored. They are used to determine the allocation of bonus funds.


Up to 45 total organizations will be selected in two rounds

• Round One: The highest-scoring organizations within each major category

• Clinical Providers / Hospitals

• Community-Based Organizations

• Pathways partners

• Round Two: The remaining slots will be assigned based on strategic considerations

• A panel consisting of ACH staff, MCO representatives, HCA representatives, and others

• Considerations

• Importance to project success

• Strength of partnering

• Strength of current or proposed investment in projects

• County representation


Allocation of Bonus Payments

Attribution

• Clinical

o Number and percentage of individuals on Medicaid

• Non-Clinical

o Number and percentage of individuals who are at or below 310% of the federal poverty level

Rural and Equity

• Zip codes of residence for the individuals served and the number of individuals served in each zip code

• Rural designation based on National Center for Education Statistics

• Equity designation based on the Community Needs Index

First-Year Funds Flow: Provider Payments

Provider Payments

Base Pay

Assessment*

Agreement

Participation

Bonus Potential

Attribution

Equity

RuralPerformance

Capacity Fund

C4T

Goal: AVG MIN Pymt per Partnering Provider: approx. $70,000 = 35-45 Partners

*One payment per EIN

First-Year Funding: Projected Direct Payments to Providers

PROVIDER ENGAGEMENTDisbursement

Timing

Proposed Funds

Allocation

Proposed Funding Amount

Projected No. of

Partners

Projected MIN Disbursement Per

Partnering Provider

A. Basic Engagement 80%

Base Payments

Assessment Survey Pre RFP 5% 176,384 65 $2,714

Standard Agreement Post RFP 5% 176,384 35-45 $5,040-$3,920

Project Participation Post RFP 35% 1,234,689 35-45 $35,277-$27,438

Total Base Payments 45% 1,587,457 $43,030-$34,071

Bonus Payments

Attribution (Medicaid Lives Served) Post RFP 18% 634,983 ? ?

Equity Post RFP 10% 352,768 ? ?

Rural Post RFP 7% 246,938 ? ?

Total Bonus Payments 35% 1,234,689 ? ?

TOTAL PROVIDER ENGAGEMENT 100% 3,527,683 ? ?

PROVIDER PERFORMANCE (Implementation Plan) Post RFP 8% 940,715 35-45 $26,878-$20,905

Total MIN Distributable to Partnering Providers in 2018* 3,762,861 $69,908-$54,976

*Excluding C4T and Local Community Forum allocations

Summary of Funds Flow Changes

• Special Projects Fund renamed Capacity Development Fund: Provides limited funding to potential future partnering providers rather than supporting one-off projects.

• Centers of Excellence renamed Centers For Transformation (C4T); formation of C4T delayed until after RFP closes to allow sufficient time for meaningful partnering; funds for lead organizations potentially carried into 2019.

Use Category Previously Now Change

Capacity Dev. Fund $235,179 (2%) $335,179 (3%) $100,000 (+1%)

Project Participation $881,921 (25%) $1,234,689 (35%) $352,768 (+10%)

Attribution $1,058,305 (30%) $634,983 (18%) ($440,960) (-12%)

Equity $352,768 (10%) $352,768 (10%) No Change

Rural $176,384 (5%) $246,938 (7%) $70,554 (+2%)

Revised First-Year Funds Flow: PROPOSED – May 2018

48

Use Category Action % $Project Management/Administration Hold 10% 1,175,894 Reserve/Contingency Hold 5% 587,947 Regional Wellness Fund Hold 8% 940,715 Capacity Development Fund Disburse 3% 335,179 Sub-Total 26% 3,039,736

Health Systems & Comm. Cap. Bldg (D1) Invest Centrally 30% 3,545,272 Health Systems & Comm. Cap. Bldg (Tribes) Disburse 3% 352,768 Sub-Total 33% 3,898,040

705,537 / 7Provider Engagement Disburse 30% 3,527,683 Provider Engagement (Tribes) Disburse 3% 352,768 Provider Performance (Implementation Plan) Disburse 8% 940,715 Sub-Total 41% 4,821,166

Grand Total 100% 11,758,942

NON-TRIBAL PROVIDER ENGAGEMENT 3,527,683 A. Basic Engagement 85% 2,998,530 Base PaymentsAssessment Survey Pre RFP 5% 176,384 Standard Agreement Post RFP 5% 176,384 Project Participation Post RFP 35% $1,234,689

Bonus Payments

Attribution (Medicaid Lives Served) Post RFP 18% $634,983

Equity Post RFP 10% $352,768

Rural Post RFP 7% $246,938 Local Community Forums Post RFP 5% 176,384

B. Centers For Transformation Hold 15% 529,152


Contingency (5%)


community)


Provider Engagement

Provider Engagement -

Tribes


8%

2% 3%

15%

Wellness Fund

8%

Special Projects

Capacity Building (health systems &

community) - Tribes

31%

3%

30%

Provider Performance

Wellness Fund


community, including tribes)


Partner Engagement (including special

projects, local forums & tribes)

Partnering Providers (project implementation,

bonus payments & Centers for Transformation)


Approx. 8%Approx. 34% Approx. 12%Approx. 31%


Contingency (5%)

51

Questions? Comments?

Summary and Next Steps Main meeting outcomes

What worked? What can we do better next time? What do we need to bring to our local forums?

Next Council Meeting:

Thursday, June 14, 2018, 12:00-3:00 PMLocation: Great Wolf Lodge,

Grand Mound, WA

52

Documents

Breanne Laughery - cpaawa.org