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

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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

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• 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

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• 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

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ech

Collective ImpactRespect | Innovation | Collaboration | Leadership

Inte

grati

on

Qua

lity

Mea

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Flexible Model for Reducing Chronic Disease

Improve Diabetes and Depression

ACHIEVE TRIPLE AIMH

ealth

Info

Exc

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Com

m H

ealth

Wor

kers

an

d Ca

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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

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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: lpleong@hinet.org

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?