Accountable Community of Health Design Getting Grounded Accountable

Accountable Community of Health Design: Getting Grounded Accountable Community of Health Interim Leadership Council May 7, 2015

Three questions 1. What’s behind the Accountable Community of Health initiative? 2. What might happen with an ACH partnership that otherwise would not? 3. What’s this ACH design year about and why am I here?

What’s behind the Accountable Community of Health Initiative? ❶

By 2020, the people of King County will experience significant gains in health and well-being because our community worked collectively to make the shift from a costly, crisis-oriented response to health and social problems, to one that focuses on prevention, embraces recovery, and eliminates disparities. King County Health and Human Services Transformation Plan, 2013 4

Rethinking system “edges” Primary care Specialty care Schools Oral health Employers / business / workplaces Behavioral health Long-term services & supports Housing Parks Transportation Neighborhood organizations; faith communities Government Health plans Based on graphic from Institute for Healthcare Improvement Social / human services Public health

To succeed, must apply the “Triple Aim” Framework Better health of populations System designs that simultaneously improve three dimensions Better care for individuals Lower per capita health care costs The IHI Triple Aim framework was developed by the Institute for Healthcare Improvement in Cambridge, Massachusetts (www. ihi. org). ” 6

Meanwhile, down in Olympia – a Health Innovation Plan is crafted (and funded) • Build healthier communities through a broad, collaborative regional approach (Accountable Communities of Health) • Ensure health care focuses on the whole person (focus on physical/ behavioral health integration) • Improve how we pay for services (pay for value, not volume) Through combined savings and avoided costs, adjusting health system can save $1. 05 billion over 5 years 7

Clinical ACHs Community Accountable Community of Health Defined: A regionally governed, public-private collaborative or structure tailored by the region to align actions and initiatives of a diverse coalition of participants in order to achieve healthy communities and populations 8

What will ACHs do? • Facilitate collaborative decision-making across multiple sectors and systems, focusing on social determinants of health, clinical-community linkages, and whole person care. • Bring together all sectors that contribute to health to develop shared priorities and strategies for population health, including improved delivery systems, coordinated initiatives, and value based payment models. • Drive physical and behavioral health care integration by informing financing and delivery system adjustments, starting with Medicaid. • Engage in state-community partnership to achieve results. 9

Accountable Community of Health Boundaries

Washington’s Accountable Community of Health Initiative Timeline 11

What might happen with an ACH partnership that otherwise would not? ❷

How an ACH Partnership can drive toward prevention and equity 1. Plan: Develop common agenda (regional health improvement plan) 4. Act: Capture & reinvest portion of savings + align other $$ → for next cycle 3. Study: Show improved health & social outcomes 2. Do: Carry out strategies to increase health & equity; reduce costs Governance structure that’s accountable for the results of this cycle Convening, data, shared measurement system, engagement & communication to support this cycle (“backbone” functions) Adapted from “Closing the Loop” – The Prevention Institute 13

Different kinds energy are needed to propel the ACH 4. Act: Capture & reinvest portion of savings + align other $$ → for next cycle 14

Transformative Energy Management 4. Act: Capture & reinvest portion of savings + align other $$ → for next cycle Gas - examples • Local government funding • Federal grants • State grants • Hospital community benefit • Philanthropy support Regenerated energy - examples • Social impact bonds / pay for success • Shared savings with health care • Global Medicaid waiver investments Changes in policies, purchasing, and contracting strategies 15

What’s this ACH design year about and why am I here? ❹

Design Year Deliverables – Path to ACH “Designation” Figure out an 1. Plan: Develop approach to this common agenda (regional health improvement plan) 4. Act: Capture & reinvest portion of savings + align other $$ → for next cycle Work on an initial path for sustainability . . all against a backdrop of “doing” 2. Do: Carry out strategies to increase health & equity; reduce costs 3. Study: Show improved health & social outcomes Formalize this Governance structure that’s accountable for the results of this cycle Convening, data, shared measurement system, engagement & communication to support this cycle And formalize this 17

. . Backdrop of “doing” (some existing shared priority initiatives) The Plan for 2015 Communities of Opportunity Housing-health partnership Physical/ Behavioral Health Integration Committee Familiar Faces (jail high users) Learn / support / test Create Interim ACH Leadership Council Partner with equity network/ coalition Work groups for cross-cutting issues Regional health Performance measurement improvement plan approach Sustainability

Partnership with an equity network/coalition Network representation Interim ACH Leadership Council Community “Public Shareholders” Public Sector Reps Private Sector Reps Equity network/ coalition

Roles of Interim ACH Leadership Council • Develop partnership with equity networks/coalitions • Design elements of ACH Readiness Proposal: - Approach to future regional health improvement plan - Approach to sustainability - Governance model - Backbone functions (measurement, communications, convening, etc. ) • Take actions as appropriate to support success of the four initiatives of focus, and learn from them to inform ACH design. • Endorse model of care for full integration of physical/behavioral health, developed via the committee. • Provide feedback to state/county on ACH-related matters throughout the year. • Help figure out responses to new opportunities if they arise in 2015.

Coming Up in the Near Term (May/June) Exploring equity network connection & capacity: With leadership of Regional Equity Network, Healthy King County Coalition, and Wendy Watanabe Work groups launch: 1. Performance measures work group – Eli Kern 2. Regional Health Improvement plan work group – Gloria Albetta 3. [Sustainability work group – ? ? ] Physical / behavioral health integration committee: Susan Mc. Laughlin, King County Dept of Community and Human Services May 11 Familiar Faces Guidance Team: Will be discussing link to ACH May 21 King County Board of Health: Briefings on ACH and the joint Community Health Needs Assessment by KC Hospitals for a Healthier Community Engagement with State partners: • Continued participation in ACH Advisory Committee and ACH gatherings • Expecting May 15 release of designation criteria

Resources Interested parties who want to join King County ACH stakeholder list can write to: hhstransformation@kingcounty. gov King County ACH Website: http: //www. kingcounty. gov/exec/HHStransformation/ach. aspx Washington State ACH Website: http: //www. hca. wa. gov/hw/Pages/communities_of_health. aspx This project is supported by Funding Opportunity Number CMS-1 G 1 -14 -001 from the U. S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies