SE WA Aging and Long Term Care Council

SE WA Aging and Long Term Care Council of Governments Governing Board Meeting April 6, 2017

Washington State vision for creating healthier communities and a more sustainable health care system by: Building healthier communities through a collaborative regional approach Ensuring health care focuses on the whole person Improving how we pay for services Better Health, Better Care, Lower Costs

Healthier Washington recognizes that health is more than health care. Health Care 20% Physical Environment 10% Socio-economic Factors 40% Health Behaviors 30% Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper, State Quality Improvement Institute. . Minnesota. 3 Better Health, Better Care, Lower Costs

ACHs are a forum for regional collaborative decision making

Accountable Communities of Health A volunteer association of independent stakeholders focused on developing and implementing a shared action agenda established by consensus (collective impact) with the goal of improving health within a region. Better Health, Better Care, Lower Costs

Backbone Organization GCACH Carol Moser, Executive Director Aisling Fernandez, Communications Coordinator Wes Luckey, Program Manager Eastern WA University Dr. Patrick Jones, Facilitator Board of Directors Public Health Hospital FQHC Columbia County Meghan Debolt Yakima Memorial Hospital Eddie Miles Tri-Cities Community Health Martin Valadez, President Education ESD 123 Les Stahlnecker Philanthropy Three Rivers Community Foundation Carrie Green Managed Care Healthcare Provider Sunnyside Community Hospital Brian Gibbons, Treasurer Housing Yakima United Healthcare Amina Suchoski Neighborhood Health Rhonda Hauff, Vice-President Mental Health Provider Comprehensive Mental Health Ed Thornbrugh Workforce Dev Washington State Allied Health Center of Excellence Dan Ferguson CBO/FBO Social Services Catholic Family and Child Services Darlene Darnell Tribes Yakama Nation Frank Mesplie Public Safety Kittitas Fire John Sinclair, Secretary SE WA Aging and Long Term Care Lori Brown Local Gov’t GCBH Executive Director Ken Roughton Consumer Transportation Northwest Justice Project Jefferson Coulter People for People Madelyn Carlson

Greater Columbia ACH Medicaid Population* Summary Group Name AEM Expansion Adults Statewide Total Adults Children Total Medicaid CN Caretaker Adults 310 803, 828 74, 292 21 12, 476 2, 154 29, 665 136, 746 66 462 7, 476 3 1, 833 244 41 18, 038 0 132, 464 0 0 90 38 3, 285 0 66 132, 926 7, 476 3 1, 923 282 3, 326 18, 038 Medicaid CN Expansion Adults 608, 433 71, 726 0 71, 726 Other Federal Programs 18 61, 165 150, 072 16, 703 0 6, 936 14, 070 2, 762 0 0 3, 489 5 0 6, 936 17, 559 2, 767 Apple Health For Kids Elderly persons Family (TANF) Medical Family Planning Former Foster Care Adults Foster Care Partial Duals Persons with disabilities Pregnant Womens Coverage Total Enrollees in Medical Programs By County Report, 201611* 1, 895, 883 123, 657 139, 371 263, 028

Greater Columbia by County Population & Medicaid %** County Population OFM 4 -1 -16 % GCACH Population on Medicaid* % of GCACH Pop on Medicaid Asotin 22, 150 3% 6, 497 Benton 190, 500 26% 55, 853 4, 050 1% 1, 145 Franklin 88, 670 12% 34, 916 Garfield 2, 200 0. 3% 599 Kittitas 43, 710 6% 9, 974 Klickitat 21, 270 3% 6, 588 Walla 60, 730 8% 16, 568 Whitman 47, 940 7% 7, 822 Yakima 250, 900 34% 113, 780 2. 6% 22. 0% 0. 5% 13. 8% 0. 2% 3. 9% 2. 6% 6. 5% 3. 1% 44. 8% Total GCACH Pop 732, 120 100% 253, 742 100% Columbia Comparison to WA State 13. 9% Comparison to GCACH Population 34. 7% ** https: //fortress. wa. gov/t/51/views/Healthier. Washington. Dashboard/Population. Explorer

Greater Columbia ACH Characteristics Rural Statewide GCACH 18% 23. 3% 11. 2% 26. 4% American Indian/Alaska Native 1. 2% 14. 3% Less than high school graduate 10% 19. 2% Non Citizen 7. 1% 10. 0% limited English proficient 7. 9% 13. 5% Migrant Seasonal Farmworker 4. 1% 19. 6% 13. 5% 18. 2% 26% 34. 7% 12. 9% 19. 5% Hispanic/Latino Uninsured Medicaid Insured Below Poverty

Regional Needs Assessment 10

Medicaid Transformation Current System Transformed System Fragmented clinical and financial Integrated systems that deliver approaches to care delivery whole person care Disjointed care and transitions Coordinated care and transitions Disengaged clients Activated clients Capacity limits in critical service areas Optimal access to appropriate Individuals impoverish themselves to access long term services Timely supports delay or divert need for Medicaid LTSS services and supports (LTSS) Inconsistent measurement of Standardized performance measurement with accountability for delivery system performance improved health outcomes Volume-based payment Value-based payment 12 Better Health, Better Care, Lower Costs

Washington’s Medicaid Transformation Goals Medicaid Transformation Project (MTP) • Reduce avoidable use of intensive services and settings • Improve population health • Accelerate the transition to value-based payment • Ensure that Medicaid per-capita cost growth is below national trends 8 Better Health, Better Care, Lower Costs

Initiative 1 Medicaid Transformation Project Initiatives Transformation through Accountable Communities of Health Initiative 2 Initiative 3 Enable Older Adults to Stay at Home; Delay or Avoid the Need for More Intensive Care Delivery System Transformation Benefit: Medicaid Alternative Care (MAC) • Each region, through its Accountable Community of Health, will be able to pursue projects that will transform the Medicaid delivery system to serve the whole person and use resources more wisely. • Community-based option for Medicaid • Also known as Delivery System Reform Incentive Payments (DSRIP). Pay for Performance Projects Targeted Foundational Community Supports Benefit: Supportive Housing • Individualized, critical services and supports that will assist Medicaid clients to obtain and maintain housing. The housing-related services do not include Medicaid payment for room and board. clients and their families. • Services to support unpaid family caregivers. Benefit: Tailored Supports for Older Adults (TSOA) • • For individuals “at risk” of future Medicaid LTSS not currently meeting Medicaid financial eligibility criteria. Primarily services to support unpaid family caregivers. Benefit: Supportive Employment • Services such as individualized job coaching and training, employer relations, and assistance with job placement. Medicaid Benefits/Services 9

Initiative 1: What is the Work? Domain 1: Health & Community Systems Capacity Building Domain 2: Care Delivery Redesign Domain 3: Health Equity Through Prevention & Health Promotion • Regional VBP Transition Plan • Workforce Action Plan • Systems for Population Health Management Transformation Plan • Bi-Directional Integration of Care & Primary Care • Community-Based Care Coordination • Transition Care • Diversion Interventions • Addressing Opioid Use Public Health Crisis • Maternal & Child Health • Access to Oral Health Services • Health Equity through Chronic Disease Prevention & Control 10

KEY: Green boxes are required: Regional Health Needs Inventory 2 taskforces 3 DOMAINS 2 Required projects (green) 2 Optional projects (yellow). Orange boxes ACH specific Medicaid Transformation 5 -Year Demonstration through ACHs Initiative 1 Performance Measurement Regional Health Needs Inventory (RHNI) System-wide measures for each project HCA will provide data & ACHs will fill in gaps using local data sources. Will inform planning of projects. Statewide VBP Transition Taskforce Workforce Development Taskforce Requires ACH Participation Requires ACH participation Practice Transformation Support Hub Will assist providers in ACH regions with transformation efforts Health & Community Systems Capacity Building Care Delivery Redesign Domain 1 Financial Sustainability through Value Based Payment Focus Area #1 Bi-Directional Integration of Care & Primary Care Transformation Workforce Focus Area #3 Community-Based Care Coordination Domain 2 Domain 3 GCACH SIM Project Required Project 2 A Focus Area #2 Systems for Population Health Management Healthy Equity through Prevention & Health Promotion Optional Project 2 B Transitional Care Optional Project 2 C Optional Diversion Project Interventions 2 D Addressing the Opioid Use Public Health Crisis Required Project 3 A Maternal & Child Optional Health Project 3 B Access to Oral Health Services Optional Project 3 C Health Equity through Chronic Optional Disease Project 3 D Prevention & Control

Initiative 1: What Will Be the Role of ACHs? 11

March RHNI Data Provided and HW Data Website Created March Certification Requirements Complete March STATE/PARTNERS ACH/REGIONAL July Project Application Template March/April VBP Taskforce April DSRIP TA Starts April March ACH Transition Plan in Place May Certifie d Phase 1 May 15 th Certification Phase 1 Due June July June 30 th Update SIM Budget Project Plan Development Q 1 2017 Q 2 2017 Dec 2017 Applications Approved Aug Certified Phase 2 Q 3 2017 Aug 14 th Certification Phase 2 Due Oct Project Plan Applications Due Q 4 2017 Dec Oct 31 st SIM Narrative Report Jan Project Implementation Jan 2018

MTP: Up to $1. 125 Billion Over 5 Years ACHs will receive a share of waiver dollars ACHs will select transformation activities aligned with Regional Health Improvement Plan ACHs will coordinate regional transformation activities ACHs will distribute funding to partners to carry out transformation activities ACHs will monitor impact Improve Health Outcomes

Questions? For more information: Carol Moser cmoser@greatercolumbiaach. org Wes Luckey wluckey@greatercolumbiaach. org Aisling Fernandez afernandez@greatercolumbiaach. org Website: www. greatercolumbiaach. org Thank you!