Working Together for a Healthier Washington

Transcription

1 Working Together for a Healthier Washington Dorothy Teeter, HCA Director Nathan Johnson, HCA Chief Policy Officer All Alliance Meeting June 9, 2015

2 By 2019, we will have a Healthier Washington. Here s how.

3 The plan for a Healthier Washington Build healthier communities through a collaborative regional approach Fund and support Accountable Communities of Health. Use data to drive community decisions and identify community health disparities. Ensure health care focuses on the whole person Integrate physical and behavioral health care in regions as early as 2016, with statewide integration by Spread and sustain effective clinical models of integration. Make clinical and claims data available to securely share patient health information. Improve how we pay for services Measure, improve and report common statewide performance measures. As purchaser for Apple Health and state employees, drive market toward valuebased models. Implementation tools: State Innovation Models grant, state funding, potential 1115 Medicaid waiver, philanthropic support Legislative support: HB 2572, SB 6312

4 Strategy 1: Build healthier communities through a collaborative regional approach

5 Accountable Communities of Health Regionally governed, public-private collaborative tailored by region to align actions and initiatives of a diverse coalition of players in order to achieve healthy communities and populations. State Health Care Innovation Plan

6 No single sector can do it alone No single sector or organization in a community can create transformative, lasting change in health and health care alone Accountable Communities of Health (ACHs) will: Facilitate collaborative decision-making across multiple sectors and systems Engage in state-community partnership to achieve transformative results

7 ACH boundaries and pilot ACHs Aligning sectors, resources, and strategies around community and state priorities Pilots: Cascade Pacific: Backbone Support CHOICE Regional Health Network North Sound ACH: Backbone Support Whatcom Alliance for Health Advancement

8 Partner in Purchasing State Government Shared Data Resources Value-Based Purchasing Criteria & Designation Hospital Health Plans Business Consumers Tribes Philanthropy Education Local Government ACH Transportation Health Care Providers Public Health Food Systems Social Services Housing Community & Faith-Based Organizations Shared Data Mutually Reinforcing Membership Payers and Delivery Systems within the Region Apple Health MCOs / BHOs PEB plans NEW PEB ACP Delivery Systems and Providers 8

9 ACH Timeline and Milestones Q Pilot and Design Regions Selected Q ACH staff hired Technical Assistance RFP and Selection Statewide ACH Leadership Convening Q3-Q ACH Evaluation led by GHRI Begins ACH Designation Opportunities Leading to Statewide Designation ACHs are designated and continually evolving

10 Strategy 2: Ensure health care focuses on the whole person

11 Integrating Physical and Behavioral Health Governor Jay Inslee has articulated a vision of full integration of mental health, chemical dependency and physical health care to improve health, advance care quality and control costs. Office of the Governor, November 2013 statement, A New Approach to Behavioral Health Purchasing

12 Integrating Physical and Behavioral Health Senate Bill 6312 integrates physical health, mental health, and chemical dependency in a managed care health system for Medicaid clients by Regional Service Areas (RSAs) establish a common regional purchasing approach. Shared savings incentives (payments targeted at 10 percent of savings realized by state) in Early Adopter regions begin in April 2016.

13 Regional Service Areas A common regional purchasing approach: Recognizes that health and health care are local. Promotes shared accountability within each region for the health and well-being of its residents. Empowers local and county entities to develop bottom-up approaches to transformation that apply to community priorities Aligned with Accountable Communities of Health

14 Regional Service Areas

15 Medicaid integration pathway 2020: Fully Integrated Managed Care System Across the State 2014 Legislative Action: 2SSB 6312 By January 1, 2020, the community behavioral health program must be fully integrated in a managed care health system that provides mental health services, chemical dependency services, and medical care services to Medicaid clients Transition Period Apple Health Managed Care Behavioral Plans Health Organizations 2016 Regional Service Areas (RSAs) Integrated Purchasing in Early Adopter RSAs, with shared savings incentives

16 Strategy 3: Improve how we pay for services

17 Four payment redesign models Model Test 1: Early Adopter of Medicaid Integration Test how integrated Medicaid financing for physical and behavioral health accelerates delivery of whole-person care Model Test 2: Encounter-based to Value-based Test value-based payments in Medicaid for federally qualified health centers and rural health clinics; pursue new flexibility in delivery and financial incentives for participating Critical Access Hospitals Model Test 3: Puget Sound PEB and Multi-Purchaser Through existing PEB partners and volunteering purchasers, test new accountable network, benefit design, and payment approaches Model Test 4: Greater Washington Multi-Payer Test integrated data platform capacity to allow providers to coordinate, share risk and engage a sizeable population across multiple payers

18 Payment Redesign Model 1: Early Adopter Medicaid Regional Service Area designation in November 2014 Counties requested early adopter transition to fully integrated managed care purchasing for medical, mental health and substance use disorder services Southwest WA (Clark, Skamania) formally committed to becoming Early Adopter region April 2016; Klickitat will transition by 2020 North Central region considering options decision to be made by Jun 15 Broad collaboration on early adopter model design fully integrated managed care and regional crisis system Letters of interest to Early Adopter RFP in SW WA received from all Medicaid MCOs RFI on Behavioral Health Administrative Services Organization interest in managing crisis system in SW WA Common core performance measures selected for early adopter contracts 18

19 Payment Redesign - Model 1: Early Adopter Fully Integrated Managed Care Contracts 2015 Dates Medicaid contract reviewed by stakeholders (~1,000 comments) May 27 Non-Medicaid contract released for stakeholder comment Jun 4 MCOs RFP distributed Aug 6 MCO RFP responses due Sep 25 Successful MCO bidders announced Nov 2015 Crisis and Other Services Contract Administrative Services Organization contract released for stakeholder comments Aug 7 RFP distributed Sep 18 RFP responses due Nov 4 Successful bidders announced Nov 2015 Contracts start

20 Payment Redesign Model 2: Encounter to Value Overview Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) Scope: Develop alternative payment methodology (APM) that encourages the use of team-based care models and moves from volume-based reimbursement model to one tied to achievement of improved outcomes. Payments will be predictable and comply with federal standards. Status: Building capacity and contracting for modeling expertise, assessing clinic participation criteria and partnering with clinic systems in discovery, design and development. Gathering and analyzing the landscape of current approaches and application of APM in other states: CA, MD, MN and OR.

21 Payment Redesign Model 2: Encounter to Value cont. Critical Access Hospitals (CAH) Scope: Payment approaches for CAHs that help meet changing community needs and ensure sustainability Aligned to degree possible with RHCs due to strong affiliation with CAHs Looking at other state models and pilots as a framework for a new delivery model Status: Working with the Washington Rural Health Access Preservation (WRHAP) Initiative coordinated by the Washington State Hospital Association and the Washington State Department of Health Have identified CAHs for potential demonstration Have begun to outline potential models

22 Payment Redesign Model 3: Accountable Care Program RFI Assessed WA market valuebased readiness & capacity 13 Providers 15 Health Plans Everyone on the value-based road. Some further along RFA - Public Request for clinically integrated networks accountable for costs, quality, member experience - 6 submissions ACP 2 Networks selected: UW PSHVN - Available to PEBB members in Puget Sound region starting 1/1/16 WHA Tools & Support - Purchaser Affinity Group ACO Checklist - Community Checkup - Alliance support for Innovation Grant Without a strong, purchaser-driven countervailing force, value-based payment reform often reverts to a least common denominator, low-risk model. - WHA, blog 22

23 Payment Redesign Model 3: Accountable Care Program Best in class design High-quality and timely services at a lower cost Integrated physical, mental, and substance abuse Financial and clinical accountability for a defined population Competitive bidding process and negotiations resulted in two ACP vendors University of Washington Accountable Care Network Puget Sound High Value Network LLC Initially offered in five counties (Snohomish, King, Kitsap, Pierce and Thurston) Plan to expand purchaser participation in accountable care networks, starting in 2017, using WHA Purchaser Affinity Group ACO Checklist

24 ACP Value Based Reimbursement PEBB ACP

25 None of this can happen without some key foundational elements

26 Practice Transformation Support Hub Support providers across the state to effectively coordinate care, increase capacity, and adapt to value-based reimbursement strategies. Help providers with integration of physical and behavioral health. Help providers move from volume to value-based care. Help build broader community clinical linkages in service of the whole person.

27 Measurement and transparency Measures must be transparent for consumers, providers, and purchasers to ensure improved quality and informed decision making HCA will leverage measures to provide transparency to statewide reporting on cost and quality performance.

28 Learning and evaluation Continuous rapid-cycle evaluation to learn, adjust, and improve in real time. Evaluation led by the University of Washington. Act Check Plan Do

29 Join the Healthier Washington Feedback Network: Learn more: The project described was supported by Funding Opportunity Number CMS-1G 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.