ACH-Tribal Workshop. North Sound July 21, Presented by: American Indian Health Commission For Washington State

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1 ACH-Tribal Workshop North Sound July 21, 2016 Presented by: American Indian Health Commission For Washington State

2 Forum for 29 tribal governments and 2 urban Indian organizations Working to improve the health status of American Indian/Alaska Native people Providing Technical Support and Advocacy

3 About the AIHC-ACH Project Outreach & Engagement 29 tribes 2 UIHOs Technical Assistance HCA Tribes ACHs Facilitation Consultation Engagement Coordination Assessment ACH Alternatives Tribal Coordinating Entity/ies

4 Today s Goals To produce a vision for how tribes and UIHOs and ACHs will begin to work together to improve American Indian/Alaska Native health (AI/AN).

5 Today s Desired Outcomes for Tribes Increase understanding about ACHs & State Medicaid Transformation Plan Potential implications of ACHs for IHCPs, AI/AN, and tribes Local ACHs and key contacts

6 Today s Desired Outcomes for ACHs Increase understanding about Indian health care delivery system Tribal expertise in health system transformation Communication, coordination, and engagement with tribal governments

7 Today s Desired Outcomes Gather Feedback from you on 1. What problems are AI/AN having accessing health and social services outside AI/AN system 2. How can ACHs work with Tribes to address these problems 3. How will ACHs include Tribes in development and implementation of Regional Health Needs Inventory and Regional Health Improvement Plan

8 Today s Desired Outcomes Gather Feedback from you on 4. Historical and present issues that will influence relationship between tribes in the region and the ACH 5. Next steps for Tribal ACH collaboration, engagement, and representation

9 Potential Benefits of ACH-Tribal Partnerships Hold ACHs accountable for inclusion of and engagement with tribes and urban Indian health organizations Improve coordination of services between Indian health care providers and other providers within the ACH region Improve overall population health by improving access to care and correcting service delivery problems for AI/AN Correcting problems with the current RSN/BHO system

10 Part II Federal Framework: Medicaid Transformation & Accountable Communities of Health

11 Federal Framework for Medicaid Transformation Affordable Care Act 3021 New Patient Care Models Medicare/Medicaid Reduce Health Care Costs Preserve/Improve Quality of Care

12 Washington Medicaid Transformation CMMI has provided funding to Washington State to design and implement a State Health Care Innovation Plan designed to implement the Triple Aim. The plan is now referred to as Healthier Washington.

13 The TRIPLE AIM 1. Reduce cost of health care 2. Improve patient care 3. Improve population health

14 ACA 3021 Putting it All Together establishes CMMI funds Centers for Medicare & Medicaid Services Innovation State develops Test Patient care models to reduce spending and preserve quality of care Healthier Washington creates ACHs

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16 Some Key Medicaid Transformation Activities for Tribes and Urbans Integration of Medical & Behavioral Health Services Healthier Washington/ Medicaid Transformation Transition from Fee-For- Service to Value-Based Purchasing Creation of Accountable Communities of Health

17 A Note on Tribes and Managed Care AI/AN will remain exempt from managed care. BUT AI/AN will still need to access certain care from non-indian health care providers.

18 Accountable Communities of Health An essential component of the State s Medicaid Transformation Plan to improve overall health and lower health care costs Locally governed, public-private partnerships

19 Accountable Communities of Health Lead partner in Medicaid Transformation 1. Advise the State on Health needs of the region Medicaid purchasing Implementation of value-based purchasing 2. Coordinate with regional & state partners re transition to integrated physical and behavioral health care

20 Accountable Communities of Health Lead partner in Medicaid Transformation 3. If they are coordinating entities, they will determine and implement projects intended to further Medicaid transformation goals 4. Evaluate health needs within their region

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22 ACH MEMBERS Health and long-term care providers Health insurance companies Public health agencies School districts Criminal justice agencies Nonprofit social service agencies Legal services organizations Tribes Philanthropic agencies

23 Accountable Communities of Health KEY ROLE: determine and implement projects intended to further Medicaid Transformation goals. These projects are expected to be funded by a Medicaid waiver and are referred to as Transformation Projects.

24 Transformation Projects will be aimed at 1. Improved Patient Care 2. Improved Population Health 3. Reduced Health Care Costs 4. Integration of Physical & Behavioral Health Services 5. Transition from Fee-for-Service to Value-Based Purchasing For up-to-date information on Transformation Projects, visit

25 Transformation Projects Possible Examples 1. Telemedicine access to services in underserved areas 2. Asthma home-based self-management (Tribal focus) 3. Care coordination for transitions from jail to community 4. Complex care management for high-risk emergency department users 5. Care transition interventions for skilled nursing facility residents

26 Transformation Projects 6. Support for providers to adopt value-based payment models 7. Opiate overdose prevention 8. Prevention of smoking, pediatric obesity, diabetes, and cardiovascular disease 9. Oral health preventions and management of early childhood caries 10. Promotion of healthy women, infants, and children (safe pregnancy and delivery)

27 Transformation Projects a work in progress A note on Tribal Transformation Projects Funding is being set aside for tribes to apply and develop their own projects

28 Selection of Projects Informed by: 1. ACH Regional Health Needs Inventory; and 2. ACH Regional Health Improvement Plan

29 ACHs are required by their contracts to collaborate with relevant partners in this process.

30 What Will ACHs NOT DO? Not a referral system Not intended to duplicate or replace existing services Will not have legal and financial responsibility for Medicaid contracting, including monitoring and oversight, which will remain with the state

31 What Will ACHs NOT DO? The State will continue to contract with Medicaid Managed Care Organizations (MCOs). There is no intent to transfer this risk bearing function to ACHs.

32 The Good (maybe) Increased coordination of services and collaboration of regional resources for better health for AI/AN patients who receive all or some services outside their Indian health care provider Transformation projects may address many of the chronic health illnesses that AI/AN face

33 The Good (maybe) Tribes and Indian health care providers will have the opportunity to apply for transformation project funding Potential for increased tribal influence in regional health systems

34 The Good (maybe) Opportunity to correct problems from the past in gaining access to crisis services and higher level mental health services through the RSNs (now BHOs)

35 The Bad (maybe) Without engaging tribes at the appropriate level and time, ACHs can take actions that affect tribal and urban Indian programs and services Tribes may be lumped in with all the other ACH partners Potential watering down of government-togovernment relationship between tribes and State ACHs still need education on the Indian health care delivery system

36 Federal and State Consultation & Engagement Federal and State law require the State of Washington to consult with tribes and urban Indian health organizations regarding Medicaid matters that will directly impact tribes and/or UIHOs. See RCW Social Security Act, Section 1902(a)(73) State Plan Amendment, #11-25

37 Tribal Consultation re ACHs on May 11 Topics Discussed: Model ACH Consultation Policy (recommended by 17 tribes and both Urban Indian health Organizations) ACH Consultation Requirements Tribal/UIHO Representation within ACH Governing Bodies (North Sound and Olympic already have)

38 Outcomes of Consultation on ACHs on May 11 Consensus among all parties that engagement of tribes needs to happen at the ACH governing board level 8 out of 9 ACHs have agreed to have a seat for each tribe on the ACH board Health Care Authority disagreed with recommendations to require ACHs to adopt consultation

39 Gathering Feedback White Board

40 Discussion One What problems are AI/AN having in accessing care outside Indian health care system?

41 Discussion Two How can ACHs work with Tribes to address these problems?

42 Discussion Three How will ACHs include Tribes in the development and implementation of Regional Health Needs Inventory Regional Health Improvement Plans

43 Discussion Four Historical and present issues that will influence relationship between tribes in the region and the ACH?

44 Discussion Five Next steps for Tribal ACH collaboration, consultation, and representation

45 Discussion Six Tribal Coordinating Entity or other alternatives? Tribal Transformation Projects

46 Tribal Slides for Afternoon

47 Questions and Concerns