Technical Council Activity Summary

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Below are summaries of notable Technical Council and Board activities and decisions for October 16-November 12, 2018. Visit our calendar for dates of future meetings, and visit our Technical Councils and Board pages for meeting minutes.

Provider Champions Council • 10/15

The Champs approved for recommendation to the Board a list of Pay-for-Achievement measures by which providers will earn 40% of their Pay-for-Reporting dollars throughout the rest of the transformation. This “menu” of measures addresses local priorities identified by primary care and behavioral health providers across the region, such as reducing unintended pregnancy, improving oral health, and supporting bi-directional integration of care.

Community Voices Council • 10/30

The council has been working hard sharing information about the IMC transition to their circles (beneficiaries, providers, case workers, etc). The group decided to host several town halls at different Community Health Advocate (CHA), low-income housing sites. The council is also developing plans for an event to inform those who work with Medicaid populations with at least enough information to answer basic questions and direct individuals to Navigator services.

Community-Based Care Coordination (Hub) Council • 10/22

The Hub Council continued their discussion of a regional resource directory, including an overview of HealthBridge. There is still more discussion to be done, including around data sharing, what information to included in the provider/program listings, and connection to the Hub platform. The group also got an update on the Pathways Hub pilot in Spokane County, which has announced successful bidders for Care Coordination Agencies.

Board of Directors • 10/31

The Board received a preview of the funds flow model that had been presented to the Waiver Finance group in October. They also got a sneak peak of the Final Partnering Provider Transformation Plan template and contract. The only motion passed was to approved the consent agenda.

Waiver Finance Workgroup • 11/7

The workgroup passed three motions regarding Waiver funds flow for the coming years, which will be presented to the Board of Directors on November 28. The first motion approved a policy to disburse Pay-for-Performance and Pay-for-Reporting dollars according to provider service volume, with organizations falling into three tiers; there was a grandfather clause added to protect organizations from a funding penalty in the case of a merger.

The second motion approved the creation of three funding pools for Pay-for-Reporting dollars, including progress in measures identified in Partnering Provider Transformation Plans, local “Pay-for-Achievement” measures, and measures selected from a menu addressing equity. This motion also included an optional carve out for tribal participation, as well as a Bonus Pool for unearned implementation funds.

The third motion approved the disbursement of 75% of earned Pay-for-Performance funds to the large-tier providers, with the remaining 25% being evenly disbursed across the medium tier. These motions have not been approved by the Board.

To approve Volume policy with the inclusion of a grandfather clause (no funding penalty) if there are mergers that occur during the three-year transformation period.

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To approve Pay-for-Reporting Implementation funding ranges for Behavioral Health and Primary Care providers for 2019, 2020, and 2021.

Funds will be allocated by volume per adopted policy.

Providers will earn funds based on:

  • Pay-for-Milestone (40%)

  • Pay-for-Achievement (40%)

    • 2019: Select measures/measure progress

    • 2020: Achievement of 4 measures

    • 2021: Achievement of 4 original and 4 additional measures

  • Pay-for-Equity (20%)

  • Tribal partners will have the opportunity to participate in either implementation funding or tribal carve out

  • Unearned Implementation Funds will be placed in a pool to be distributed at the recommendation of Waiver Finance Workgroup and approved by BHT Board

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To approve Pay-for-Performance 75/25 Implementation funding ranges for Behavioral Health and Primary Care Providers for 2019, 2020, and 2021 for payment in 2021, 2022, 2023.