BHT Summer's End Update

End of summer and back to school……

Is anyone else checking their calendars because they can’t believe the summer is almost over? I sure am!

It’s been a productive summer for BHT and our ACH work. In June, we launched our Social Determinants of Health and Population Health teams. Our local teams of 20+ people are working hard to build out our local strategy maps with strong community linkage work attached to each goal area. We’re grateful to our friends at the Spokane Regional Health District and THEZONE for introducing us to the Results Based Accountability model to further push our work forward. You can see this work in progress through a series of blog posts that we’ve posted this summer

In July, we agreed to pilot the Pathways hub model. On September 29th-30th we will be heading to Akron, Ohio for the Pathways Community Care Coordination Summit. We are so excited for the opportunity to engage with a real HUB and hear from folks who have been actively involved in implementing the Pathways. We are sure to come home with a better understanding of how this model could fit in our region. I know Ohio is a trek, but if you are interested in attending the summit you can Click here to learn more and register.

Still no word on the Medicaid Waiver decision, but whether we talk to federal staff or the HCA, we still feel confident the Washington is on track for this important investment to further accelerate our efforts to transform the health of our region. We’ll keep you up to date!

Finally, a few changes to the Better Health Together Board of Directors. We have updated our board governing policy documents. You can see the policy the board passed here.

We are also excited to announce that we are currently recruiting for four new board members with a strong interest in reducing health disparities. If you have someone who would be a good referral, please send them our way. Alison@betterhealthtogether.org

Enjoy the last few days of summer, this Fall will be a wild ride!

Governance Policy: Board of Directors & ACH Leadership Council

As of July 2016, the Better Health Together Board of Directors has adopted a revised Governance Policy for our ACH. Take a look here. 

May ACH Leadership Council Update

Thank you to all who joined us to talk next steps for our ACH. And a special thank you to the Health Care Authority for driving all the way across the state to help bring some additional clarity on our role as an ACH.

This was a big meeting that produced some concrete action items for Leadership Council members. In case you missed it, here is the recap and documents:

We started the morning with a presentation from Kali Morris from the Health Care Authority on the role of the ACH in Medicaid Transformation. You can view those slides here. In her presentation, Kali made some comparisons to Medicaid transformation work happening in New York, and shared some lessons learned from their efforts. If you are interested in learning more, you can read this report on New York's DSRIP Program put together by The Commonwealth Fund. On the topic of Value Based Payments, HCA also shared this helpful visual on Alternative Payment Models.  

After that we looked at our refined Community Strategy maps. Consider these our first draft as we synthesize the wealth of information that came out of our Idealized Design Sessions. The next step will be to form workgroups, each chaired by a BHT Board Member, to validate strategies, develop metrics, and finalize our community linkage maps. We will be forming a workgroup for each strategy map, reflecting our three ideal states of design. For more information, please review the following charters:

1. Integrated Care
2. Population Health
3. Community Determinants of Health

Additionally, we've made some headway on selecting our regional health improvement project around the development of a centralized community referral system ("air traffic control") based on the Pathways Community HUB model. We will be forming one additional workgroup to explore this model and serve as the steering committee to launch our project. You can take a look at the ACH Project Team Charter here. 

We are looking for volunteers to join one (or many!) workgroups, with the intent of meeting through the summer, to have Strategy Maps finalized by September 20th. If you are interested in joining one of these workgroups, please read through the above charters and consider which group best fits your expertise, and email your interest to Alison@betterhealthtogether.  

We also shared with everyone Empire Health Foundation's new Oral Health Access document. Please take a look and feel free to share!

That was a big update! But we are thrilled to have some actionable to-dos as a group. Thank you all for your willingness to jump aboard. 

ACH March Leadership Council Meeting Recap

Thanks to all of you who joined us for our March ACH Leadership Council meeting. It was a great discussion and gathering, with a full room of partners in person and online.
 
Cool things to know
The State expects to hear in late April if we are successful in our Medicaid 1115 Waiver application. We will keep you posted as we learn more.
 
April is Spokane Gives month, United Way and partners will host a month of volunteer opportunities in Spokane. Check out the volunteer projects here and see how you and your teams can Give to your community.
 
The new Apple Health Foster Care program, Apple Health Core Connections, will launch April 1st managed by Coordinated Care. This new program will bring increased care coordination to children in all stages of the foster care system.
 
A number of organizations are seeing Spring time growth and bringing on new hires to increase their capacity to serve our region. We are especially excited about Newport High School’s hiring of an additional school nurse.
 
And if you are a Bloomsday fan, start training now at Providence and Group Health’s free Bloomsday training clinics.
 
Next Steps in ACH Development
We’ve been synthesizing the wealth of information and ideas generated at our Community Linkage Mapping and Idealized Design sessions over the last two months. We debuted and discussed our first strategy map Priority area: Scaling Community Based Care Coordination. We received helpful feedback to further streamline the use of the maps. The feedback included more context, clear prioritizing and the sharing of the current community efforts for each of our strategy areas. There is much work still to do, so stay tuned!
 
Thought Starting Presentations
Alisha Fehrenhabcher, shared some of her experiences and lessons learned from her work with Health Matters of Central Oregon on the Pathways to Health Hub model. This model demonstrates a pathway (sorry for the pun) forward for our Scaling Community Based Care Coordination based on an evidenced based practice that is scalable across regions and sectors. We are lucky to have her in our BHT region.
 
Our friends at SNAP Spokane shared their new Low Acuity Transportation Pilot program aimed at reducing the cost of ambulance rides by creating alternative transportation to more appropriate care centers. This is a great demonstration of community entrepreneurship. Go SNAP Go!
 
Lots of great work happening in our region! If you missed the meeting, we have all of the slides and handouts available for you here: 

• ACH at-a-glace document from the Year 1 ACH Evaluation Report
• ACH Priority: Scale Community Based Care Coordination strategy map
• On the Horizon: Document showing what is coming up for ACH development
• Leadership Council Meeting PowerPoint, with presentation from Alisha
• SNAP Spokane’s Low Acuity Transportation Pilot presentation

 
As always, if you have questions or comments, let me know.

Alison Carl White
Executive Director


 

Next Steps for our ACH

True health care reform cannot happen from Washington DC. It has to happen in our kitchens, in our homes, in our communities. All health care is personal.

-Dr. Mehmet Oz

Over the last few weeks, I had the good fortune of spending time with our friends from Pend Oreille, Ferry, and Stevens counties. After watching these local communities take ownership of their community health, especially in contrast with rhetoric coming from our Presidential hopefuls, I’m more convinced than ever that health transformation happens in our kitchens, our homes, and our communities.  

When we first launched our ACH work, it was a hard concept to wrap our heads around. We aren’t government, we don’t have any power to make people do things, we aren’t a risk bearing entity. But we are a compilation of community members who care deeply about the health of our community, with a strong bias towards action that improves health.

Fast forward a year to now and we are on our way! In January, we hosted a fabulous gathering of 80+ people who helped us launch our Community Linkage Mapping and Idealized Design efforts. We have now recruited another 80 folks to help refine our Community Linkage Maps and define the functions necessary for effective action. From there, we’ll start to build our Regional Health Improvement Plan and select our ACH Regional Projects.

It’s good work happening! Thanks for being part of the team that is radically improving the health of our region. 

ACW

If you missed Monday's "What Is Possible" webinar, you can view a recording and read through the slides here. 

Measuring Health Care Performance in the Better Health Together Region

High-value care is high quality care, with a good patient experience and at a fair cost. Unfortunately, the quality of care patients receive varies among counties, medical groups, clinics and even within medical groups and clinics. Unwarranted variation, without a clear connection to how sick patients are, can be a signal of poor quality, or at the very least an opportunity for improvement. In a highly functioning health care delivery system, everyone would receive a similar high level of evidence-based care for the same condition. However, we know this is not the case in Washington and elsewhere around the country.

An important first step in reducing variation is measuring it and broadly sharing results to develop a common understanding of what needs to improve and where it needs to improve.

The Washington State Common Measure Set for Health Care Quality and Cost, implemented for the first time in 2015, is a “starter set” of 52 measures that enables a common way of tracking important elements of health and health care performance. These results are published on the Washington Health Alliance’s Community Checkup website.

Policymakers and health care leaders within Better Health Together can use the results from the Community Checkup to determine how well health care and community systems are performing. The results also can serve as a baseline for future reporting. Consumers within Better Health Together’s jurisdiction can look to results for medical groups, clinics and hospitals to help make informed decisions on selecting a primary care home as well as where to find high-quality hospital care.

Opportunities for improvement

When looking at results from the Community Checkup, it’s important to look at not only the results for all of Better Health Together ACH, but also at the county level, as well as the amount of variation among provider organizations within the ACH. We’ve called out some results to show where variation is especially pronounced. To compare full scores, please visit wacommunitycheckup.org.

ACH-level results

On many of the measures reported in the Community Checkup, the Better Health Together community is performing at the state average. However, when possible, we compare rates to national 90th percentile benchmarks. When we compare against these goals, there is significant opportunity for improvement across several measures, such as Avoidance of antibiotic treatment in adults with acute bronchitis (Better Health Together commercial rate = 28% compared to NCQA national 90th percentile rate = 38%).

On a few measures (for example, Well-child visits between ages three and six), we saw pronounced disparities between Medicaid and commercial enrollees. Across all payers, the Better Health Together community can improve appropriate testing for children with pharyngitis before dispensing an antibiotic for strep. This is particularly important as antibiotic overuse plays a role in the rise of antibiotic-resistant bacteria.

County-level results

If variation can be a signal of poor quality, then looking at variation within the ACH will reveal opportunities for quality improvement. We looked within the Better Health Together area to see where there was the most variation in performance. When looking at combined commercial and Medicaid enrollee data, we see the most variation among counties on the following measures:

• Almost all of the health screenings measures
• Immunizations measures. (In particular, the childhood and adolescent immunization measures, meaning more work needs to be done to make sure children and adolescents are getting their recommended vaccines.)
• Adherence for diabetes medications
• Hospitalization for COPD or asthma

We saw the most variation among medical groups on the following measures:

• Diabetes measures
• Health screenings, in particular breast cancer and colon cancer screenings

Spotlight on Spokane

Overall, Spokane County rates average (results are not significantly above or below the Washington state rate) on most of the measures reported in the Community Checkup. Spokane County is serving residents with commercial insurance pretty well. The county ranks average on most measures, and better than average on many, including health screenings, most generics prescribing measures and medication adherence. The county has room to improve in how it serves Medicaid patients. For example, we see worse than state average results for many of the measures for Medicaid enrollees, including potentially avoidable ER visits.   

 

Successes to celebrate

As the highlighted results reveal, there are many areas where targeted efforts to improve how care is delivered to residents within the Better Health Together jurisdiction. But there are also many successes to celebrate (and replicate!).

For example, the Better Health Together community overall is exceeding national benchmarks on screening for cervical cancer among Medicaid enrollees. However, as stated above, it’s important to look at variation within Better Health Together to see how all organizations and regions could be lifted up to this higher standard. As regional conveners of key stakeholders that influence local health and health care, ACHs like Better Health Together are well-positioned to prioritize and take action on these findings.

Next Steps for our ACH

More than 90 folks joined us for our Healthy People Champions Regional Gathering last month. It was an inspired day for BHT as we saw the key players in our region roll up their sleeves and get to work on moving our Accountable Community of Health work forward.

The week of February 29, we will launch our next phase of work with our Community Action Teams. We’ll be hosting ten work sessions focused on our “Community Linkage Mapping and Architecting the Ideal” for each priority area. We are building our teams now, if you have an interest in participating please let me know at Alison@betterhealthtogether.org.

Wondering why we are asking so much of you—or just wondering how these activities will actually make people healthier?

We are pleased to host an educational webinar on Tuesday, February 23 from 9:30-10:3a.m. That includes three thought leaders who are not just talking about transformation but are making it happen.

• Göran Henriks, Chief Executive of Learning and Innovation, Qulturum, County Council of Jönköping, Sweden, will join us to share the success and possibility Jönköping, Sweden,  has achieved by transforming health through the alignment of programs and resources within the community. I am especially inspired by their work because it has very little to do with their funding and more to do with how they work together as a community
   
• Alisha Fehrenbacher, Chief Strategy Officer for Empire Health Foundation, is the former Oregon Care Coordination Organization CEO. The Oregon CCO movement preceded the creation of Healthier Washington and our ACH movement. I am intrigued by some of their lessons learned and making sure we learn in our development.
   
• Dr Marc Pierson, an ER doc turned visionary health transformer, who has led some of the most innovative health work in Washington through his home base in Whatcom County.

I promise we will structure this session to be fast-paced and informational, leaving time for questions. We hope you will join us.

BHT’s ACH Medicaid Waiver Endorsement Criteria

Over the past few weeks, we have seen increased conversation around the proposed Medicaid Waiver. Many of us realize the waiver is a game-changer for our communities. 

As you know, the Health Care Authority has released an “all call” for potential Medicaid Transformation Projects. This is a great opportunity to ensure the good work happening in our region can be scaled across the full region as well as the state.

On Thursday, the BHT Board (serving as the governing body for our region’s ACH), approved ACH Medicaid Waiver Transformation Project endorsement criteria.  We believe it’s critical to put forward a set of projects that aligns with our Regional Health Priorities so that we can dramatically improve the health of our region.  The BHT ACH will submit an endorsed list of projects (our version of a “Good Housekeeping Seal of Approval”) on January 15.

Directions to seek a BHT ACH endorsement
If you are interested, please submit your completed HCA Project Template to alison@betterhealthtogether.org by 3pm on January 12. A review committee consisting of Tom Martin, Lincoln Public Hospital District; Dr Joel McCoullough, Spokane Regional Health District; Pam Tietz, Spokane Housing Authority; Kristen West Fisher, Empire Health Foundation; and Dean Larsen, Spokane Medical Society, will review applications for alignment with our criteria and will consider endorsement on behalf of the BHT ACH.

What does a BHT ACH endorsement mean?
BHT is undertaking this process to demonstrate to the Health Care Authority the power and alignment of our region. The Board would like to endorse the most promising, most aligned projects. This will demonstrate how well our region is cooperating in the development of our ACH as well as ensure we have a set of projects that are aligned with our Regional Priorities.

Does that mean I cannot submit my own projects?
Of course not. We encourage everyone to think about how the waiver could have a transformative effect on our region.

Questions?
Let Alison know at alison@betterhealthtogether.org or 509.499.0482

Resources

• HCA Waiver Project Template
• HCA Project Template Webinar
• Medicaid Transformation Waiver Slide Deck 
• ACH Priorities for BHT

Official Designation as an Accountable Community of Health

You may have heard a collective “Woohoo” from the BHT team yesterday when the Health Care Authority officially designated Better Health Together as an Accountable Community of Health. I can’t help but think of Sally Fields: “You like me … you like me!” 

Click here to read the official designation announcement.

We are really proud of the work our region has accomplished. We have convened the right players around the table: rurals and urbans, health systems and human services organizations, philanthropy, government and many other people and organizations that will be required to make our community radically healthier. We have come together as a region and prioritized five key areas . I wish I could say that our first year of forming was the hard work, but it really was not. Instead, the hard work is ahead, but I am optimistic about what is possible.

We had planned to host our 2nd Annual Health Champions Regional Gathering on Thursday, November 19th, but Mother Nature had a different idea. Due to the severe weather impacts throughout our region, we rescheduled this gathering to January 14th. Our goals and plans stay the same, we will just be a few weeks later launching the second phase of our Accountable Community of Health as well as the development of our Regional Health Action Plans. This fast-paced, highly interactive day will include design sessions for each of our key priority areas and a community mapping of the key activities that will be required to make meaningful and impactful progress.

After the Gathering, we will launch a series of Community Action Teams to further develop the community linkage maps and begin the hard work of transforming the system.  We know this is no easy task, but I know our region’s “can do” spirit will again make us a leader in this work. If you would like to attend please let Casey know you will be there at casey@betterhealthtogehter.org.

Accountable Community of Health

Accountable Communities of Health (ACHs) are a key component of of Healthier Washington, our state’s coordinated effort to help ensure better health, better care and lower costs for Washington residents.

Better Health Together serves as lead for the Spokane region ACH, a community-based partnership working across all sectors and all seven of our counties, to develop shared priority, strategies and action plans to improve health.

Visit the Regional Impact Map to see our network of ACH partners.

ACH Resources

Healthier Washington

ACH Designation Information

FAQ: Accountable Communities of Health

What is Results Washington?

Rural Health Care Strategic Plan for Washington State

Healthier Washington

Washington's Health Care Innovation Plan

Accountable Communities of Health Fact Sheet

Practice Transformation Support Hub

Healthier Washington Videos

Medicaid Waiver

Medicaid Waiver Fact Sheet

Medicaid Waiver Slides from Spokane Public Forum

Better Health Together Resources

BHT Board of Directors

BHT Leadership Council

Summary Findings on the ACH

BHT ACH Designation Portfolio

BHT Regional Health Priorities Framework

Data

Adopted Common Measure Set, December 2014

Common Measure Set Status Report June 2015

A Data Landscape Overview from King County Public Health

Behavioral Health & Physical Health Integration

Behavioral Health Organization Overview

Early Adopters of Behavioral Health & Physical Health Overview

Upcoming Events