As the backbone organization supporting the Collaboratives in health systems change, BHT believes part of that responsibility is ensuring that as many dollars go to our partners as possible. We can stay narrow because our role is of a coordinator; we believe our community has the experts it already needs to get the work done.
Read MoreA weekly webinar to prepare organizations to participate in transformation project planning.
Read MoreWe have learned that some of the initial calculations HCA made in the application to meet CMS requirements for matching funds were insufficient. This will mean a reduction in funds available to ACHs.
Read MoreWe recently had the opportunity to participate in a collaborative learning session with Joe Conte, a leader in New York’s Delivery System Reform Incentive Payment (DSRIP) Program. Joe works with Staten Island’s Performing Provider Systems (PPSs), the equivalent of ACHs in New York, and we were excited to share in some of what they have learned along the way.
New York PPSs are almost in Year 4 of their demonstration, and their partners include over 75 fully engaged organizations and 20 population health practice partners which include 100 percent contracted healthcare providers, agencies, schools and community-based organizations. Their goal, similar to our own, has been to improve quality of care and transform the healthcare delivery system of Staten Island as well as ready providers for VBP contracting. Staten Island currently has 180,000 Medicaid beneficiaries, and Joe stated that combining cultural competency into their PPS work has been extremely important.
By Year 5 of their demonstration, they anticipate that 80 percent of funds in New York will be by performance and 20 percent by reporting. A priority for them has been minimizing overhead expenses while maximizing the amount of funds used for:
1. Project implementation
2. Incentive payments
3. Lost Revenue/Innovation Funds/Cost of Services Not Offered
Joe also emphasized that it was important to give a voice to SDOH organizations and smaller practices for equivalent payments for units of work regardless of organization size. 97 percent of provider satisfaction for Staten Island was reportedly due to financial engagement. They found that if there was a network-wide loss, then everyone was affected. “You don’t want to lose partners just because they are unable to make a financial commitment,” said Joe. Creating necessary partnerships and supports for participating organizations has been crucial.
Lastly, Joe openly shared some unanticipated issues with DSRIP, which we found very relevant. These issues included:
1. Working with the plans should be a top priority.
2. Understanding the best way to gather data from different sources is necessary with community consent.
3. Co-located services could be talked about more at a state-level and earlier on.
While much of DSRIP in New York looks very different than in Washington, we are so grateful for this chance to share in lessons learned. It is inspiring to compare efforts of folks across the nation as we work to improve the health system in our respective regions.
You can download more detailed notes from the webinar here, and watch a recording below.
Another milestone for BHT! Download our Phase 2 Certification doc here.
“In our region every person, regardless of background, life experience, or environment, will live a productive, high quality life, with access to stable housing, nutritious food, transportation, education, meaningful employment that pays the bills with some left over for savings, and social support networks that foster emotional, social, and psychological wellbeing. Each person’s health will be supported by an integrated community health system, accountable to improving health through delivering culturally competent, whole person care. ”
At our July Leadership Council meeting we debuted an updated vision statement drafted by BHT staff, looking for feedback and truthing on our vision to be included in our ACH's Phase 2 Certification Process.
Thank you to everyone who gave feedback during the leadership council meeting, or through the survey we sent out. With the work we are trying to accomplish being so expansive, it sure is hard to define a "short and succinct" vision, but with your help wordsmithing we are feeling pretty happy with what we came up with.
If you'd like to follow our process, you can see comments we received on our vision statement here, and a redlined word doc showing the changes we made in response to feedback.
BHT and all 9 ACHs pass Phase 1 Certification, a major demonstration milestone.
Read MoreBetter Health Together has intentionally built a multi-tiered governance structure with distributed decision-making, joint ownership and mutual accountability that drives innovation and creativity, and fosters co-investment that leads to results, not process. This structure rests on our partners aligning around a common agenda with mutually reinforcing activities, and continuous communication between all parties.
The Standard Terms and Conditions of the Medicaid Demonstration specifically call out requirements for ACH engagement with stakeholders and opportunities for community feedback. To these ends, the Better Health Together ACH is establishing more robust protocol for membership as a Leadership Council Organization or Health Champion to ensure we meet these requirements. All meetings will remain open to the public, however there will be specific requirements to be considered a Member Organization.
Leadership Council Meetings are open to all organizations located or delivering service in the BHT Region. This is an open forum for community members to receive and share updates on ACH work and activities in the region. These meetings will always remain public.
Membership within this council is granted at an Organizational basis. To be considered a member of the Leadership Council as the strategic synthesizer for the ACH, your organization must sign an ACH Community Commitment form. This indicates your organization’s alignment with our Regional Health Priorities and commitment to collaborating on health improvement. Members are expected to have representatives participate in at 2 out of every 3 Leadership Council meetings.
If attendance requirements are not met, members will be flagged as "Disengaged." This is an internal designation only, which signals to ACH staff that this organization needs outreach to stay up to speed. If outreach cannot be met, membership and voting rights will be suspended after 3 missed meetings. Membership can be reinstated after contact and catch up with BHT staff. With the incredibly fast pace of information flow, this structure ensures everyone at the decision making table is equipped with the latest information.
Similar to Leadership Council, starting 2017 we will be asking Coalitions to sign a Community Commitment form, and formalize their organizational members in order to meet Health Champion status. Health Champions do NOT have a vote at the Leadership Council level, because it is expected all organizations making up the coalition would be members.
Rural Health Champions Expectations:
Each Rural Health Coalition has a slightly different structure to meet the unique logistical needs of their community. Better Health Together Staff will work with Coalition members to design a Rural Health Coalition (RHC) engagement structure that is consistent with each Coalition’s unique needs while meeting minimum requirements for the ACH.
BHT will ask each RHC to designate a Coordinator and Ambassador.
The Coordinator is responsible for scheduling, logistics, agenda, attendance and minutes for each meeting. The Coordinator could be a BHT staff member OR coalition member.
The Ambassador represents the County Coalition at the Leadership Council level, and maintain the following responsibilities:
BHT Staff can serve in the coordinator role where coalition does not have local capacity; Coordinator and Ambassador can be the same person, however BHT staff may NOT serve in the Ambassador role.
BHT Staff is available to support coalitions in the following capacity:
Spokane Health Champions Expectations:
Spokane County, as an urban center, has many active and robust community coalitions centered around key community health issues and priorities. To capitalize on the momentum and expertise these groups have already gathered, ACH Staff will staff a Spokane Health Champions coalition, formed as a quarterly call between Spokane based coalitions. Examples of this would include collaborative that are not a standalone organizations, and therefore can’t be a standing LC member.
The BHT Board has appointed Co-Chairs for some expanded ACH Councils, which will spearhead some of the planning and design work we'll need to do before we submit our fill project templates in September.
Read MorePlease share your feedback on which Medicaid Demonstration Projects are the best fit for our region through this survey.
Read MoreAccepting applications to join our Opioid Response planning team now until April 17th.
Read MoreNow requesting Letters of Interest for Medicaid Demonstration Project Proposals
Read MoreOn Sunday March 12th, we welcomed the Health Care Authority to the Philanthropy Center for a Public Forum on Medicaid Demonstration. We want to thank the nearly 50 folks who attended for taking time out on a Sunday to talk Medicaid!
If you missed it, HCA will be giving one final Public Forum through a webinar on March 28th, which you can register for here: https://engage.vevent.com/index.jsp?eid=7198&seid=26
You can see the slide HCA used in their presentation here.
After, BHT gave a short update on our ACH Pilot Project, using these slides.
Well, the excitement of securing the Medicaid Transformation Demonstration (formerly known as the Waiver) has worn off and you might hear some deep breathing at BHT as we figure out how to move forward on these interconnected health projects to achieve the highest impact. This work was always going to be challenging, but when you add threats to the Affordable Care Act our deep breathing gets a little heavier… The BHT Board and many of our partners have expressed concerns about the disruption to the health system if we see ACA Repeal and Replace. We have concerns that the progress we’ve made in our region to reduce the uninsured rates (check out ACA effects on BHT Region (aka Congresswoman McMorris Rodgers Congressional District)). We by no means think that this is a perfect law. But it has helped our region improve coverage, and coverage is a first step to improving access. We’re focused on moving our work forward despite this uncertainty, and remain confident in our region’s ability to work together to transform the way we deliver community health. We will not be deterred by politics.
So enough about that, let’s get to work. The next step for our Accountable Community of Health is to launch the planning process for the Medicaid Transformation Demonstration Projects. As you can imagine there is a lot to know and understand. We are committed to sharing the resources we have created and information as we learn. A few points to remember:
And because we need to keep our energy and good humor up, here’s a link to our new favorite Doctor: ZDOGGMD
Better Health Together has always considered Whitman county a part of our region. In our programmatic arm, DENT and the Navigator Network both serve Whitman, and the county falls within the service bounds of Empire Health Foundation. However, when ACHs were designated the boundaries were drawn to match the Regional Service Network from which counties purchase their behavioral health services. This put Whitman county in the bounds of Greater Columbia ACH.
Recently, Whitman County Commissioners penned a letter to Health Care Authority requesting to be reassigned to the BHT ACH.
BHT expressed our full support in this letter to HCA, requesting a conversation with key leaders to thoughtfully explore reassignment.
To the best of our abilities in a 45 minute time slot, at our 1/25/17 Leadership Council meeting, Alison gave an overview of the projects outlined in the Medicaid Demonstration Toolkit. This Toolkit is open for public comment until 5PM February 2nd, we strongly encourage you to get together with some peers (it's 78 pages...), explore the listed projects, and make a public comment to the Health Care Authority. BHT is also requesting feedback on our regions interest and readiness in these projects in a survey below. We will post any feedback we share, or receive from the community on our blog. Here are some useful links from our discussion:
In response to feedback from our January 25th meeting, we are attempting to schedule more opportunities to deep dive into the toolkit. Stay tuned. In the meantime, BHT staff are available for questions.
I’m fresh back after some time off to celebrate the holiday. As I reflect on 2016, it was a big year of planning and preparation. We established our health priorities, created community strategy maps and selected a regional pilot project. We convened, discussed and aligned. Though, when I look back, I find myself unsatisfied with our progress in radically improving the health of our region. While we know planning is important, I’m sure you share my desire to take action.
Excitingly, 2017 is shaping up to be a year of action. January 31st marks the end of Open Enrollment, we are on track to sign up more than 1,000 new people on health insurance at our Storefront on Division, adding to the thousands of people our navigator team has enrolled/renewed throughout the region. The first week of February, we’ll train our first cohort of Pathfinder Community Care Coordinators, and in March we will get to work with our first set of clients in Republic. Additionally, in short order, we’ll be selecting and developing our implementation plans to launch the first phase of our Medicaid Waiver Transformation Projects. I expect by the end of 2017, we’ll remember fondly the calmness of 2016 after another busy year, but I am confident we’ll feel more satisfied with the real impact of our collective work.
Over the next few weeks, we’ll be rolling out a lot of new information and growing the content curation on our website. Our goal is to provide timely, well thought out information that keeps our community up to date on the comings and goings of Better Health Together.
To launch us, don’t miss our new team page that includes our three chamber governance and engagement structure, including our new board members. Very soon we will be updating the page to include all of the ACH Leadership Council members who signed our community commitment for, and
And make sure to watch our recently produced short video on the Pathways model, which we are affectionately now calling the Pathfinder Community Hub.
Hang on! We’re going to make some big things happen.
Throughout 2016, we hosted multiple series of community feedback sessions where we worked to learn and build out our community’s perspective on regional health improvement strategies.
January Regional Gathering:
In January we hosted our first iteration of Community Linkage Mapping, an exercise we have been building and refining throughout the year where participants inventory their organizational relationships in an effort to build a “map” of our health system. Also in this session, participants broke out into dynamic Idealized Design feedback sessions in each of our Priority Areas.
February/March Community Linkage Mapping:
At the end of February/Early March we hosted an expanded second round of Community Linkage Mapping and Idealized Design. We spent the months of March and April synthesizing the information and building out our community strategy maps. A few voiced themes from those sessions included the need to:
Summary of May Leadership council meeting:
In May we debuted the first draft of our community strategy maps, which represent a snapshot of the feedback we heard in the previous sessions. After, we announced the formation of Community Action Strategy Teams which would meet throughout the summer to validate and expand the identified strategies and decide on appropriate indicators measure. Each was chaired by a BHT Board Member. From June-September, we hosted feedback sessions and conducted individual outreach using the Results Based Accountability framework. The resulting updated Community Strategy Maps for Social Determinants and Population Health were debuted in September.
In October, we began working with the Spokane Regional Health District Data Center to execute a process for finalizing our Community Linkage Map. We will be surveying organizations across the region, asking them to identify their organizational relationships, which we will be able to visually inventory in a “Network Analysis” (example). This network map will help us visually represent where there are gaps of care in our health system. The map will live on the BHT website available for the public to view and explore. We will gather survey responses until December 31st, and expect to have the analysis complete in 2017.
When this map is completed, we intend to bring back this systems level view of our region to our Community Strategy Action Teams to validate our strategies and prioritize areas of impact.
This meeting featured updates on our Community Action Strategy Teams, our ACH Pilot Project, and Governance Structure. We have slides from these presentations available here.
We were thrilled to share out our updated Strategy Maps for Social Determinants of Health and Population Health. Our Community Action Strategy Teams were meeting all summer to help us understand our community’s perspective on regional health needs, and identify goals, metrics, and strategies for moving the needle. These maps represent a snapshot of the conversations we’ve heard. A huge thank you to all of you who donated some of your summer to these meetings. These maps are very much work in progress, and we intend for them to be living documents that are continuously updated as the work progresses and priorities change.
Another big update was the announcement of our first selected ACH Pilot Project. Starting in October, we will begin design sessions in Ferry County around a Jail Transition pilot to connect folks transitioning out of the Ferry County Jail and their families to stabilizing services.
We wrapped up the meeting with a presentation on the ACH and BHT governance structure. If you haven’t already, make sure you take a look at our Governance Policy which explains in-depth the role of our Board, Leadership Council, and Health Champions and how they intersect.
We are currently recruiting for 4 open seats on our Board, and need your help finding the right people to fill those positions. Click here to see our board recruitment packet, which includes more information about the commitment and an application. To apply, you must submit the application, your resume, and a letter of support from a current BHT Board Member or ACH Leadership Council Member, by Friday October 14th at 5pm.
We are also working to update and clean up our Leadership Council list. If you can’t quite remember what you signed up for when you joined the Leadership Council, take a minute to read through our recruitment packet. We will be asking all Leadership Council members to renew their Community Commitment to the ACH. Rather than deal with the hassle of asking all of you to print/sign/scan these letters to us, we will be sending out a DocuSign to each Leadership Council Member Organization with a request for contact information of each person who should receive ACH updates. Stay tuned…and as always feel free to email hadley@betterhealthtogether.org with any questions.
