BHT's Navigator, Israel Vidales, Goes to D.C. for 2018 Families USA Conference

The Navigator Network team gave their newest team member, Israel Vidales, the opportunity to attend the 2018 Families USA conference in Washington D.C. last month. Israel learned about the various ideas that states are planning with their Medicaid waivers. These ideas included Medicaid buy-in options and payment reform. He also attended a panel discussion on lowering prescription costs and how states were strategizing to implement bills pertaining to price gouging and drug pricing transparency. Israel had the pleasure of hearing inspiring speeches from Senators Cory Brooker, which can be found here, and Elizabeth Warren, which can be found here. Besides the exciting topics and speakers from the conference, Israel managed to visit all the national monuments around the D.C area. Out of all the monuments, he enjoyed the Lincoln and Jefferson Memorials. Our Navigator team are making east coast connections and enjoying the sites in their spare time.

Managed Care Contracting Training with Adam Falcone

As part of our FIMC investment in Behavioral Health providers in the region, BHT hosted a presentation and training session on Managed Care Contracting, presented by Adam Falcone. With a turnout with 23 agencies and 60 individuals participating, it was clear this was a topic of importance for our region! His presentation included preparing for Managed Care contracting, evaluating contracts, negotiation, and key terms and legal protections. Check out the agenda of the presentation here to take a look at the full span of everything that was covered. 

ACH Communications Council Recap

Last Wednesday, BHT sat in on a call with the eight other ACHs and the HCA for our monthly Communications Council call, an opportunity for all parties to align on communication projects and language for Healthier Washington.

One discussion point during the call was around the use of the word “Demonstration” in our project work. This word was determined to be insensitive because of its association with experimental medical and surgical practices in the antebellum South. Going forward, it has been decided that ACH work will be referred to as the Medicaid Transformation. For more information, see the full guidance here.

A second point of discussion was the HCA’s VBP webinar series, which launched in January and will continue through March. This series is a great opportunity to get familiar with all things VBP, so we encourage everyone to participate if they are able to or listen to the recordings of the webinars when they find time. Find out more about the series here. 

Community Voices Council Meets for the First Time

The Community Voices Council met officially for the first time this week in its very early stages. Co-chairs Phil Tyler and Marion Lee led a lively discussion on factors to consider as we work together building the rest of the council in a way that best represents the diverse needs and interests of the Medicaid community in the BHT region.

The nomination survey is still open—we would love to hear who you consider to be a strong community advocate with either lived experience as a Medicaid beneficiary or experience navigating the Medicaid system on behalf of others and who is willing to make their voice heard.

Delay of Collaborative Launch

Throughout the ACH development process the BHT team has committed to keeping our partners informed on the many moving parts of this work. This often means we release information ONLY to find it to be “clarified” by new information or additional guidance provided via the Health Care Authority. As we noted on Friday, there are ongoing uncertainties surrounding ACH Funds Flow, specifically related to negotiations with the BHO and HCA, on behalf of our region, for our Integrated Managed Care efforts and the timing of earned Project funds for Year 1.
 
Both of these outstanding issues caused us pause. We know we have a lot of work to do to be ready for transformational efforts. We are also very clear that this is a heavy lift for our Providers and Partners, and we want to maximize the amount of time we give you to plan and make sure we aren’t getting ahead of ourselves. To this end, we are delaying both the release and request for signed Commitment Forms/MOUs from Providers and Partners until the week of February 19th. We are encouraged by several conversations that have occurred in the last couple of days that the outstanding issues will be resolved and we will have more clarity on the release of earned funds to our region.
 
Throughout our 101 sessions, we noted that Collaborative membership was due on February 22nd. It’s our intent to extend this deadline until late March providing ample time for Collaboratives to develop and partners to be clear on commitments.
 
As always, please continue to reach out to BHT staff if you have any questions. We look forward to sharing updates as soon as we can.

-Alison Carl White, BHT Executive Director

Funds Flow Allocation for Year 1 Update

At our January 24th BHT Board meeting, the Board approved the first round of Funds Flow allocation for Year 1 Project Funds. Our intent is to push out as many dollars as we can now to support our partners in planning and preparation for transformation in their settings, while holding back a portion of funds to target investments based on our partner gap assessments.

The first set of Funds Allocations includes two streams of ACH Funding: Year 1 Project Funds: Collaborative, and the first payout of the FIMC Incentive dollars.

Year 1 Project Funding will be distributed to partners within our Community Health Transformation Collaboratives in three ways: 

1. Base Funding will consist of payouts for meeting specific milestones on ACH work, such as submitting a letter of commitment, completing an assessment, and completing implementation plans.
2. High Volume Funding acknowledges the needs of larger Primary Care and Behavioral Health providers to coordinate across multiple locations and more staff involved in delivery system efforts. This will be a payment to partnering providers based on the number of Medicaid patients they serve.
3. Equity Accelerator Funding will provide extra dollars for partnering providers whose Medicaid patient pool is over 10% racially or ethnically diverse.

Please note that partners not in Primary Care or Behavioral Health settings (aka partners who do not bill Medicaid directly) will only have access to base funding pool.

FIMC Incentive Funding became available to the region when we voted to become a mid-adopter of Integrated Managed Care. The year one payment total will be $3,120,000. BHT is prioritizing our first round of funding to Contracted BHO Providers delivering mental health and substance use disorder services and Tribal Behavioral Health providers, to support a core set of transitional efforts required for financial managed care integration.

• Contracted BHO providers will receive a base pay of $50,000 and a technical assistance payment of $20,000
• Tribal Behavioral Health Providers will receive a base payment of $25,000 and a technical assistance payment of $20,000
• Each rural county Collaborative will also receive a $50,000 rural accelerator payout, recognizing the unique challenges of providing care in rural settings.

This is our first run of funds flow allocation. Once we have completed assessments with our partners and are more informed around Domain 1 areas where investment may be needed, the Waiver Finance workgroup will begin building recommendations for the next round of funds flow. See the materials below for more information. 

FIMC Executive Summary

Year 1 Project Fund Executive Summary

1/22 Provider Champions Council Recap

The Provider Champions Council met last Monday evening. Robbi Kay Norman from Uncommon Solutions began the meeting with a brief presentation on the role of the ACH moving forward. Where BHT has previously had a heavy hand in helping to build partnerships and build a framework for regional health improvement, it will now serve as a high-level governance structure to provide support, facilitation, data collection and analysis. Alison Carl White, BHT Executive Director, walked the council through some of the reasoning behind the funding allocations that have been decided up to this point in the funds flow model.

Brian Sandoval of Yakima Valley Farm Workers Clinic then gave an overview of the differences and similarities between the Bree Collaborative and Collaborative Care models for bi-directional integration of Primary Care and Behavioral Health, and led a discussion on which concepts of each model might promote best practices for providers in our region. While both models are evidence-based approaches for integrating behavioral health into the primary care setting, each model brings different strengths into the care system. The Collaborative Care Model is a team-based model that adds a behavioral health care manager and psychiatric consultant to support the primary care provider and can be practice-based or telehealth-based, an important concept for our region. The Bree Collaborative’s Behavioral Health Integration Report and Recommendations focuses on routine, same day access to a shared care plan at the point of care and places a heavy emphasis on psychiatric services, including for those patients who are not improving or require a higher level of care. Both models rely on screening and tracking to monitor patient progress.

The discussion around best practices for integration of behavioral health and primary care will be ongoing in this council, and Monday’s discussion was an important introduction of what will be a significant topic for future work of the Collaboratives.

Special Guest at Upcoming Leadership Council

Ann Monroe, a friend from Buffalo, New York, will be joining us to present on her experiences with the health transformation taking place in New York. Ann works in a PPS, the equivalent of ACHs in New York, and will be sharing some of what she as well as other PPSs have learned during their Transformation Project, which is currently in Year 3. She will be giving a short presentation and there will be a large period of time dedicated to Q&A after. This will be a great opportunity to ask questions to someone that is a little further ahead in their health systems transformation experience and we hope it can be utilized to its fullest. We look forward to seeing you at the Spokane Regional Health District for our first Leadership Council of 2018! If you plan to attend, register here. 

Collaborative 101 Learning Sessions Recap

Thank you to everyone that was able to attend one of our Collaborative 101 learning sessions! If you didn't get a chance to make one of the learning sessions this week, there are still two dates left - one in Spokane County and one in Lincoln. View dates and details here. You can also view the slides for the presentation here as well as the Collaborative Work handout here and the background data for BHT Collaboratives here. It was great to start talking about Year 2 and beyond for BHT ACH's Medicaid Transformation Project (MTP) and we really appreciate all of the time that our partners and community members have taken to make it possible. A lot of great questions were asked at these learning sessions and in further efforts to keep consistent communication and understand each other's work, we thought it would be good to share a couple of questions and answers.

Q: Who gets to decide on the Collaborative participants?
A: We have set the structure of Collaborative to include participants from the following settings; primary care, behavior health & SUD, oral, pharmacy, social determinants of health, county, hospitals, and tribal. We have also complied a list of suggested partners, but it will be up to the Collaborative members to make the connections to bring the individual partners to the table from each setting.

Q: What’s the next step? What are the expectations for partner organizations moving forward?
A: The most immediate action we need is a signed commitment form. This is a soft commitment (the final date to withdraw is June 30), but there will be an incentive payment for this commitment form due on February 22. From that point forward, the Collaborative work really kicks in. BHT is here to support all Transformation efforts, but our stewardship will be to assist you and your county partners in determining the most important metrics and goals for your county, and in taking the initial steps to transition to VPB and integrated care.

BHT Kicks Off Year 2 with Collaborative Work and Learning Sessions

Happy New Year from BHT! We are so excited for Year 2 of the Medicaid Transformation Project (MTP) and its kickoff with Collaborative work and the Collaborative 101 Learning Sessions. The Community Health Transformation Collaboratives will be comprised of Health System and Social Determinant partners serving as the activation network for Transformation Projects. Collaboratives will form in each of our counties, and will be responsible for developing an implementation plan to meet project requirement of MTPs.

During the month of January, the focus will be on developing members for these, bringing everybody up to speed on where MTP work will be taking us next and outlining Collaborative responsibilities. We hope to see you at one of the Collaborative 101 Learning Sessions! See dates and details below, and please RSVP to Chelsea@BetterHealthTogether.org if you plan to attend. We hope to see you there! 

Adams County- Tuesday, January 9th, 10:00 am – 12:00 pm; Columbia Basin Health Association Othello Clinic, 1515 E. Columbia St, Othello WA 99344

Ferry County- Tuesday, January 9th, 10:00 am – 12:00 pm; First Presbyterian Church, 605 S. Keller St, Republic WA 99166

Lincoln County- Tuesday, January 16th, 2:00 pm – 4:00 pm; Lincoln County Courthouse – Commissioners’ Chambers, 450 Logan St, Davenport, WA 99122

Pend Oreille County- Thursday, January 11th, 8:00 am – 10:00 pm Camas Center for Community Wellness, 1821 LeClerc Rd N, Cusick, WA 99119

Spokane County

• Monday, January 8th, 1:30 pm -3:00 pm; Downtown Spokane Public Library, 906 W Main Ave, Spokane, WA 99201
• Wednesday, January 10th, 10:30 am – 12:00 pm; Location TBD
• Tuesday, January 16th, 11:30 – 1:30 pm (following the ACH Leadership Council at the Spokane Regional Health District), 1101 W College Ave, Spokane, WA 99201

$118,000 to Partners for Inventory Completion

To date, we've authorized $118,000 in payments to partners who completed our Health Systems and Care Coordination Inventories. These inventories have provided helpful data to shape project and Community Health Transformation Collaboratives recommendations and planning to inform implementation. We offered a performance payment for completion of the inventories. We are in the process of authorizing payments; the total anticipated payout is $181,000. We are excited to make another set of transformation Performance payments to the region.

BHT Welcomes Director of Clinical Integration to the Team

The BHT team is delighted to welcome Charisse Pope as our new Director of Clinical Integration! We feel like we’ve scored the jackpot on recruiting her to our ACH efforts. Charisse will bring on the ground clinical experience as both a provider and an administrator, and her work with the RSN/BHO will be invaluable as we move to integrated care. She will hit the ground running, as BHT only knows one speed full speed ahead, on January 2nd. Here’s a bit of bio on Charisse, if you don’t already know her.

Charisse grew up in Eastern Wasington and has 20 years of non-profit and social service experience. She has a Masters in Counseling Psychology and started out in social services as a therapist working with adolescent girls. She then went on to earn a Masters in Business Administration to support the work of others as an administrator.  Charisse continued in administration working for the Spokane County Regional Support Network overseeing a provider network, contracting, fiscal allocations, utilization, and working with other counties and regions as chair of County Human Services for several years. She then returned to her roots at Excelsior and served as Chief Business Officer. In her free time, she loves being at home with family, weekend outings, and playing with her sidekick dog. Welcome, Charisse!

Provider Champions Council Recap

The Provider Champions Council met on Tuesday night for the first time and it was a great success. The Provider Leadership Council represents a group of provider champions and practitioners from the region necessary to improve the community health of our region. We discussed the Medicaid Transformation timeline, the BHT Integration Framework and the 2018 Collaborative work. View the slides from the meeting here as well as the Provider Champions Council Charter here for more information on the council and its goals.  

Request for Feedback - Practice Transformation Hub Prepares for Integrated Billing Toolkit

The Practice Transformation Support Hub hosted four webinars, Preparing for Integrated Billing: An Assessment for Behavioral Health Agencies, in December. 175 providers, stakeholders, governmental staff and others registered participated in the webinars and received the self-assessment and other planning tools provided prior to the webinar, which you can see below. 
 
Practice Transformation is making a special request to all BHOs, ACHs and provider organization stakeholders to provide feedback on the tools so that they can modify and improve them for final statewide publication in early 2018. Completing the survey will take 5 minutes and is an opportunity to provide them with essential user feedback. You can also access a recording of the webinar here.
 
Also, they invite you to join them for the scheduled office hours to hear answers to commonly asked questions and to ask your specific questions related to the Integrated Billing tools.

• January 4, 12-1pm - Register here 
• January 9, 8-9am - Register here.

You can also contact them via the Practice Transformation Help Desk at HubHelpDesk@qualishealth.org and by phone at (206) 288-2540 or (800) 949-7536 ext. 2540. It is important to prepare early for a successful transition to MCO billing processes, so take advantage of this current opportunity for resources!

BHA Billing Readiness Checklist

BHA Billing Scoring Tool

BHA Billing Self-Assessment Annotated

BHA Billing Self-Assessment

BHA Billing Transition Plan Template

Preparing for Integrated Billing

Community Checkup at the Philanthropy Center Recap

Last Wednesday, Susie Dade, Deputy Director of the Washington Health Alliance, came to Spokane to present the 2017 Community Checkup, a comprehensive report on health care quality in our state. It includes results for dozens of measures of quality and patient experience, and results cover four million insured lives, both commercial and Medicaid, as well as 39 counties and all 9 ACHs. Excitingly, we got to explore and focus on results for the greater Spokane area and BHT region, and there was definitely no shortage of new information.

Something that we were unaware of is that Washington is actually one of only three states in the country that has earned an ‘A’ for healthcare reporting. Although this unfortunately does not correlate with the actual quality of health care in Washington state, this transparency helps us know what we are doing well and where we need to target improvements. As a state, we strive to be in the top 10 percent in the nation on the most important measures of quality, and this report helps to inform us on how to get there.

So, how do we get there? Some things discussed during the presentation were collaboration as well as aligning efforts, implementing effective strategies and aligning payment with outcomes. Transparency is also a foundational step on a long journey that involves various different publics and stakeholders. While transparency remains the foundational step for success, action is the critical one. In addition, fostering honest dialogue about the challenges ahead and what needs to change is essential to drive improvement.

At the end of the day, it is important to celebrate our successes, stay positive and look ahead. We are thankful for all of our partners and are extremely excited about where this work will be taking us together. It’s been a great Year 1 in our Medicaid Transformation and BHT is definitely looking ahead as we move into Year 2.

Read more about the Community Checkup as well as its 2017 report here.