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

Understanding quality in health care

From Washington Health Alliance | November 23, 2015

Quality varies widely from one provider’s office to another and even from one doctor’s patient to another. Not all care is equally good. Learn what you can do to find a provider that will help you stay healthy and care for you when you need it.

What is high-quality care?

Good health care is the right care, at the right time, for the right reason. The quality of health care varies, but trustworthy, public information can help you decide what test or treatment is best for you and if the care meets accepted standards.

• Your doctor should be using the appropriate tests or procedures for your age, gender and medical history.
• You should get health services when you need them and before you get sicker.
• You should get health services you actually need, nothing more and nothing less.

Doctors committed to quality will not only welcome your involvement but also encourage it. While your doctor should be able to direct you to reliable information on a health topic that affects you and talk to you about your options, you have a major role to play when it comes to your health and well-being.

How can you get what you need?

Compare care. Finding a good primary care team is the first step in getting high-quality care. Go to the Community Checkup website where you can “shop” for a clinic in your health plan’s network to see how well they rate on quality measures that matter to you. The quality measures that were chosen for this website serve as a proxy for the overall quality of the care delivered by that clinic. For example, even if you don’t have diabetes, seeing how well a clinic is following recommended care guidelines for that disease can signal to you how well they treat any chronic disease.

Make an informed choice. After you’ve looked at options on the website, contact the clinic and ask questions to see if they would be a good fit. Do they offer hours that are convenient to you? Do they accept your insurance? Do the providers have knowledge or specialized expertise in the health areas that matter to you or your family?

Be an active member of your health care team. Do your homework. Go online or use the library to learn more about your condition and treatment options before your doctor’s appointment. Talk to your doctor about what you’ve learned. After your visit, take an active role in your health and health care so you can stay as healthy as you can. Your primary care doctor may tell you to exercise more or eat better, but it’s up to you to follow through on this advice.

Get the right amount of care. Unnecessary care costs money and can be harmful. Patients with chronic conditions do not always get the recommended care. Many people don’t get regular screenings, which can detect disease earlier. Certain drugs, treatments and tests are sometimes offered for common health complaints even though they aren’t really effective. Learn more about the value and effectiveness of specific tests and procedures at Choosing Wisely® patient resources.

Work with your doctor to make decisions about your care. This is sometimes known as “shared decision-making.” It’s important to ask questions, such as:

1. Do I really need this test or procedure?
2. What are the downsides?
3. Are there simpler, safer options?
4. What happens if I do nothing?
5. How much does it cost?

While health care consumers have a big role to play in ensuring they get the right care, you are not alone. Providers are the ones ultimately responsible for making sure they are delivering the right care at the right time.

Know you have options. If your expectations aren’t being met, talk to your doctor about your concerns. And if necessary, look for a new doctor.

Quality should be part of the equation for good, high-value health care, as much as patient experience and cost. 

Download the infographic about how to find high-quality care and be a savvy health care shopper.

Infographic: Washington Health Alliance.

This post is second of a series called The Savvy Health Care Shopper. The Washington Health Alliance is partnering with the Washington State Health Care Authority’s Healthier Washington initiative to educate consumers on finding value in health care.

DENT Story: A Pregnant Woman Receives Vital Dental Care

The initial visit to the ER doesn’t always mean the dental patient will accept the resources offered the first time. In the case of a 31-year-old woman with right and left lower teeth pain who was referred from the ER to the DENT Program, she received antibiotics and her abscess appeared to have cleared. However, pain and abscesses almost always return with a vengeance.

Unfortunately, the woman did not return DENT calls with offers of dental appointments the next day.  DENT staff continued to call and text and even mailed a letter, reminding her that she was Apple Health eligible and that the insurance would pay for her dental care. Still no response.

A little over a month later, she called in pain with a very swollen face. She was newly pregnant and very ill and needed emergency dental care. She was very concerned about the pain and swelling but even more worried about the possible effect on her unborn child. In crisis, she became motivated to call. Luckily, she kept the DENT phone number. 

Both the Unify and CHAS Clinics (FQHCs) offer immediate dental appointments to pregnant women because they are committed to assisting in any way to ensure healthy births. DENT staff was able to schedule the woman the following day with the Unify Clinic for emergency dental care.

The woman stated, “I am so thankful you did not give up on me after not calling back last month. I was in a bad situation and just couldn’t think about my teeth. I started to feel better and I thought the tooth problem was over. I was so wrong.”

Announcement: Warming Center Transportation

Tonight, Pastor Stephen Johnson and the volunteers from United Methodist Church, on 3rd and Howard,  will transport folks to the warming center located at the Salvation Army from 7:15-8:15 pm.

They will return to the warming center at 6:45-7:45 am to transport folks back to the United Methodist Church.

If you know someone who needs a warm place to go tonight, please direct them to the United Methodist Church on 3rd and Howard.

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.

Open Enrollment Launched November 1st

There was a lot less fanfare than our first Open Enrollment period and fortunately a lot less technical glitches—but BHT is at it again. We want to make sure every person in our region has health insurance. As of March 31, 2015 we were under 5%; our goal is to get that number down to 2% this year. We can do it!

Thanks to our robust Navigator Network of 125 on-the-ground partners, our dedicated BHT Navigator team and our plan to participate in more than 40 community events, we are confident we will meet our goal to enroll/reenroll 4,000 people between November 1 and January 31. We are focused this year on individuals who are eligible for Qualified Health Plans; these are the people who can are eligible for a tax subsidy to purchase health insurance.

Insurance Opportunity by County