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.

Great Results from Open Enrollment

Wow, according to the Health Benefit Exchange, Washington state enrolled or re-enrolled over 200,000 people in health insurance during Open Enrollment (November-January). This number is up 35% over last year during this time period.

We could not have achieved these results without our robust Navigator Network as well as the hard working team at BHT. I am grateful to our friends at CHAS and Columbia Basin Health Association who were some of our biggest producers!

Remember: if your clients, patients or friends have any life-changing event (have a baby, lose a job, retire), it will likely make them eligible for a special enrollment period; we are here to help.

Free Tax Services

In Spokane County, in 2013, 36% or 13,485 of families who were eligible for the Earned Income Tax Credit (EITC) used a paid tax preparer. If these families utilized free tax preparation alternatives an additional $1,928,355 would have been saved (figure based on the National Society of Accountants average cost for a return prepared without itemized deductions).

That’s why Spokane County United Way is encouraging eligible households to use local, free tax preparation resources. The organization is working with employers to provide employees information about tax preparation services available in our community. There are two available options for free tax preparation.

1. Free Tax Preparation Sites are available for low to moderate income wage earners (tax site appointments can be made now at 509-353-4851, walk in appointments starting February 1, 2016).

2. MyFreeTaxes is a free online program with a call in helpline available to those earning less than $62,000 in 2015. Visit www.myfreetaxes.com for more information. Check out these resources about MyFreeTaxes:

• MyFreeTax Flyer
• Payroll Stuffer
• Alternate Payroll Stuffer

If you wish to have a representative from Spokane County United Way come to speak with your employees about these options, call 509-838-6581.

SHA Provides Rental Assistance for 2016

Spokane Housing Authority (SHA) will accept online pre-applications for The 2016 Open Waiting List of the Housing Choice Voucher Program from 12 a.m. on January 19 to 3 p.m. on January 21.

The pre-application can be found at www.spokanehousing.org.

Only one pre-application per household will be accepted. Applications must be at least 18 years old. Pre-applications will be placed on the waiting list by time and date of receipt of the pre-application and preference. Applicants without a preference will be placed at the bottom of the waiting list according the date of receipt of the application.

Preferences are:

1. A family whose head, cohead, spouse, or sole member is a person with disabilities; two or more persons with disabilities living together; or one or more persons with disabilities living with one or more live-in aides.
2. A family whose head, cohead, spouse, or sole member is a person who is at least 62 years of age; two or more persons who are at least 62 years of age living together; or one or more persons who are at least 62 years of age living with one or more live-in aides.
3. Applicant families with dependent children. Preferences will be verified and must be valid when an applicant reaches the top of the waiting list.

For assistance applying online, visit:

• SHA at 55 West Mission during regular lobby hours (8:30 a.m. to 4 p.m. Tuesday and Thursday, 1 p.m. to 4 p.m. on Wednesday).
• SHA’s booth at Homeless Connect on January 19 at Salvation Army, 222 East Indiana Avenue.

Note: After placement on the 2016 waiting list, applicants must notify Spokane Housing Authority of any mailing address changes in writing otherwise you may be removed from the waiting list.