MEDICAID WAIVER APPROVED!

As you can see, staff was pretty excited about this announcement...

After months and months on the edge of our seats, we were thrilled to hear on Monday that CMS and Health Care Authority have come to principle agreement on the Medicaid 1115 Demonstration Waiver. The five-year demonstration provides up to $1.1 billion of incentives for delivery system reform and $375 million to support critical services for Apple Health clients over five years. 

Significant stakeholder and community input informed the four goals of this demonstration plan:

• Reduce avoidable use of high-cost services such as acute care hospitals, psychiatric hospitals, and nursing home facilities.
• Improve population health, with a focus on prevention and proactive management of diabetes and cardiovascular disease, pediatric obesity, smoking, mental illness, and substance abuse for Apple Health clients.
• Accelerate Medicaid payment reform to pay providers for better health outcomes.
• Bend the Medicaid cost curve below national trend.

The specific terms and conditions will be negotiated over the coming months, so it will still be some time before those dollars start flowing to health improvement projects across the state, but we've just leaped a major hurdle on the track to a Healthier Washington. 

You can read more from the Governor's media release here. 

Population Health Strategy Map

View fullsize

DRAFT - Work in progressp

After a summer of focus groups, we are thrilled to release an updated draft of our Community Action Strategies Map! Thank you to all who contributed feedback in one of our sessions. 

A reminded this document is very much in draft form. We intend for these maps to be a living document, that we regularly return to and update as needs and priorities change. Today, this map represents a snapshot of the most prominent themes we heard throughout the focus groups.

Social Determinants of Health Strategy Map

View fullsize

DRAFT - Work in progress

After a summer of focus groups, we are thrilled to release an updated draft of our Community Action Strategies Map! Thank you to all who contributed feedback in one of our sessions. 

A reminded this document is very much in draft form. We intend for these maps to be a living document, that we regularly return to and update as needs and priorities change. Today, this map represents a snapshot of the most prominent themes we heard throughout the focus groups.

Background

There are many factors that lead to whole-person health and most of those factors happen outside of a doctor’s office. We have identified 6 target factors in the Social Determinants of Health: Housing, Income Stability, Food, Transportation, Education, and Community Support

Originally, the ACH Leadership Council, Social Determinants Subgroup worked on the strategy mapping for these 6 areas collectively, but it was very apparent that we needed a more systematic approach where we could engage the regional experts in targeted discussion. In August, ACH staff and SDOH workgroup co-chair Pam Tietz participated in a Results Based Accountability training hosted by THEZONEPROJECT, which presented a fortuitous opportunity to reform the workgroup into targeted community "turn-the-curve" work sessions. We split the 6 social determinants into separate work groups and asked Leadership Council members to invite any pertinent individuals or organizations to join the meeting. Our goal is to engage as many people and organizations as possible for feedback and input.

Greg Knight, the Executive Director of Rural Resources and BHT Board member co-chair of this group helped coordinated outreach sessions in rural counties. Individual outreach is still being conducted for additional organizations, and the strategy map will continue to expand. 

Through these workgroups, the group identified over 160 key partners and organizations that should be included in this work.

To date, the ACH Project Team has engaged with over 65 individuals in various work groups and outreach.

September Leadership Council Recap

ACH Updates

 
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. 
 

BHT and ACH Governance

 
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.
 

Leadership Council – Community Commitment

 
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. 

Almost time to renew your health insurance!

Open Enrollment is approaching!

Better Health Together has worked tirelessly to help reduce the rate of uninsured residents in Eastern Washington through our Navigator Network. Navigators are available to answer questions about coverage, and help folks enroll in health insurance through Washington Healthplanfinder. 

What is open enrollment?

Open enrollment is the once-a-year period in which you can register for health insurance. It begins November 1, and is available through January 31. A lot of people don't realize this is the only time of year you can enroll in or change your qualified health plans, excluding some special circumstances. 

Why does it matter to me?

Under the Affordable Care Act, it is now mandatory to have health insurance, whether through an employer, self-purchased or under public programs like Medicaid. If you are signed up for insurance through your employer, they will likely handle the renewal for you. Medicaid enrollment is available year round, and there are special enrollment periods for folks experiencing major life changes that may shift eligibility, such as losing a job, moving, or having a baby. However, if you have your own qualified health plan, and you want to renew or change your plan, November 1st 2016 - January 31st 2017 is your only chance! Better Health Together is here to help you get ready to enroll!

How and where do I go to register?

There are several options:

1.     Online: There is an application available at: https://www.healthcare.gov/screener/

2.     By phone: Better Health Together can personally help you sign up at (509) 321-7500. We have real friendly human beings ready to help you, and all of our services are free. 

3.     By mail: The printable application is available at: https://marketplace.cms.gov/applications-and-forms/marketplace-application-for-family.pdf

4.     In person: There are approximately 85 navigators in the Eastern Washington region, stationed in clinics, hospitals, services and places where people gather. CHAS Clinics, Unify Community Health Center, and Providence Sacred Heart Hospital are just a few examples of places where Navigators work. 

Here in Spokane County, uninsured rates have fallen from 13.1% to down around 3%. Next to engaging those final folks in the enrollment process, the big goal for the Navigator Network is to keep that number down by making sure renewal rates stay high, and folks are supported when life changes effect their coverage. No matter your level of coverage, BHT Navigators are ready to answer your questions and help you and your family stay covered.

Give us a call! (509) 321-7500

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!

Food as Preventative Medicine

In 2010, 86% of total healthcare spending in the US was spent on individuals diagnosed with chronic medical issues. The most prominent among these diseases include cancer, cardiovascular disease, diabetes, HIV/AIDS and obesity. Of the various components of our health that we can control, nutrition is one of the most influential factors.

We are thrilled to see a rising trend in providers and payers partnering with programs to provide nutritional support in three forms; provision, incentive and education.

1.     Provision

Provides a direct provision of food that is customized to the patient’s personal medical diagnosis through both home delivery and medically customized food banks. These programs primarily serve patients who have serious chronic disease diagnoses and attempt to both improve both quality of life and prevent additional hospital visits and or medical costs. These programs come in the form of non-profit companies, sustained primarily by donations, as well as companies contracted with health insurers.

2.     Incentives

Comprised of food purchasing incentives, in which particular foods with health benefits such as fruits and vegetables are either subsidized by the programs or incentivized. Patients may receive a food prescription from their primary care physician which functions as a kind of coupon at local vendors for fresh and healthy foods. Additionally, some insurance providers are partnering with grocery stores to provide discount cards on certain healthy foods.

3.     Education

Not knowing how to prepare healthy meals can be the biggest barrier to good nutrition. Education programs seek to teach individuals how to properly construct a diet that fits with their health needs. These programs are prevention focused, and tend to target audiences that are at risk for developing chronic illness. Lifestyle education focuses on healthy cooking, how to exercise effectively and how to understand the cause and effect of their lifestyle choices on their health.

“Food insecurity is linked to a 46 percent increased likelihood of becoming a ‘high cost user’ of healthcare” (source)

Utilization and implementation of nutrition intervention programs has the ability to drastically impact chronic illness rates, medical costs, insurance coverage and nutrition accessibility.

Here in Eastern Washington, where 1 in 3 children is overweight or obese, and rates of Diabetes are climbing, innovating new programs to help people access and prepare healthy food will be essential to preventing health crisis. In our prevention work, we collaborate with local partners to innovate ideas like those above, and increase food access and food literacy to meet our region's health needs upstream. 

To read more, visit: http://www.chlpi.org/wp-content/uploads/2013/12/Food-is-Prevention-Report-July-2015.pdf

Letter to Health Care Authority on Value Based Roadmap

Payment system reform is complicated, and we are so impressed with the hard work and energy the Health Care Authority has put into the Value-Based Roadmap. However, there are a few elements of this framework that raised some red flags for us. 

We took some time to write HCA a letter detailing some of our concerns. Give it a read here. 

The Health Care Authority then followed up with this letter as a response. We appreciate their thoughtful response, and willingness to hear our concerns and work together. 

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. 

Hood River Site Visit Canceled

A couple months ago, we chatted with our friends in Hood River about a site visit to see the Pathways work in action. We were excited to meet with local partners who had come to a similar conclusion that “coordinating the coordinators” and organizing community assets to improve health was a noble and achievable community goal.

However, the team in Hood River has been selected for a large investment from an important funder. They are under a tremendous amount of pressure to be ready for this big announcement. Most of us in this field can relate to the pressure that can put on non-profits and community efforts, and we know big investments are few and far between. Hood River graciously asked if we could delay our visit. We could not, in good conscience, ask them to power through on this, and so we are canceling the site visit. 

We know this is a let down, however there will be another opportunity to get up close and personal with Pathways at the Pathways to Community Care Coordination Summit in Ohio on September 29th and 30th. 

While we were excited about the site visit to Hood River, we think the technical assistance and networking with many of the regions implementing the Pathways model may even be better! More info below:

Pathways to Community Care Coordination Summit

Register today! Click here to complete the Enrollment Link
Date: September 29-30, 2016
Location: Akron Children’s Hospital, Akron Ohio

Scholarships are available to cover travel costs and the registration fee for this event. Scholarships will be available on a first-come, first-served basis. Click here to request a scholarship.

For questions, please contact 100mlives@ihi.org.

Our goal: Invest in upstream efforts to improve all aspects of health for the whole population.

The Population Health Community Action Team is tackling some of our regions biggest health concerns an looking for ways to prevent them upstream. Our targeted results include:

• Control and prevent Diabetes
• Prevent Adverse Childhood Experiences and mitigate the associated negative health outcomes. 
• Reduce rates of unintended pregnancies 
• Improve oral health
• Prevent and control environmentally induced Asthma 
• Prevent and Reduce Tobacco, eCig, and Marijuana usage 
• Increase age appropriate immunization rates

Currently the group is in the process of prioritizing the metrics we would use to measure successful intervention in these areas. If you are interested in getting involved please email hadley@betterhealthtogether.org.  All are welcome!

Health Care Authority Releases Value-Based Road Map

Click here and we will take you there. 

Social Determinants Work Groups

The Community Action Team for Social Determinants has broken into smaller workgroups around the goal areas below. Currently, we are using the Results Based Accountability (RBA) method of Turn-the-Curve thinking, to identify strategies and performance measures that address the root problems causing some of our communities' most widespread health issues. These open meetings are paired with targeted outreach by BHT ACH Staff to key movers-and-shakers of social programs and public forums requesting feedback. Once developed, all strategies will be made available on this site for public review. Please consider joining us at one of our upcoming meetings:

Transportation: Increase access to transportation through innovative partnerships
Next Meeting: Tuesday, August 16th - 9am – 10:30am

Community Support: Increase community access to socially supportive peer-groups.
Next Meeting: TBD, please check back

Food: Increase access to healthy, affordable food
Next Meeting: Wednesday, August 17th – 10am – 11:30am

Education: Improve education attainment
Next Meeting: Thursday, August 18th – 10am – 11:30am

Housing: Increase access and placement to stable and safe housing
Next Meeting: Tuesday, August 23rd 1pm-2:30pm

Income Stability: Increase opportunities to stabilize income
Next Meeting: Wednesday, August, 24th -10am-11:30am OR 2pm-3:30pm

All are invited to join these meetings, hosted at the Philanthropy Center (1020 W Riverside, Spokane WA 99201). We welcome anyone to join us at any step in the process, but please do email justin@betterhealthtogether.org to let us know you'll be joining. We discuss current and needed work in our region, and develop strategy to radically improve community health. 

Question: Does basic Medicare cover regular dental visits?

Question:

Does basic Medicare cover regular dental visits?
A)    Yes
B)    No
C)    I’m not sure…

If you answered A or C, you aren’t alone, as a recent Washington Dental Service Foundation survey showed 51% of respondents in Spokane believe Medicare covers dental. However, you would be wrong.

Correct answer: B) No, basic Medicare does not cover dental, and a lot of folks entering retirement are learning that the hard way. A recent article in The Spokesman Review talks about what steps folks approaching retirement should take for their oral health.

Good oral health relates to a lot more than just our teeth; our ability to chew effects the nutrition we receive, our ability to smile effects our confidence, and chronic conditions like Type 2 Diabetes can exacerbate dental decay.

Organizations like Smile Spokane, WDSF’s The Mighty Mouth, and our own DENT program are helping connect folks to the dental care they need, but for lasting change, we need a health care system that includes our mouths as part of our overall health. That's why the BHT ACH has set full integration of Oral, Physical, and Behavioral health systems as one of our region's main priorities. 

Read the Spokesman article to learn more:
http://www.spokesman.com/stories/2016/aug/08/financial-decay-dental-care-can-threaten-retiremen/

More on the Pathways HUB

On Tuesday July 19th, we hosted a second presentation on the Pathways HUB, this one from Dr. Sarah Redding. This webinar more specifically looked at the process of building a HUB and achieving certification, as well as some examples of specific Pathways and how to build or bundle one's own Pathways. Once again this was a lively discussion with ample question and answer time from Dr. Redding, and we are so grateful she took the time to share with us. You may watch the webinar or download the slides here in case you missed it. 

Integrated Care Community Strategy Team meetings delayed

We have decided to hold off on starting out Integrated Care work group until September. Our Social Determinants and Population Health work groups are identifying strategies that address health upstream, and our ACH Project Team is exploring the Pathways HUB model to see if it fits for our regional project. We feel the decisions made by these groups will be crucial in shaping our Integration strategies, so we've decided to delay. If you want to be involved in the Integrated Care work group once if forms, shoot us an email.