Forward into a new year

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.

Updates from Open Enrollment

Our Navigator team has been busy, as we are now two thirds of the way through Open Enrollment meaning folks now only have until January 31st to renew or enroll in health coverage. Navigators have worked tirelessly since the passing of the Affordable Care Act in 2013 to cut Washington’s uninsured rate by providing direct assistance to individuals who need help enrolling. Their work has paid off, with the statewide rate dropping from 14.3% to a record low of 5.8% in 2015. We’ve seen even more dramatic decreases specific to our own region, largely due to Navigators efforts to be active and out in the community engaging families when they need help. Adams County for example, dropped from 23.1% to just 3.5%. 

We have continued to see high demand for health care sign ups despite the percentage of uninsured dwindling. The team is well on their way to signing up over 1,000 people at the Open Enrollment Storefront.  

This drop in uninsured rates is by no means the only success Washington state has seen since the passing of the Affordable Care Act in 2013, we’ve also seen:

• 750,000 people gain access to care
• 51,000 health related jobs created in the state, and 1,335 of them in the Better Health Together region in 2015
• Healthcare inflation slowed to a historically low rate of 3%

Better Health Together has been so grateful for these opportunities presented by the ACA to open up access to care for so many of our community members. We continue to watch closely national and state efforts to preserve access to care. To read even more about the impact of the ACA on coverage and economic development, read this recently released report from the Washington State office of Financial Management. 

Dr. Sarah Redding

We were so lucky to have Dr. Sarah Redding, co-founder of the Pathways Model, join us for two days in Spokane presenting to our community on the model and helping us better understand how our region could benefit from a centralized care coordination HUB. You can view one of her presentations on the model below. 

DENT's 3rd Year of Success

The Dental Emergencies Needing Treatment (DENT) Program has almost completed their 3rd year of connecting Apple Health patients to a dentist for emergent dental needs while preventing unnecessary and costly ER visits, and wow has this program grown. In 2016 we we scheduled 2786 appointments for clients with dental issues.

At our start in July 2014, there were 51 monthly dental appointments being offered through DENT, and this year we consistently offered over 200 appointments each month. This is in large part due to the work our DENT Program Manager Karen Davis has put into recruiting more dentists to participate in the Dental Provider Network by making appointments available to Apple Health patients – that number has grown from 22 participating dentist at the start of the program to 71 today.

Even more exciting from this year was a drop in our no-show rate. Nationally, the the now show rate for dental appointments is between 15-35%. Each patient who is referred to DENT receives personal coaching from a Community Health Worker on what to expect and how to prepare for their appointment. In on recent example, our DENT CHW Rita, worked with a young single mother of two who had severe dental decay in her front teeth. She had extreme anxiety which had kept her away from the dentist for 10 years, but the pain in her teeth had driven her to the ER multiple times. She told Rita that she was so afraid of the dentist that she would prefer to just go under, have all of her teeth taken out, and be given dentures. Rita worked hard to build a relationship that would make this patient feel safe and supported, answering all of her questions, dispelling myths, and encouraging her to take charge of her health. Leading up to the appointment, this young woman sent Rita multiple texts and calls about how nervous she was and how she didn’t think she could do it, but Rita’s support and encouragement helped to get her through the door, and to successfully treating the pain in her mouth. This individual attention and coaching has kept the no show rate of DENT patients at 7% in 2016, which means better access to care for patients, and dollars saved for providers.

DENT’s successes even achieved national attention in 2016, when Karen Davis was asked to present at NASHP’s 29th Annual State Health Policy Conference’s Oral Health Preconference. We couldn’t be more proud of the achievements of the DENT team.

BHT Community Strategy Development Timeline

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:

• Foster a culture of self-care and personal responsibility
• Build on opportunities for communities to nurture grassroots health
• “Coordinate the Coordinators”
• Build a common platform to ease information sharing and access
• Balance coordinated decision-making across the region, while honoring self-determination in local communities

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. 

Announcing Ferry County Jail Pilot

Ferry County Pilot One Pager

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

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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

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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!