HCA Public Forum

On Sunday March 12th, we welcomed the Health Care Authority to the Philanthropy Center for a Public Forum on Medicaid Demonstration. We want to thank the nearly 50 folks who attended for taking time out on a Sunday to talk Medicaid! 

If you missed it, HCA will be giving one final Public Forum through a webinar on March 28th, which you can register for here: https://engage.vevent.com/index.jsp?eid=7198&seid=26

You can see the slide HCA used in their presentation here.

After, BHT gave a short update on our ACH Pilot Project, using these slides. 

Alison's Musings

Well, the excitement of securing the Medicaid Transformation Demonstration (formerly known as the Waiver) has worn off and you might hear some deep breathing at BHT as we figure out how to move forward on these interconnected health projects to achieve the highest impact. This work was always going to be challenging, but when you add threats to the Affordable Care Act our deep breathing gets a little heavier… The BHT Board and many of our partners have expressed concerns about the disruption to the health system if we see ACA Repeal and Replace. We have concerns that the progress we’ve made in our region to reduce the uninsured rates (check out ACA effects on BHT Region (aka Congresswoman McMorris Rodgers Congressional District)). We by no means think that this is a perfect law. But it has helped our region improve coverage, and coverage is a first step to improving access. We’re focused on moving our work forward despite this uncertainty, and remain confident in our region’s ability to work together to transform the way we deliver community health. We will not be deterred by politics.

So enough about that, let’s get to work. The next step for our Accountable Community of Health is to launch the planning process for the Medicaid Transformation Demonstration Projects. As you can imagine there is a lot to know and understand. We are committed to sharing the resources we have created and information as we learn. A few points to remember:

• The demonstration projects are funded through a contractual relationship between the federal government and the state of Washington.
• BHT, as our region’s Accountable Community of Health, will be a partner to the state to implement.
• We’ll be in charge of planning, selecting and implementing the projects that meet the state and federal criteria.
• This is not a Grant program. We have to earn the investment through the achievement of outcomes. It’s going to be a much different model than many philanthropic or government contracts are structured, so please be patient as we figure this out together.

And because we need to keep our energy and good humor up, here’s a link to our new favorite Doctor: ZDOGGMD 

Whitman County

Better Health Together has always considered Whitman county a part of our region. In our programmatic arm, DENT and the Navigator Network both serve Whitman, and the county falls within the service bounds of Empire Health Foundation. However, when ACHs were designated the boundaries were drawn to match the Regional Service Network from which counties purchase their behavioral health services. This put Whitman county in the bounds of Greater Columbia ACH.

Recently, Whitman County Commissioners penned a letter to Health Care Authority requesting to be reassigned to the BHT ACH.

BHT expressed our full support in this letter to HCA, requesting a conversation with key leaders to thoughtfully explore reassignment.

Draft Medicaid Transformation Toolkit

The Health Care Authority released a draft of the Medicaid Transformation Toolkit for public comment period at the beginning of 2017. All comments will eventually posted and addressed on the Health Care Authority's website. For now, if you would like to read the comments that Better Health Together submitted on behalf of our Board of Directors, you can view our letter here. 

Medicaid Demonstration Toolkit Overview

To the best of our abilities in a 45 minute time slot, at our 1/25/17 Leadership Council meeting, Alison gave an overview of the projects outlined in the Medicaid Demonstration Toolkit. This Toolkit is open for public comment until 5PM February 2nd, we strongly encourage you to get together with some peers (it's 78 pages...), explore the listed projects, and make a public comment to the Health Care Authority. BHT is also requesting feedback on our regions interest and readiness in these projects in a survey below. We will post any feedback we share, or receive from the community on our blog. Here are some useful links from our discussion:

• Demonstration Overview Slides
• 3-Page Demonstration Overview Document
• Survey Link to provide feedback for BHT
• Link to watch Alison's presentation

In response to feedback from our January 25th meeting, we are attempting to schedule more opportunities to deep dive into the toolkit. Stay tuned. In the meantime, BHT staff are available for questions. 

Shared Learning: Michigan Hub

We were so lucky to host this webinar from a Pathways HUB in Muskegon Michigan who has been using Pathways to run a Jail Transition Program very similar to what we are designing with partners in Ferry County. They gave a very clear and impressive overview of the model and their program, and showed they've seen great success in reducing recidivism. Watch it below!

Thank you Hot Spotters and FAR

2016 was certainly a year of big changes for BHT. Our work as the backbone organization for our region’s Accountable Community of Health has picked up speed since the announcement that the state has reached agreement in principle on the Medicaid 1115 Demonstration Waiver, creating an opportunity to transform the Medicaid delivery system by providing flexible dollars to invest in needed community infrastructure that supports health and community. As we built out this work, we were intent on identifying community infrastructure gaps, which we assessed through several community design and linkage mapping sessions targeting Social Determinants of Health and Population Health improvement goals. The more we learned about the landscape in our region, the more important it seemed for Better Health Together to carve out a unique and value added role in the community. 

Better Health Together started out 2016 with a goal of growing our Community Health Worker (CHW) task force through our Community Cares programs, among them Health Homes, Family Assessment Response and Hot Spotters. The use of CHWs has proven to be a successful model in saving dollars by reducing unnecessary and/or inappropriate use of the Emergency Room and other health expenses by connecting clients to appropriate care and and support at the right time. However, we learned a lot about CHW strategies throughout our own work and these community conversations, including it that can be most effective if CHWs are placed at locations where other services are being delivered, for instance at a supportive housing complex, a clinic or at a community service organization. After careful consideration and conversation with our partners, we chose to close out our CHW care coordination services for Hot Spotters and FAR as of December 2016. This was a tough decision, but made much easier by the incredible partnerships in the community which are ensuring this work remains supported.

The Hot Spotter program has found a new home with Volunteers of America who, having just opened 50 new units of supportive housing at the Merilee, stand to make a big impact in the lives of chronically homeless individuals by providing CHW support the stability of newly housed individuals. The Hot Spotter program not only advocates and improves outcomes for some of our most vulnerable, but the incredible partnerships through the program also demonstrate our community’s commitment to collaborate on tackling our most complex challenges. Hot Spotters closed 2016 serving 120 clients in total, and Community Health Worker support for those clients helped 59 secure housing, 30 obtain a primary care provider, 60 obtain chemical dependency or mental health services, and 12 increase their income.

Thanks to generous funding from Empire Health Foundation and United Way of Spokane County Better Health Together employed one FAR CHW in 2016, who worked in tandem with a Children’s Administration social worker to support families at risk for separation due to parental neglect. The families we work with received individualized coaching and encouragement from their CHW with referrals to needed health and social supports to keep their family healthy and united. 100% of all clients were enrolled in health insurance, thanks to a strong partnership with the Navigator Network. Additionally, families received referrals to oral health, mental health, housing, parenting classes, domestic violence, basic needs, vision, and substance use disorder. We are immensely proud that of all the families we worked with over 80% were able to remain united. Of course we have to give great thanks to our team of passionate Community Health Workers who gave their hearts to supporting these clients. We are incredibly honored to have had the opportunity to serve and support these individuals and families.

Press Release: 1115 Waiver Signed!

The following news release was published January 9th 2017 from Health Care Authority. 

Washington gets final go-ahead from federal partners to begin next phase of health care transformation

OLYMPIA – Gov. Jay Inslee and the Washington State Health Care Authority announced today a final contract that ensures the state can continue transforming health care to achieve better health, reward high-quality care and curb health care costs.

“This agreement is critically important to Washington and comes at a time when many people are feeling great uncertainty about their health care,” Gov. Jay Inslee said. “As we work to protect the great gains our nation has made in ensuring access to affordable, high-quality health care, we know that health transformation will continue in our state.”

The five-year Washington State Medicaid Transformation Project provides up to $1.1 billion of incentives for rewarding high-quality care. It takes a patient-centered, holistic approach to care, creates partnerships with communities to address social determinants of health, and holds down cost increases; as well as $375 million to support critical services for Apple Health clients.

“This step represents an important opportunity to demonstrate that we can transform health care to better serve the needs of working families, children, seniors, and people with disabilities by helping providers work with each other and with their communities,” U.S. Sen. Patty Murray said. “It will lead to a smarter, more efficient delivery system that works to keep people healthy in the first place. This project is a testament to the flexibility of Medicaid and I am proud to continue giving my full support to our state’s efforts to coordinate care and improve outcomes for so many families across Washington.”

“With this demonstration, Gov. Inslee has set a course that enables Washington to deliver smarter, better care,” HCA Director Dorothy Frost Teeter said. “This ongoing, innovative work dovetails with the goals of Healthier Washington, exemplifying a systemic and thoughtful approach to providing high-quality care, controlling costs, and realizing better health outcomes. We have the desire, drive and momentum to stay on the path of transformation.”

“Improving the health of our children and their families through better medical, mental and substance use treatment is fundamental to improving the economic and social well-being of our citizens,” Acting DSHS Secretary Pat Lashway said. “This demonstration project will provide support to all areas of the state to improve the effectiveness of care and enable mental health services to reach all of our communities. And it helps us address the rapid growth in the aging population by providing innovative ways of delivering long-term care services."

The demonstration is a collaborative effort to streamline the health care system. Fundamental components of the transformation effort were designed with input from health care leaders, providers, community advocacy groups, public health representatives, and citizens, among others.

Locally-led efforts will engage and support clients, providers, and communities through:

• Delivery system transformation strategies led by regional Accountable Communities of Health.
• A broader array of service options to enable older adults and individuals with disabilities to stay at home and delay or avoid need for more intensive care.
• Key foundational community support services for Medicaid clients with the most critical needs.

“Making sure people get healthy and stay healthy is the backbone of a thriving population,” Cassie Sauer, president and CEO of the Washington State Hospital Association said. “This demonstration positively impacts the people of Washington by ensuring they get the right care at the right time, in the right care setting. This allows Washington hospitals to focus not only on the people who walk through our doors, but to provide innovative approaches to care for the whole community."

“Putting our patients’ interests first is the focus of every physician,” Shane Macaulay, MD, president of the Washington State Medical Association said. “Complete health care requires care for both physical needs and mental health. Providing patients access to necessary services in the community helps them remain healthy. This effort gives our state the opportunity to bring the community together so that all Washingtonians have resources and access to 'whole-person' care that addresses their health needs and enables them to live healthy lives."

In a speech today, HHS Secretary Sylvia Burwell said, “Today we approved a Washington waiver that will improve health and bring down costs by improving coordination of behavioral and physical health services.”

For more information about the demonstration, visit www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation.