HCA seeks input on VBP

The Health Care Authority released their value-based payment survey in July. This will be used to establish a baseline for VBP adoption and will serve as a critical progress tracking mechanism as we move towards the goal of 90% of all Medicaid contracts being value based. We care about this because as the state meets CMS goals, we earn waiver dollars. (And we are a region of high achievers.) To complete the survey, click here.
 
The VBP survey was developed with advice from HCA’s Medicaid Value-based Payment (MVP) Action Team, whose members represent a variety of provider organizations, Accountable Communities of Health, and Medicaid managed care organizations (MCOs) from around the state. Our representative Mark Wakai, Chief Population Health Officer from Providence Health Care will be providing an update at the ACH Leadership Council in September. To make it fair, HCA also released a similar version of the survey to MCOs in June. The survey is open until August 25. To learn more, visit https://www.hca.wa.gov/about-hca/healthier-washington/paying-value. 

Our Region Wide Vision

“In our region every person, regardless of background, life experience, or environment, will live a productive, high quality life, with access to stable housing, nutritious food, transportation, education, meaningful employment that pays the bills with some left over for savings, and social support networks that foster emotional, social, and psychological wellbeing. Each person’s health will be supported by an integrated community health system, accountable to improving health through delivering culturally competent, whole person care. ”

At our July Leadership Council meeting we debuted an updated vision statement drafted by BHT staff, looking for feedback and truthing on our vision to be included in our ACH's Phase 2 Certification Process. 

Thank you to everyone who gave feedback during the leadership council meeting, or through the survey we sent out. With the work we are trying to accomplish being so expansive, it sure is hard to define a "short and succinct" vision, but with your help wordsmithing we are feeling pretty happy with what we came up with. 

If you'd like to follow our process, you can see comments we received on our vision statement here, and a redlined word doc showing the changes we made in response to feedback. 

Washington State Diabetes Connection’s Website Gets New Look

The Washington State Diabetes Connection’s website is new, improved and better than ever. Besides having a new look, the site will allow its users to see what’s new with the organization as well as view upcoming events with greater ease than before. We’d like to send a huge thank you to the Washington State Diabetes Connection as well as all supporters addressing diabetes in our state! Check out their new website at https://diabetes.doh.wa.gov.

Community Care Programs

Community Care programs are the heart of our work here at Better Health Together. Our Community Health Workers provide support in navigating complex health systems, ensuring basic needs are met, and providing the emotional support people need to be healthy. Through this work, we link people with the right care at the right time and gain first-hand insight into opportunities for innovative health solutions.  

Collaboration is key to the success and impact of our programs. Visit the Regional Impact Map to see our network of funders and partners.

Leadership Council and Health Champions Engagement Structure

Better Health Together has intentionally built a multi-tiered governance structure with distributed decision-making, joint ownership and mutual accountability that drives innovation and creativity, and fosters co-investment that leads to results, not process. This structure rests on our partners aligning around a common agenda with mutually reinforcing activities, and continuous communication between all parties.

The Standard Terms and Conditions of the Medicaid Demonstration specifically call out requirements for ACH engagement with stakeholders and opportunities for community feedback. To these ends, the Better Health Together ACH is establishing more robust protocol for membership as a Leadership Council Organization or Health Champion to ensure we meet these requirements. All meetings will remain open to the public, however there will be specific requirements to be considered a Member Organization.

Leadership Council

Leadership Council Meetings are open to all organizations located or delivering service in the BHT Region. This is an open forum for community members to receive and share updates on ACH work and activities in the region. These meetings will always remain public. 

Membership within this council is granted at an Organizational basis. To be considered a member of the Leadership Council as the strategic synthesizer for the ACH, your organization must sign an ACH Community Commitment form. This indicates your organization’s alignment with our Regional Health Priorities and commitment to collaborating on health improvement. Members are expected to have representatives participate in at 2 out of every 3 Leadership Council meetings.

If attendance requirements are not met, members will be flagged as "Disengaged." This is an internal designation only, which signals to ACH staff that this organization needs outreach to stay up to speed. If outreach cannot be met, membership and voting rights will be suspended after 3 missed meetings. Membership can be reinstated after contact and catch up with BHT staff. With the incredibly fast pace of information flow, this structure ensures everyone at the decision making table is equipped with the latest information. 

Health Champions

Similar to Leadership Council, starting 2017 we will be asking Coalitions to sign a Community Commitment form, and formalize their organizational members in order to meet Health Champion status. Health Champions do NOT have a vote at the Leadership Council level, because it is expected all organizations making up the coalition would be members.

Rural Health Champions Expectations:
Each Rural Health Coalition has a slightly different structure to meet the unique logistical needs of their community. Better Health Together Staff will work with Coalition members to design a Rural Health Coalition (RHC) engagement structure that is consistent with each Coalition’s unique needs while meeting minimum requirements for the ACH.

BHT will ask each RHC to designate a Coordinator and Ambassador.

The Coordinator is responsible for scheduling, logistics, agenda, attendance and minutes for each meeting. The Coordinator could be a BHT staff member OR coalition member.

The Ambassador represents the County Coalition at the Leadership Council level, and maintain the following responsibilities:

• Attend ALL Leadership Council Meetings (in person OR by webinar) or designate a proxy when unavailable, to ensure coalitions are always represented at Leadership Council meetings. 
• Sharing any updates of concerns from the County Coalition, speaking on behalf of coalition interests in Leadership Council discussions and reporting back to Coalitions with updates and any opportunities for action or next steps
• Attending Quarterly All-Coalition check in call - June 26th, 2017
• Recruiting new members to Coalition based off of community and engagement goals, with strategic alignment from Leadership Council membership requirements

BHT Staff can serve in the coordinator role where coalition does not have local capacity; Coordinator and Ambassador can be the same person, however BHT staff may NOT serve in the Ambassador role. 

BHT Staff is available to support coalitions in the following capacity:

• Staffing, scheduling, creating agendas, taking minutes and attendance
• Writing By-Laws and designing structure
• Supporting and training an Ambassador and Coordinator
• Providing clarity on ACH activities
• Staff quarterly All-Coalition call between each regions Coordinators/Ambassadors

Spokane Health Champions Expectations:
Spokane County, as an urban center, has many active and robust community coalitions centered around key community health issues and priorities. To capitalize on the momentum and expertise these groups have already gathered, ACH Staff will staff a Spokane Health Champions coalition, formed as a quarterly call between Spokane based coalitions. Examples of this would include collaborative that are not a standalone organizations, and therefore can’t be a standing LC member.

BHT Board supports mid-adoption of FIMC

In 2014 the Washington state legislature passed 2SSB 6312 that requires integration of behavioral health benefits into the Apple Health managed care program by 2020. Additionally, this provided a road map for integration, that included the transition from a Regional Service Network to Behavioral Health Organizations. Spokane County serves as our region’s Behavioral Health Organization and has done a tremendous job integrating our mental health and substance abuse services through Adams, Lincoln, Stevens, Pend Oreille, Ferry, and Spokane Additionally, Okanogan county selected to receive BHO services from Spokane but will ultimately be transitioned to North Central no later than January 1, 2020.

Additionally, the legislation provided a provision for early and mid-adopter regions. Southwest, comprised of Clark and Skamania counties, were the only region in the state to select to be an early adopter. This region launched fully integrated managed care in April 2016 after a RFP process that selected Molina and Community Health Plan of Washington.

Late in 2016, North Central, comprised of Chelan, Douglas and Grant counties, announced their intention to be mid-adopters. North Central is currently in their RFP process, all 5 Managed Care plans are applying and we expect to have an announcement in mid-May of the selected 2-3 plans.

On April 10, the HCA released new incentive information for region’s willing to be mid-adopters. For our region, this would mean $8.7 million dollars for investment in providers to prepare for fully integrated managed care (FIMC). In order to trigger the investment, step one is for each county’s Commissioners to submit a binding letter of intent by September 1, 2017.

There is current legislative movement occurring, in which the Spokane BHO is active, to shift the integration deadline beyond 2020, carve out a specific role for BHOs moving forward, and provide a mechanism for BHOs to have a right of first refusal for the Behavioral Health Administrative Role that will deliver crises services, administer certain non-Medicaid funding sources and other negotiable regional functions. Additionally, the state legislature still needs to adopt a policy to move current funding from DSHS to Health Care Authority. This is currently still active legislation.

BHT Board Decision

As noted above, this is a decision for each of our region’s County Commissioners to make. BHT could adopt a policy and direct BHT staff to provide information and advocacy to partners and Commissioners to assist in encouraging our region to be a mid-adopter of FIMC.

APPROVED MOTION:

To actively support moving the BHT ACH region to FIMC by 2019 in order to trigger a $8.7-million-dollar investment and accelerate our efforts to move to whole person care.

Rep. Cathy McMorris Rodgers Meets with BHT

This past week Rep. Cathy McMorris Rodgers came to Eastern Washington to listen to and meet with people from the community. Last Friday, April 14, Rep. McMorris Rodgers met up with the Better Health Together Board to discuss their work on transformative Medicaid programs in Washington state. The Congresswoman is focused on how to create a 21st Century health care system that will provide quality and affordable health care to all Americans.

More information on her visit: https://mcmorris.house.gov/recap-mcmorris-rodgers-friday-spokane/

Letter of Interest Webinar

This webinar overviews the finer details of our request for Letters of Interest for Medicaid Demonstration Projects. If you plan to submit a letter, we strongly encourage you to watch. 

Jail Transitions Project Gains Traction

Better Health Together recently launched a new program in Ferry county called the Jail Transitions Project. The jail transitions project connects people exiting the county jail with local care workers and providers. The program has successfully been piloted in Ferry County, and Better Health Together plans to expand the program to more counties in Eastern Washington, including Spokane County.

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