Learning from New York's DSRIP

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We recently had the opportunity to participate in a collaborative learning session with Joe Conte, a leader in New York’s Delivery System Reform Incentive Payment (DSRIP) Program. Joe works with Staten Island’s Performing Provider Systems (PPSs), the equivalent of ACHs in New York, and we were excited to share in some of what they have learned along the way.

New York PPSs are almost in Year 4 of their demonstration, and their partners include over 75 fully engaged organizations and 20 population health practice partners which include 100 percent contracted healthcare providers, agencies, schools and community-based organizations. Their goal, similar to our own, has been to improve quality of care and transform the healthcare delivery system of Staten Island as well as ready providers for VBP contracting. Staten Island currently has 180,000 Medicaid beneficiaries, and Joe stated that combining cultural competency into their PPS work has been extremely important.

By Year 5 of their demonstration, they anticipate that 80 percent of funds in New York will be by performance and 20 percent by reporting. A priority for them has been minimizing overhead expenses while maximizing the amount of funds used for:

1.     Project implementation
2.     Incentive payments
3.     Lost Revenue/Innovation Funds/Cost of Services Not Offered

Joe also emphasized that it was important to give a voice to SDOH organizations and smaller practices for equivalent payments for units of work regardless of organization size. 97 percent of provider satisfaction for Staten Island was reportedly due to financial engagement. They found that if there was a network-wide loss, then everyone was affected. “You don’t want to lose partners just because they are unable to make a financial commitment,” said Joe. Creating necessary partnerships and supports for participating organizations has been crucial.

Lastly, Joe openly shared some unanticipated issues with DSRIP, which we found very relevant. These issues included:

1.     Working with the plans should be a top priority.
2.     Understanding the best way to gather data from different sources is necessary with community consent.
3.     Co-located services could be talked about more at a state-level and earlier on.

While much of DSRIP in New York looks very different than in Washington, we are so grateful for this chance to share in lessons learned. It is inspiring to compare efforts of folks across the nation as we work to improve the health system in our respective regions.

You can download more detailed notes from the webinar here, and watch a recording below.

  

17,946 Miles Driven: Celebrating ACH Program Manager, Justin Botejue's One Year with BHT

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1. What does your role as ACH Project Manager entail?

A little bit of everything – I see the role I play as an assister to realizing and implementing the vision and goals of our partners within the BHT ACH. This can look like anything from staffing rural county health coalitions to seeking input from the community (both the provider and the recipient of services) for our ongoing strategy maps on the Social Determinants of Health and Population Health. The role also provides staff support to the BHT Executive Director and Associate Directors which includes data and policy research, project support for the Pathfinder Hub and continued community engagement.

2. You have driven 17,946 miles since starting at BHT in August of 2016. What do those miles driven show in respects to your job and how does community engagement fit into the effectiveness of your role?

Yes, I’ve driven almost 18,000 miles within one year of working for BHT! It’s not really about how many miles I’ve driven, but more about the time I get to spend with partners around our region. Relationships are built better face-to-face and I can say that whenever I go and meet with partners, I come in with an understanding that we’re friends and I’m here to help however I can. I always offer a carpool to those based out of Spokane and when you’re in the car for a couple of hours, you tend to partake in good conversation (and hopefully it’s not just work related). I’m grateful that BHT actually encourages us to do face to face meetings and I consider myself lucky that I get to see the sheer beauty and ruggedness of Eastern Washington that I wouldn’t otherwise see!

3. What is one thing that you have learned while out in the community that has been valuable to you or a game changer in how you fulfill your role as BHT’s ACH Project Manager?

A game-changing pearl of wisdom I’ve learned over the past year is “framing the narrative”. Let’s face it, change and learning new lingo (virtually a new language) related to healthcare is difficult and the early morning phone calls and long meetings can be tiring, but set in the context of transforming lives for the better gives me new energy and drive to keep on pushing. Healthcare transformation is real and imminent especially when the narrative is framed toward meaningful impact on silo-ed systems, efficient distribution of resources, and most of all – an improved quality of life for our community.

4. What has been a major highlight in your one year at BHT?

Uh, all of it? Working for BHT through the Accountable Community of Health has been a fascinating experience! Doing healthcare transformation in this way is new and different and we are all learning together. 

In pursuit of radically improving the health of our region.

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“Darkness cannot drive out darkness; only light can do that.  Hate cannot drive out hate; only love can do that.” -Martin Luther King Jr.

In the wake of the tragic events in Charlottesville this past week, we believe that hate and racism has no place in America, in Eastern WA, or in any healthy community.  It is in these key moments that all of us, whether individuals or organizations, need to express our values.  So that our neighbors and partners and children do not interpret our silence as agreement with those who act on hate. 

While we may not have any Confederate monuments to tear down, our community is sadly not immune to hateful action.   In the past year, Spokane headlines have included racist vandalism scrawled on the Martin Luther King childcare center, desecrating a Sikh temple being mistaken for Muslim, anti-Semitic and racist flyers posted multiple times on the Community Building, hateful words of “Get out!” spray painted on the garage of a refugee family, and hateful graffiti on the Salish School.  While the community and leadership have come together in support in each incident, we all go back to our busy lives the next day.  Never stopping to notice that what used to be a once a year headline is now nearly monthly - are hate crimes now normal in our community?

As non-profits with health missions, we believe that advancing healthy communities means advancing equity.  At our leadership team meeting this week, we asked the question:  it’s not if but when the next tragic incident happens either nationally or locally, and will we sit back and wait for it, or will we be proactive and do something to advance equity?  And if we are proactive, what does that mean? We didn’t come up with any answers that made us feel like we had the right answer, but a deep commitment to take action. What are your thoughts?  We would love to hear from you.

Better Health Together selected to manage in-person assistance for Eastern Washington

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The Washington Health Benefit Exchange today announced the selection of Better Health Together to oversee in-person assistance provided to residents of Ferry, Stevens, Pend Oreille, Lincoln, Spokane, Adams and Whitman Counties during the upcoming open enrollment period scheduled to begin on Nov. 1.

Better Health Together is one of nine public health agencies, regional health networks, and community organizations selected to provide free support to individuals and families signing up for coverage through Washington Healthplanfinder and one of two in the state with an active storefront.

“Given the uncertainty currently surrounding healthcare, the support and communication Better Health Together and all other lead organizations provide is especially essential,” said Pam MacEwan, CEO of the Washington Health Benefit Exchange. “Their outreach and education efforts offer reliable assistance at a time when many residents may have questions about their coverage.”

Better Health Together is responsible for building and managing a network of navigators who are available to guide individuals and families through the enrollment process, determine how well their current health plans worked, and explore new coverage options.

During the previous open enrollment period, more than 225,000 Washingtonians utilized resources provided by Better Health Together and other lead organizations located across the state to enroll in health coverage through Washington Healthplanfinder.

“Being selected has given us the ability to provide this service and stability to the community twelve months a year in our new enrollment center, instead of what used to be three months,” said Curt Fackler, Navigator Program Manager of Better Health Together.

Better Health Together’s Navigator Network launched in 2013 with the goal of enrolling 10,000 people in health insurance through Washington Healthplanfinder. Today, Better Health Together’s Navigator Network has enrolled and re-enrolled over 100,000 people, dropping the uninsured rate to less than 5% in the region.

HCA seeks input on VBP

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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

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“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

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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

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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

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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

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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

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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/