Tag: accountable community of health

May ACH Leadership Council Update

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Thank you to all who joined us to talk next steps for our ACH. And a special thank you to the Health Care Authority for driving all the way across the state to help bring some additional clarity on our role as an ACH.

This was a big meeting that produced some concrete action items for Leadership Council members. In case you missed it, here is the recap and documents:

We started the morning with a presentation from Kali Morris from the Health Care Authority on the role of the ACH in Medicaid Transformation. You can view those slides here. In her presentation, Kali made some comparisons to Medicaid transformation work happening in New York, and shared some lessons learned from their efforts. If you are interested in learning more, you can read this report on New York’s DSRIP Program put together by The Commonwealth Fund. On the topic of Value Based Payments, HCA also shared this helpful visual on Alternative Payment Models.  

After that we looked at our refined Community Strategy maps. Consider these our first draft as we synthesize the wealth of information that came out of our Idealized Design Sessions. The next step will be to form workgroups, each chaired by a BHT Board Member, to validate strategies, develop metrics, and finalize our community linkage maps. We will be forming a workgroup for each strategy map, reflecting our three ideal states of design. For more information, please review the following charters:

  1. Integrated Care
  2. Population Health
  3. Community Determinants of Health

Additionally, we’ve made some headway on selecting our regional health improvement project around the development of a centralized community referral system (“air traffic control”) based on the Pathways Community HUB model. We will be forming one additional workgroup to explore this model and serve as the steering committee to launch our project. You can take a look at the ACH Project Team Charter here. 

We are looking for volunteers to join one (or many!) workgroups, with the intent of meeting through the summer, to have Strategy Maps finalized by September 20th. If you are interested in joining one of these workgroups, please read through the above charters and consider which group best fits your expertise, and email your interest to Alison@betterhealthtogether.  

We also shared with everyone Empire Health Foundation’s new Oral Health Access document. Please take a look and feel free to share!

That was a big update! But we are thrilled to have some actionable to-dos as a group. Thank you all for your willingness to jump aboard. 

Hello Rubber, Meet The Road!

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Hello road, meet rubber!

Over the past 18 months, we have worked hard as a region to prepare for health transformation. We’ve established the right partners at the ACH table, selected priorities, imagined our ideal state of health, and now it feels like the forces of opportunity and hard work are aligning to create the ideal environment for big impact.

In some ways it feels like a long road, in other ways, just a start. Either way, the BHT team and I are more energized and enthusiastic than ever before. We see the potential of this work to unleash radical improvement the health of our region.

It’s clear we’ve been talking about the right things: Payment Reform, Investment upstream and in community determinants of health, regional decision making and the need to make stronger community linkages. And now we are ready to take this ACH for a test ride. In the coming 90 days we’ll be selecting our regional project, hearing a (hopefully positive) announcement about the Medicaid Waiver and launching further education on the state’s effort to accelerate the change from fee for service to value based purchasing. These big initiatives are about to move from talk to action. I’m proud of our region for embracing this, even when many of us weren’t sure if there was any there-there, but now we’re ready. It’s going to be a wild ride. I’m glad to be here with this amazing group of partners.

 

 

PS- Our blog is chocked full of great resources on Payment Reform, Access to Care and Prevention news. Don’t forget to check it out.

Value Based Purchasing

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A recent Healthier Washington webinar shed some light on new ideas for Value Based Purchasing and in the context of our state’s Accountable Communities for Health.

First question: What the heck is value-based purchasing?

 The status quo payment model for health care is “Fee-For-Service”. All services cost a set fee, and the equation is simple: 

“# of service” x “Fee for service” = Cost of care

As we well know there are a few shortfalls with this model. The big challenge being that it rewards for quantity: the more services provided, the higher the cost and the greater the revenue generated by the provider. Providers are paid for the service they administer to the patient and that’s the end of the equation.

But on the patient side the equation is much more complex; what patients need are quality health outcomes. It’s not just about the services provided to them but whether or not those services made them healthier. If the payment model doesn’t include value of services, it doesn’t really include the patient, and does not incentivize providers to be truly invested in their patient’s health outcomes.

Washington is shifting that equation to be more patient centric, aiming to maximize outcomes for costs. In a Value Based Purchasing system, the equation is like this:

Outcomes/Cost = >1

Or for the less mathematically inclined, we want the ratio of Patient Outcomes to Cost to always be positive, making sure the quality of care is always worth the cost.

This system tells us how the provider is performing, and helps them see what is working for patients while creating financial incentives that reward for quality of care. We want both the providers and the patients to know what they are getting out of their payments.  

So why is this better?

Value Based Payments incentivize a lot of the changes we are prioritizing within our ACH work.  

The Fee-For-Service model contributes to our fractured or “siloed” care system. Providers have no incentive to follow up with patients after care, or track their outcomes through the system as they bounce from care point to care point. If payments are based on outcomes, providers have to start thinking about what happens before and after the patient enters the room. Similarly, those providers can’t stay inside their silos to be effective, they have to shift to integrated care in a system that pays for and delivers services that treat the whole patient. This encourages more transparency and accountability for those services as well.

 The fee-for-service system also puts strains on rural communities where accessing services is much harder. Health centers and Critical Access Hospitals are the primary backbone of care for the Apple Health population. In a fee-for-service system, these facilities are paid for each face-to-face encounter with a patient, but in counties with a less dense population beds often go unfilled. The need for those care points is huge, but with fewer patients encounters they have a much harder time generating revenue in a fee-for-service system. In switching to value based service, rural health providers are not dinged for having less patients, but are rewarded for positive outcomes. This also encourages rural health centers to try alternative pathways for care to engage patients, like group visits, tele-visits, and developing Community Health Worker programs.

The Health Care Authority, which currently purchases healthcare coverage for 1 in 3 Washingtonians, has set a goal of moving 80% of state financed care and 50% of commercial market plans to switch to a value based payment model over 5 years, and are currently piloting 4 models throughout the state. If you want a high level overview of those payment test models, you can watch the full webinar here.  

Pay for Sucess

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BHT was thrilled to see a Request for Information circulating from the Health Care Authority on Pay For Success programs for Community Engagement in Supportive Housing Interventions. The request demonstrates a clear sign that we are getting closer to seeing opportunities for Pay for Success pilot programs implementation soon.  

Pay for Success (PFS) is a relatively new funding model that aims to maximize funding potential for programs that work, and incentivize those programs to work for more people. Private and philanthropic dollars are leveraged to pay the up-front costs for services; if the program reaches target goals qualifying it as a success, they receive additional funds from the government or other entities. In this system, government dollars are only used to pay for what works, a more efficient use of resources that also holds programs more accountable to outcomes.

PFS is still in the beginning phases. The Social Innovation Fund (SIF) launched their PFS program in 2014, giving grants to state and local governments, and nonprofits, to pay for technical assistance and capacity building while grantees explore the best PFS strategies and solutions. SIF selected eight organizations as initial grantees that are now exploring opportunities to fund PFS activities in local communities. One of these organizations was the Corporation for Supportive Housing, which in turn selected Washington Health Care Authority as one of six sub-grantees to receive assistance in pursuing PFS pilot projects that improve outcomes and reduce costs for our region’s most vulnerable citizens, those facing homelessness. 

Upon hearing the request, BHT jumped to action and called a convening with all five of Washington’s Managed Care Organizations and many local partners who work in housing and/or homeless services. We have been working together all week to take inventory of the resources, programs and partnerships we have currently in place our community, and are exploring how implementing PFS could benefit our community. We are so grateful for the collaborative spirit of our partnerships in the BHT region, and are excited to experience tangible momentum building behind Pay for Success.

If you are curious about the State’s inquiry, you can read the Request For Information here. 

To learn about what opportunities for supportive housing are presenting in our region, you may also view our collaborative draft response for this RFI here.  

ACH March Leadership Council Meeting Recap

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Thanks to all of you who joined us for our March ACH Leadership Council meeting. It was a great discussion and gathering, with a full room of partners in person and online.
 
Cool things to know
The State expects to hear in late April if we are successful in our Medicaid 1115 Waiver application. We will keep you posted as we learn more.
 
April is Spokane Gives month, United Way and partners will host a month of volunteer opportunities in Spokane. Check out the volunteer projects here and see how you and your teams can Give to your community.
 
The new Apple Health Foster Care program, Apple Health Core Connections, will launch April 1st managed by Coordinated Care. This new program will bring increased care coordination to children in all stages of the foster care system.
 
A number of organizations are seeing Spring time growth and bringing on new hires to increase their capacity to serve our region. We are especially excited about Newport High School’s hiring of an additional school nurse.
 
And if you are a Bloomsday fan, start training now at Providence and Group Health’s free Bloomsday training clinics.
 
Next Steps in ACH Development
We’ve been synthesizing the wealth of information and ideas generated at our Community Linkage Mapping and Idealized Design sessions over the last two months. We debuted and discussed our first strategy map Priority area: Scaling Community Based Care Coordination. We received helpful feedback to further streamline the use of the maps. The feedback included more context, clear prioritizing and the sharing of the current community efforts for each of our strategy areas. There is much work still to do, so stay tuned!
 
Thought Starting Presentations
Alisha Fehrenhabcher, shared some of her experiences and lessons learned from her work with Health Matters of Central Oregon on the Pathways to Health Hub model. This model demonstrates a pathway (sorry for the pun) forward for our Scaling Community Based Care Coordination based on an evidenced based practice that is scalable across regions and sectors. We are lucky to have her in our BHT region.
 
Our friends at SNAP Spokane shared their new Low Acuity Transportation Pilot program aimed at reducing the cost of ambulance rides by creating alternative transportation to more appropriate care centers. This is a great demonstration of community entrepreneurship. Go SNAP Go!
 
Lots of great work happening in our region! If you missed the meeting, we have all of the slides and handouts available for you here: 

 
As always, if you have questions or comments, let me know.

Alison Carl White
Executive Director