2020 Equity Commitments

This week, BHT’s Board of Directors unanimously approved several motions regarding racism and the action we will take to combat systems of oppression and steward change. The heart, courage, and vulnerability shown by this group of community leaders has renewed our spirits and inspired us to take more action. 

The first approval was of a policy statement declaring our belief that racism is a public health issue. Read our entire position document here. The policy statement was approved as follows:

Racism is not just when a person treats someone else differently because of their race.

Race is a developed false idea used to justify a culture whose behavior has positioned white people to dominate positions of power while perpetuating avoidable and unjust health outcomes for people of color for over 400 years.

BHT is committed to building an anti-racist community and opposing oppression in all forms – not only to stand against systemic oppression, but to invest in radical change and steward the process today that will lead us to a better future.

We commit to critical analysis of how white-supremacy culture is influencing our decision making, and to acting on opportunities to disrupt cycles of oppression and discrimination.

The group recognized the importance of having this policy to help guide the work but was in strong agreement that words are not enough. We must also make changes to how we approach and execute our work. The Board approved the following actions: 

Education

Earlier this year, the Board established an aim to define, address, and cultivate a culture of belonging within the BHT Board by 12/31. As well as the following milestones to support that aim:

  1. Finalize board norms and mechanisms to practice them within our work

  2. Increase understanding and comfort addressing issues related to health equity, race, and otherness through Board education

  3. Define what belonging means to BHT Board – identify who feels they belong and who is missing

  4. Define and implement a plan to increase diversity and representation on the BHT Board

  5. Explore how a culture of belonging can build more engagement with community and collaboratives 

 This week the Board agreed to take part in a 5-part training series developed by BHT staff to support milestone #2. This training will require an additional 90 min time commitment of our Board members each month and will continue through the rest of 2020.

Accountability

The creation of an Equity Accountability Council. This council will be comprised of a diverse set of community leaders and equity champions compensated for taking the time to understand how BHT decision making works and give meaningful input to opportunities for BHT to enhance equity or representation in our decision-making.

Action

Amendments to the Pay-for-Equity requirements for partner contracts requiring all partners to create an equity statement as a prerequisite before selecting from the menu of activities (previously an option within the menu). Partners will also participate in a 6-part equity learning series to support development of an equity statement.

Funding

A $1,000,000 allocation of funding from the Community Resiliency Fund for grants to combat racism as health crisis. Grants will be awarded to organizations lead by and serving impacted communities, with priority to black and indigenous run organizations. Watch for a release of the RFP in July.

What’s Next

This is only the beginning of BHT’s anti-racism work. We will continue to look for ways to address these systemic issues in everything we do internally and with partners. Stay tuned.


Guest Blog: Better care through integrated Behavioral Health Organizations

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By Jeff Thomas, CEO of Frontier Behavioral Health

Published in Frontier Behavioral Health Magazine

Behavioral health conditions, including mental illness and substance use disorders, are widespread among Medicaid’s high-need, high-cost recipients, many of whom also have chronic physical conditions.  As a result, many states across the country are working on new strategies to improve the coordination of physical and behavioral health services for Medicaid populations and other populations within state priorities and available resources.

In 2013 the state of Washington received a $1 million State Innovations Model (SIM) planning grant from the Center for Medicare and Medicaid Innovation (CMMI).  This grant enabled the state over the next year, with significant stakeholder participation, to develop the State Health Care Innovation Plan (SHCIP) that outlined a bold vision for health system change in our state.

The SHCIP was used by the state as the basis for a Round 2 model test grant proposal submitted to CMMI titled “Healthier Washington,” which resulted in the state being awarded in 2014 a five year grant in the amount of $65 million.  This grant is helping to finance key initiatives that invest in Washington’s infrastructure to support system transformation over the next four years.

To help accomplish this, the legislation called for the joint creation of Regional Service Areas (RSA’s) by the Health Care Authority and Department of Social and Health Services for purposes of healthcare purchasing.  The RSA’s, the boundaries of which have shifted some since initially identified in 2014, are required to include contiguous counties, contain at least 60,000 Medicaid beneficiaries, possess and adequate number or healthcare providers, and reflect “natural healthcare service referral patterns.”

As a first step toward the integration of healthcare purchasing, SB 6312 stipulated that administration and purchase of public-funded mental health and substance use disorder (SUD) treatment services be combined under a single, financial risk-bearing Behavioral Health Organization (BHO) for each RSA.  The BHO’s, which will come into effect April 1, 2016, will replace the current system wherein mental health services are overseen by Regional Support Networks (RSN’s), and SUD services are overseen by individual countries.

Spokane County Regional Behavioral Health (SCRBH) will assume responsibility April 2016 for providing substance use disorder treatment, and the mental health services previously overseen by these Regional Support Networks (RSNs).  These services include inpatient and outpatient treatment, involuntary treatment and crisis services, jail proviso services, and services funded by the federal block grants for the Medicaid population.

SB 6312 stipulates that the only entities that can apply to become BHO’s are the current RSN’s.  In other words, it is not a competitive procurement process.  However, the RSN’s are required to submit – and have approved – a comprehensive Detailed Plan that demonstrates their ability to meet all of the state’s contractual requirements to operate as a BHO – which are significantly expanded from current requirements and include various outcome measures such as treatment retention, penetration of Medicaid eligible, timely access to care, hospital readmission, and quality improvement projects.  The SCRBH is currently creating a detailed plan for state approval in January.

The geographic boundaries of the Eastern Washington RSA have significant overlap with those of Spokane County Regional Support Network (SCRSN), with a couple of notable differences.  In addition to Spokane, counties that are currently a part of the SCRSN include Adams, Lincoln, Stevens, Pend Oreille, Ferry, Okanogan and Grant.  All but Grant County will be included within the initial boundaries of the Eastern Washington RSA, with Okanogan also potentially moving to a different RSA at some future point.

Inception of the BHO model will, for the first time on our state, beak down the silos that have separated funding and oversight of mental health and SUD treatment services.  Ultimately, the BHO model is targeted at a set of principles known as the Triple Aim which will direct states to strive to simultaneously improve the health of the population, enhance the experience and outcomes of the patient, and reduce per capita cost of care for the benefit of communities. 

The Triple Aim framework serves as the foundation for organizations and communities to successfully navigate the transition from a focus on healthcare to optimizing health for individuals and populations.  Among the benefits of this model will be a blending of this funding, which will afford BHO’s greater latitude than RSN’s or counties have historically had with regard to how funding is allocated and services funded.

Frontier Behavioral Health is looking forward to working closely with the SCRBH and others in our community to support successful implementation of the BHO model and help achieve the goals established through the Healthier Washington initiative.

Finding Inspiration: A Roundup of What We’re Reading

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At Better Health Together, we pride ourselves on being a team of tenacious problem solvers. We are always looking for ways to improve and be more effective at what we do. Here are some of our favorite reads over the past few months. Enjoy!

An Interesting Read on Ferry County
We’re delighted to have Brenda Parnell from Ferry County Hospital joining our Leadership Council. Here’s a story that appeared in The Spokesman-Review about Ferry County.

Challenges Faced by Individuals in Deep Poverty
This report made the rounds at Empire Health Foundation and Better Health Together this summer. It is not anything new, but it is a call to action if I ever heard one.

The Connection Between Housing and Healthcare
“Don’t be afraid to fail. Be afraid not to try”—Melinda Gates
These are words we don’t hear from funders very often. I love this blog post from David Wertheimer at the Gates Foundation.

 


 

Spotlight: Dr. Brian Macall, Unify Community Health

Dr. Brian Macall Lead Dentist  |  Unify Community Health

Dr. Brian Macall 
Lead Dentist
 |  Unify Community Health

By working at a community clinic, Dr. Macall is able to treat many individuals from underserved populations. The clinic takes patients that are unable to seek dental care elsewhere, including DENT patients.

Dr. Macall believes the biggest health challenge facing the region is access. If community clinics and providers were not present, a large percentage of the region’s population would not be able to get treatment at all. But even then, it’s not enough. Many private dentists that took Medicaid have stopped because of low reimbursements and challenging paperwork.

Eastern Washington has a huge population of individuals who have dental insurance but are unable to get treatment. Because of this, many people go weeks and months with severely decayed teeth, pain, and sometimes infections. For a lot of patients, Macall is the last resource. The best feeling, for him, is being able to say, “I can help you,” and seeing the excitement and joy on his patients’ faces.