Board of Trustees April 25, 2019 1 Board Agenda Consent Agenda - - PowerPoint PPT Presentation

Board of Trustees

April 25, 2019

1

Board Agenda

• Consent Agenda
• Finance Committee Reports
• Board of Trustees Retreat
• RHIP Council Update
• Program Update – Opioid Strategy

Consent Agenda

• February 2019 Board of Trustee Minutes
• SWACH Dash Board Report
• Update on Partner Organizations
• Budget Neutrality – HCA Information
• SAR 2.0 Approval

Operations Dashboard

Key Strategies Major Milestones Target Date Success Metric Status Staffing

• Opioid Coordinator – Jim Jensen
• Equity Manager – Sky Wilson
• Pathways HUB Coordinator – Michelle Ahmed
• Accounting & Human Resources Coordinator
• Transformation Improvement Director

November 2018 December 2018 January 2019 April 2019 April 2019 Position Filled Position Filled Position Filled Final Interviews for TID position; Accounting position remains open.

• Review organizational roles and potential staffing models that support

functions; implement changes to organizational structure to support necessary functions. October 2018 April 2019 Organizational structure to support 2019 Work Finalized; Board reviewed 12.2018; minor revisions 3.2018 Marketing & Communications

• Hired a Communications Director to develop a communications plan

August 2018 Position filled/Plan created Complete

• Communications Plan Launch and integration of Healthy Living

Collaborative

• Robert Wood Johnson Healthy Communities Application submitted
• ED participated on two community panels: Leadership Clark County and

Clark County Health Care Advisory Board

• ED spoke at Health Policy Conference on Future of ACH’s
• ED represented the ACH-EDs on Washington State CHW Task Force
• Established regular meetings with Managed Care Plans

Winter 2018/2019 November 2018 December 2018 November 2018 April 2019 Ongoing Communications Plan; SWACH brochure/video. 2nd Round Approval. Participation. Panel participation. CHW Training Recommendations. Monthly-Quarterly meetings Brochure completed; 1st Round Approval; 2nd proposal denied. CHW training recommendati

• ns submitted

to DOH.

Operations Dashboard (continued)

Key Strategies Major Milestones Target Date Success Metric Status Budget/Funds Flow/Personnel

• Board approved operating budget.
• Board approved five-year Funds Flow Allocations
• Board approved 2018 Pathways/HUB budget.
• New Financial Software Implemented.
• 2017-2018 Financial Audit Completed.
• 2018-2018 Financial Audit Completed.
• 990 Report completed and filed for 2017-2018

Winter 2018/2019 Jan-Feb. 2019 May 2019 July 2019 May 2019 Approved 2019 budget; Approved Multi-Year Funds Flow; Approved 2018 Pathways/HUB Budget. System Implemented. Receipt of Mgt. Letter from Auditor. Qualified Audit. 990 Filed. Multi-Year Funds Flow & 2018 Hub Budget approved; 2019 SWACH Budget approved. On site audit review completed. Data being collected.

• Transition HR functions from Contractor to SWACH

December- March 2019 HR Functions internalized. All HR functions internalized

• r with new

sub- contractor.

Operations Dashboard (continued)

Key Strategies Major Milestones Target Date Success Metric Status Internal Policies & Procedures

• Review operational policies and procedures for gaps; prepare and

implement policies and procedures

• -Personnel Policy Manual
• -Financial Policy Manual
• -IT Contract: Identify new IT vendor to support SWACH.

Fall 2018-Spring 2019 May 2019 Completed operations policies and procedures. Vendor approved; implementation transition completed. Personnel Policy Manual approved. Reporting & Accountability

• SAR 100%; Implementation Plan submitted
• SAR 2.0: Implementation Plan submitted

Summer 2018 January 2019 SAR 100% SAR 100% Complete. Complete. Board Governance/RHIP Council

• Bylaws Revised
• Board of Trustee Officers and Board Members Recommended.
• Executive & Finance Committee Accountabilities Defined
• Hosted a Social Determinants/Clinical Care Panel at RHIP.
• Reevaluation of purpose of RHIP Council.

December 2018 December 2018 February 2019 February 2019 January 2019 May 2019 Bylaws approved Officers & Board Members approved Accountabilities approved. Successful Panel. Updated RHIP Charter. Approved

• Dec. 2018

Approved

• Feb. 2019.

Panel completed.

Whole Person Integrated Care Dashboard

Key Strategies Major Milestones Target Date Success Metric Status Integrated Care Framework Development Co-Created Goals

• Integration of Physical and Behavioral Health
• Value Based Payment Goals Established
• Success Metrics Established
• Workforce Needs Established

October 2018 Implementation Plans submitted. Completed. Cohort of Providers for Clinical Transformation

• Clinical Partner Assessment
• Review Transformation Plan (CTP)

July 2018 Transformation Plan Developed Completed.

• Clinical Transformation Plan developed disseminated and

returned August 2018 Transformation Plan Completed Complete

• Clinical Transformation Plan review

October- early December 2018 Plans reviewed by Staff and External Reviewers. Completed.

• Established Cohort of Clinical Partners invited into a binding

agreement to begin workplan negotiations and Pay for Performance tied to transformation plans. January 2019 Binding Agreements In Process.

• Provider contracts/MOU executed

Mar-April 2019 Binding Agreements In Process.

• Established a Clark County Opioid Taskforce.

April 2019 Engagement and ongoing participation of stakeholders. In Process. Learning Collaborative(s)

• Learning Collaborative (QI) process Identified for Integration

Teams March 2019 Collaboratives Developed Meeting with individual teams.

Community Clinical Linkages Dashboard

Key Strategies Major Milestones Target Date Success Metric Status Engage Community Serving Organizations into Transformation

• Request for community serving organizations that support addressing the social

determinants of health to partner with clinical partners October 2018 RFI’s Received Complete

• Establish review and matchmaking process and criteria

November 2018 Process Developed Complete

• Invite Community Serving Organizations into a transformation Cohort; complete

Binding Agreements Mar-April 2019 CSO’s integrated with Clinical Teams In Process

• Current Project - SeaMar/CVAB Hep C CURES QI

Ongoing Improvement Cycle In Process

• New Opioid funding
• New Opioid Treatment Network Funding

September 2018 December 2018 Grant approved Funding Received Funding Approved . Healthy Living Collaborative Initiatives

• Promote and support CHW neighborhood teams in Clark, Cowlitz and Wahkiakum

counties; Select partner organizations for CHW teams. November 2018 Ongoing April 2019 Ongoing March 2019 MOUs completed Barriers identified Information. 75% attendance. Complete In Process Complete Complete

• Address barriers to school attendance at McLoughlin Middle School through the

Education Community Health worker initiative.

• RHIP Council entertained panel to discuss school based health and wellness.
• Support growth of CHAPS network (namely Advocates, Community Health

Workers, Certified Peers and their organizations) serving Southwest Washington, to improve holistic health outcomes for the Community.

• Hosted HLC Quarterly meeting with over 60 participants. Presentations by two

ACH leaders.

Community HUB Dashboard

Key Strategies Major Milestones Target Date Success Metric Status Community HUB

• Board adopts pathways

June 2018 Board Approval Complete

• CTPs identify Klickitat and Skamania interest in Pathways model (rural

engagement) September 2018 RFA released In progress

• Contract with CCS for HUB Technology and Technical Assistance
• Includes prelaunch support with Healthy Gen for CHW workforce development

September 2018 Contracts signed Complete

• Pathways HUB 2-Day Strategic Planning Meeting

September 2018 Implementation Tasks and Timeline developed Complete

• Rural CCAs announced: Skamania County Community Health & Washington

Gorge Action Program November 2018 Rural CCAs announced In progress

• HUB Advisory Committee formed

November 2018 First meetings scheduled Not complete

• All CCAs Trained

February 2019 Training completed In Process

• Community HUB Go Live! Pathways HealthConnect.

March 2019 First person enrolled Complete

Collaborative Impact Dashboard

Strategy Key Milestones Target Date Success Metric Status Cross Sector Shared Learning

• Monthly Stakeholder Meetings Held
• Opioid Learning Sessions: Successful events for providers “The Uses of Suboxone in a

Practical Clinical Setting”; Events in Clark and Skamania Counties 9/2018 Minimum attendance

• f 40 Providers

Complete Community Engagement System

• Conduct an internal assessment of SWACH’s community engagement efforts, collate

community engagement knowledge, and refine and communicate community engagement strategy 1/2019 Assessment completed In progress

• Form local and regional community councils

3/2019 Councils formed In progress

• Host community engagement sessions

Ongoing Quarterly community engagement sessions

• Create a culture of community engagement within SWACH as an organization and within the

work groups and learning collaboratives it supports Ongoing Community Resiliency Funding

• MOU approved for Housing & Health Innovation Partnership (VHA; SWWCF; Clark County

Community Services & SWACH)

• VHA to dedicate up to 50% of vouchers to people enrolled in FCS housing support benefit

until total vouchers reaches 200.

• Elwood & Tenny Creek supportive housing funded with 9% tax credit allocation.

10/18 Partnership Agreement Approved. Additional funding for supportive housing approved. Ongoing

Collaborative Impact Dashboard Cont.

Strategy Key Milestones Target Date Success Metric Status Equity Planning

• Hire Equity Manager

12/18 Position Filled Complete

• Developed Equity Shared Learning Cohort and Curriculum

3/19 5/19 12/19

• ngoing

Curriculum developed Partners complete assessment and plans SWACH completes assessment and plan Trainings completed quarterly Steering committee met.

• Support partners in equity assessment and plans
• Complete an internal assessment and plan; convened equity collaborative steering

committee.

• Support equity, stigma reduction and trauma informed training and capacity building across

the region Platform for Policy and System Changes

• Conduct policy watch and analysis at the local regional, state and federal levels.

Ongoing

• Maintain a high functioning Policy committee.

Ongoing

• Develop a policy agenda that is community led and supported.

Ongoing

• Support advocacy at local, state, and federal levels, to include letter writing, direct outreach

to decision makers, and public testimony. Ongoing 12/18 Ongoing Policy Approved. Policy Approved by Board 12/18

• Develop a process for bridging SWACH and HLC policy agenda.
• Connect to organizational/system policy change and identify opportunities to influence by

bringing an equity, health and community lens. Evaluation

• Develop 3rd evaluation plan in partnership with CORE.

2/19 Evaluation Plan completed Pending

Finance Committee Report

• Financial Report

– February YTD – 2017-2018 Financial Audit Status Report

Board of Trustees Retreat

• October 24th, 9 am – 5 pm
• Board Members Only
• Email Survey – potential discussion topics

RHIP Council Update

SWACH - COLLECTIVE IMPACT APPROACH TO ADDRESSING THE OPIOID CRISIS

REGIONAL PROGRESS REPORT August 2017 to March 2019

SWACH plays Multiple Roles in the SW Washington Region

SWACH as Connector and Convener

Developed and supported opioid workgroups, collaboratives, taskforces.

• No regular convening of opioid taskforce/workgroup in region prior to SWACH.
• Since August 2017 SWACH has convened and supported regular and ad-hoc opioid

workgroups, taskforces, learning collaboratives and summits

• Engaged cross setting stakeholders across region to inform required opioid project plans for

MTP

• SWACH supported PeaceHealth in initiating a PeaceHealth Community Opioid Collaborative -

supporting a lead role for the region’s largest Medicaid provider in innovative cross setting collaborations and responses to the opioid epidemic.

• SWACH supported Klickitat Valley Hospital (KVH) in initiation of a KVH Opioid Taskforce -

supporting a lead role for the county’s largest Medicaid provider in innovative cross setting collaborations and responses to the opioid epidemic.

SWACH as Connector and Convener

Developed educational/ shared learning convenings featuring national, state and regional subject matter experts.

• SWACH technical assistance: five-session “Taking on the Opioid Crisis” through the Institute for Healthcare
• Improvement. Sessions offered concurrently in Clark, Skamania Klickitat counties. (Feb-April 2018)
• Opioids, Feedback Reports, and Supporting Change in Provider Behavior (April 2018)
• Team Based Approaches to Medically Assisted Treatment for Opioid Use Disorder (May 2018)
• Changing the Conversation about Opioid Treatment (May 2018)
• Medication Assisted Treatment – Provider Waiver Training (August 2018)
• “How to Use Suboxone in a Clinical Setting – Provider Dinner Presentation with Dr. Hart
• Addiction and the Brain - Skamania (October 2018)
• Addiction and the Brain - Klickitat (October 2018)
• Medication Assisted Treatment – Provider Waiver Training (October 2018)
• Opioid Action Summit (Dec 2018)
• Medication Assisted Treatment – Provider Waiver Training (January 2018)
• Back to back MAT Training for ED doctors and hospitalists (March 20, 2019, March 23, 2019)
• Of course, today’s convening of the Clark County Opioid Taskforce

To Address Opioid Misuse

SWACH STRATEGY

ASSET & CAPACITY STRATEGY OUTCOME

SWACH OPIOID PROJECT:

REDUCE OPIOID DRUG MISUSE AND IMPROVE RECOVERY SUPPORT OPPORTUNITIES THROUGH CROSS SECTOR COLLABORATION IN CLARK, SKAMANIA, KLICKITAT COUNTIES

Training and Support for Providers on Opioid Prescribing Promote Use of PMP Increase Number

• f Providers

Certified to Provide MAT Support Telehealth in Underserved Areas Promote Safe Storage and Appropriate Disposal

• f Opioids

RECOVERY OD PREVENTION TREATMENT PREVENTION Increase and Diversify MAT Initiation Sites Identify and Support Access Points to Treatment Increase Distribution

• f

Naloxone Enhance / Develop the Provision of Peer Support for Long Term Recovery Strengthen Regional Communication and Coordination Across Settings Support Transition to Value Based Payment (VBP) Support Workforce Development for Sustainability Develop HIT / HIE Capacity for Information Sharing and Interoperability Increase Training and Technical Assistance Leverage Data to Inform Population Health Strategies

Top

Support for Culture Shift towards Trauma Informed Care and Understanding of Opioid Use Disorder as a Chronic Brain Disease

Expand Access to Harm Reduction and Syringe Exchange Services

ASSET & CAPACITY DEVELOPMENT Objectives SWACH PROGRESS

PREVENTION

STRATEGY

Training and Support for Providers on Opioid Prescribing

Strengthen Regional Communication and Coordination Across Settings Support Transition to Value Based Payment (VBP) Support Workforce Development for Sustainability Develop HIT / HIE Capacity for Information Sharing and Interoperability Increase Training and Technical Assistance Leverage Data to Inform Population Health Strategies

Opioid Prescribing

Return to Top

1) SWACH sponsored technical assistance: five-session “Taking on the Opioid Crisis” learning opportunity through the Institute for Healthcare Improvement. Partnered with North Shore Clinic and Klickitat Valley Hospital to offer sessions concurrently in Clark, Skamania and Klickitat counties. (Feb-April 2018) 2) Opioids, Feedback Reports, and Supporting Change in Provider Behavior (April 2018) 3) Video Resource developed for partners from April 2018 Feedback Reports Presentation (March 2019)

ASSET & CAPACITY DEVELOPMENT Objectives SWACH PROGRESS

PREVENTION

STRATEGY

Promote Use of PMP

Support Workforce Development for Sustainability Develop HIT / HIE Capacity for Information Sharing and Interoperability Increase Training and Technical Assistance Leverage Data to Inform Population Health Strategies

PMP

Return to Top

Connect partners to state programs that align with PMP registration

• Opioid Notification Pilot Program (March 2019). Partners need

to registered with the PMP to participate in the program.

ASSET & CAPACITY DEVELOPMENT Objectives SWACH PROGRESS

PREVENTION

STRATEGY

Support Telehealth in Underserved Areas

Strengthen Regional Communication and Coordination Across Settings Support Transition to Value Based Payment (VBP) Support Workforce Development for Sustainability Increase Training and Technical Assistance Leverage Data to Inform Population Health Strategies

Telehealth

Return to Top

Support discussions between regional Hub (Lifeline) and Rural partner (KVH) exploring telehealth support for MAT

ASSET & CAPACITY DEVELOPMENT Objectives SWACH PROGRESS

PREVENTION

STRATEGY

Promote Safe Storage and Appropriate Disposal

• f Opioids

Strengthen Regional Communication and Coordination Across Settings

Storage and Disposal

Return to Top

Collaborate with Prevent Coalition to support “Starts with One” Campaign (Ongoing)

SWACH PROGRESS

TREATMENT

STRATEGY

Increase Number of Providers Certified to Provide MAT

Increase MAT Providers

Return to Top

Approximately 50 providers will have completed the face to face portion of the waiver training since the first SWACH coordinated MAT Waiver Training in October 2018 (Big Thank you to Dr. Melinda Landchild!)

Medication Assisted Treatment – Provider Waiver Training (August 2018) Medication Assisted Treatment – Provider Waiver Training (October 2018) Medication Assisted Treatment – Provider Waiver Training (January 2018) Medication Assisted Treatment – Provider Waiver Training for ED doctors and hospitalists (March 20, 2019) Medication Assisted Treatment – Provider Waiver Training for ED doctors and hospitalists (March 23, 2019) “How to Use Suboxone in a Clinical Setting – Provider Dinner Presentation with Dr. Hart

ASSET & CAPACITY DEVELOPMENT Objectives SWACH PROGRESS

TREATMENT

STRATEGY

Increase and Diversify MAT Initiation Sites

Strengthen Regional Communication and Coordination Across Settings Support Transition to Value Based Payment (VBP) Support Workforce Development for Sustainability Develop HIT / HIE Capacity for Information Sharing and Interoperability Increase Training and Technical Assistance Leverage Data to Inform Population Health Strategies

MAT Initiation Sites

Return to Top

Initialization of MAT in Hospital, ED, Jail Opioid Treatment Networks PeaceHealth, Lifeline Klickitat Valley Health, Klickitat Jail

ASSET & CAPACITY DEVELOPMENT Objectives SWACH PROGRESS

TREATMENT

STRATEGY

Identify and Support Access Points to Treatment

Strengthen Regional Communication and Coordination Across Settings Support Workforce Development for Sustainability Develop HIT / HIE Capacity for Information Sharing and Interoperability Increase Training and Technical Assistance

Treatment Access Points

Return to Top

Development of Lifeline’s Rapid Response Clinic Connect Pathways Care Coordination Program- CHW’s- with opioid affected individuals and their family networks - especially people in Medication Assisted Recovery who have been referred into the program through OTN referral partners

ASSET & CAPACITY DEVELOPMENT Objectives SWACH PROGRESS

OD PREVENTION

STRATEGY

Increase Distribution of Naloxone Expand Access to Syringe Exchange Programs

Strengthen Regional Communication and Coordination Across Settings Support Transition to Value Based Payment (VBP) Support Workforce Development for Sustainability Develop HIT / HIE Capacity for Information Sharing and Interoperability Increase Training and Technical Assistance Leverage Data to Inform Population Health Strategies

Naloxone

Return to Top

Creation of Naloxone Awareness and Access Posters- SWACH supported collaboration between Lifeline, Public Health and PeaceHealth pharmacy to develop naloxone awareness project using informational posters and targeting people who inject drugs. SWACH amplification/ informing regional stakeholders of statewide opportunity for agencies to receive Narcan and technical assistance for use and distribution.

SWACH supported partnership discussion between Clark County Public Health and Share CBO to expand mobile syringe exchange.

ASSET & CAPACITY DEVELOPMENT Objectives STRATEGY Objectives

Recovery

STRATEGY

Enhance / Develop the Provision of Peer Support for Long Term Recovery

Strengthen Regional Communication and Coordination Across Settings Support Transition to Value Based Payment (VBP) Support Workforce Development for Sustainability Develop HIT / HIE Capacity for Information Sharing and Interoperability Increase Training and Technical Assistance Leverage Data to Inform Population Health Strategies

Peer Support

Return to Top

Focus on Peers as Central to the Opioid Response in “Changing the Conversation about Opioid Treatment” (May 2018) Focus on Peers as Central to Opioid Response in “Opioid Action Summit” (Dec 2018) Ongoing exploration/discussion of Peer and CHW principles and practices, and the opportunity to support community members in recovery, through Pathways Care Coordination

Irons in the Fire

• Prevention: Rational Pain Management- Non-Opioid Pain

Management Modalities

• Treatment: Alignment of Opioid Treatment Networks with

HealthConnect CHW/Peer Care Coordination

• OD Prevention: Support Opportunity for Community Paramedicine

and Narcan Distribution

• Recovery: Regional Convening to Focus on Barriers Associated with

Long-term Opioid Use Disorder Recovery

Prevention: Rational Pain Management Alternatives to Opioids

Researchers found that 61 percent of people who died from an opioid overdose had been diagnosed with a chronic pain condition during the final year of life.

[The study was published 2017 in the American Journal of

• Psychiatry. Researchers looked at medical and prescription

information for 13,089 people on Medicaid who died from an opioid

• verdose between 2001 and 2007.]

There is currently no long-term evidence to support the use of opioids for chronic pain (pain lasting longer than 3 months) and this practice has been under increasing scrutiny in recent years.

[Dowell, D., Haegerich, T., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. Morbidity and Mortality Weekly Report, 65(1), 1-49.]

Alterative Pain Management Modalities are needed.

The structural an and soc socia ial de determinants s of

• f hea

health fr fram amework is s wid idely ly un understood to to be be cr crit itical in resp esponding to to pu public ic hea health chal challenges. . Un Until l we e ado adopt this is fr fram amewor

• rk,

, we e will ll continue to to fail ail in n our

• ur efforts to

to turn the tid ide of

• f the op
• pio

ioid cr cris isis. s.

[Opioid Crisis: No Easy Fix to Its Social and Economic Determinants: American Journal of Public

• Health. Feb 2018.]

Treatment: Alignment of Opioid Treatment Networks with HealthConnect CHW/Peer Care Coordination

Recovery: Reg egional Con Convenin ing to to Foc

• cus on
• n Barri

Barriers Asso ssocia iated wit ith Lon Long-term Op Opioid Us Use e Di Disorder Recovery ry RFI to National Center for Complex Health and Social Needs - Proposed convening in Southwest Washington will focus specifically on barriers associated with long-term opioid use disorder recovery.

Community members experiencing substance use disorders (SUD) in Southwest Washington State face many barriers to high-value, complex care. Those barriers include stigma; lack of understanding of SUD as a long-term chronic illness rather than a moral failing or acute condition; and a lack of access to long-term recovery options. Furthermore, limited resources and financial support for long-term treatment paired with limited treatment options significantly hinder regional systems from effectively supporting long-term recovery.

OD OD Prevention: Su Support Op Opportunit ity for

• r Com

Community Par aramedicine an and Nar arcan Di Distrib ibution

Closing

• Next Meeting: Thursday, June 27

Thank you!