Board of Trustees September 20, 2018 Board Business Board Member - - PowerPoint PPT Presentation

Board of Trustees

September 20, 2018

Board Business

• Board Member Appointment
• Minutes Approval
• Finance Committee Report
• Board Meeting Schedule
• Election of Officers
• Conflict of Interest
• ACH Learning Session

Key Strategies Major Milestones TargetDate Success Metric Status Staffing Fill Vacancies

• Executive Director
• Community Engagement Manager
• Finance Director
• Communications Director
• Opioid Coordinator
• Equity Manager
• Aug. 2018

Positions Filled Complete

• Review organizational roles and potential staffing models that support function
• Oct. 2018
• Org. structure to

support 2019 Work In progress Marketing & Communications

• Hired a Communications Director to develop a communications plan
• Aug. 2018

Position filled/Plan created Complete

• Communications Plan Launch and integration of Healthy Living Collaborative

Winter 2018/9 In progress Budget/Funds Flow

• Board approved operating budget

Winter 2018/9 Approved budget In progress

• New Opioid funding
• Sept. 2018

Grant approved Complete Internal Policies & Procedures

• Review policies and procedures for gaps and fill gaps

Fall 2018 Full policies and procedures In progress Healthy Living Collaborative Integration

• Integrate HLC programs, staffing, and services into SWACH regional plan
• CHW Neighborhood Pilot Transition

Winter 2018/9 In Progress

Operations Dashboard

Funds Flow Update

(REVIEW) Four High Level Funds Flow Categories

ACH Admin Community Resiliency Fund Regional Capacity Investments Transformation Plan Implementation

• Administrative operating

expenses of SWACH

• Legal
• Financial
• Facilities
• Equipment
• Funds for Pathways
• Funds for ACH to make

regional investments that support partners for specific purposes including workforce, health information, training, and other infrastructure funds.

• Funds will be used to promote

large scale transformation and sustainability across the region.

• Funds paid directly to

partners to plan for and achieve DSRIP goals and

• verall transformation.
• Assessments
• Transformation plans
• Implementation

support

• Investments impacting social

determinants of health and innovative solutions.

(REVIEW) How Many Dollars Are There?

$8.67M BH Integration $? Community Resiliency Fund

$721,217 – Year 1 (10%) $? – Year 2 $? – Year 3 $? – Year 4 $? – Year 5

DSRIP Incentives

$7.2M Year 1

$1.8M (25%)

$9.2M Year 2

$?

$7.8M Year 3

$?

$7.3M Year 4

$?

$5.9M Year 5

$? $4M (55%) $? $? $? $?

% t o t he Communit y Resiliency Fund

Regional Capacit y Invest ment s Part ners Transformat ion Plans/ Implement at ion

To support bi-directional integration across Clark, Skamania, and Klickitat Counties

ACH Admin Year 1 = $721,217 (10%)

(REVIEW) Y1 Transformation Plan Implementation

$1.7M Planning

Health Information Assessment ($210,000) Clinical Assessment ($260,000) Transformation Plan Submission ($900,000) Non-Clinical Partner Engagement TBD ($330,000)

$2.3M Binding Agreements

Binding 2019 agreements negotiated September through December These funds will combine with year 2 funds to support 2019 contracts Contracts will take into account Medicaid lives served and can support equity/anti-stigma work as well as partnerships needed to achieve transformation outcomes

Y1 Transformation Plan Implementation: Budget vs Actual

Budgeted

Health Information Assessment ($210,000) Clinical Assessment ($260,000) Transformation Plan Submission ($900,000) Non-Clinical Partner Engagement TBD ($330,000)

Actual

Spent: $172,500 Owed: $37,500 Spent: $220,000 Owed: $30,000 Spent: $0 (21 plans submitted so far) Spent: $0 (RFI is currently open)

Current Thinking/Board of Trustees Decision in October

DSRIP Incentives Year 1 thru 5

ACH Admin 10% (≈$3.7M) Community Resiliency Fund 10% (≈ $3.7M) Regional Capacity Investment 25% (≈$9.3M) Transformation Implementation 55% (≈$20.5M)

BH Integration

ACH Admin $0 Community Resiliency Fund $868K (10%) Regional Capacity Investment $2.2M (25.4%) Transformation Implementation $5.6M (64.6%)

Current Thinking/ Board of Trustees Decision in October

Total of DSRIP Incentives Year 1 thru 5 and BH Integration

ACH Admin 8.11% (roughly $3.7M) Community Resiliency Fund 10.00% (roughly $4.6M) Regional Capacity Investment 25.07% (roughly $11.5M) Transformation Implementation 56.82% (roughly $26.1M)

Board Conversation

• ACH-Pay For Performance
• Strategic Plan

Measure

Date SWACH Performance Statewide Performance Relative to State

All-cause Emergency Department Utilization (per 1,000 member months) *

Q3 2017 39.4 48.0

Antidepressant Medication Management – Acute

Q3 2017 51% 50%

Antidepressant Medicaid Management – Continuation

Q3 2017 36% 34%

Child and Adolescent Access to Primary Care (12-24 months)

Q3 2017 89% 93%

Child and Adolescent Access to Primary Care (2-6 years)

Q3 2017 81% 85%

Child and Adolescent Access to Primary Care (7-11 years)

Q3 2017 87% 90%

Child and Adolescent Access to Primary Care (12-19 years)

Q3 2017 86% 90%

Comprehensive Diabetes Care: Eye Exam

Q3 2017 39% 33%

Comprehensive Diabetes Care: HbA1c Testing

Q3 2017 83% 84%

Comprehensive Diabetes Care: Medical Attention for Nephropathy

Q3 2017 86% 86%

Follow up after Discharge from ED for Alcohol or Other Drug Dependence (7 day)

Q3 2017 34% 24%

Follow up after Discharge from ED for Alcohol or Other Drug Dependence (30 day)

Q3 2017 43% 32%

Follow up after Discharge from ED for Mental Health (7 day)

Q3 2017 62% 61%

Follow up after Discharge from ED for Mental Health (30 day)

Q3 2017 75% 72%

Follow up after Hospitalization for Mental Health (7 day)

Q3 2017 86% 87%

Follow up after Hospitalization for Mental Health (30 day)

Q3 2017 91% 91%

Inpatient Hospital Utilization (per 1,000 member months) *

Q3 2017 65.3 67.1

Pay for Performance (P4P) Measure Dashboard

Measurement Period: Oct 2016 – Sept 2017

Legend Data Sources

Data sources used include: Healthier Washington Data Dashboard + RDA Measure Decomposition Reports SWACH performance is at or above statewide SWACH performance is below statewide SWACH is the lowest performing ACH region

Aug 2018

Improvement over Self Gap to Goal *lower rate indicates better performance

Legend About P4P Measures

The first year ACHs will be held accountable for P4P measures is CY 2019. Performance in CY 2019 will be compared to baseline (CY 2017). Official ACH baseline performance will be calculated for CY 2017; the state intends to release baseline results in October 2018. Official improvement targets and benchmarks for measures will also be released in October 2018. SWACH performance reported here is preliminary. Benchmarks for gap to goal measures will likely be the national Medicaid 90th percentile; ACHs must close the gap between baseline and benchmarks by 10%. Targets for improvement over self measures will be based on 1.9% improvement from baseline. Future updates of the P4P Measure Dashboard will include official baseline and benchmarks / improvement targets. The P4P Measure Dashboard will be updated quarterly where possible; however, some measures are only available annually or semi-annually. SWACH performance is at or above statewide SWACH performance is below statewide SWACH is the lowest performing ACH region

Aug 2018

Measure

Date SWACH Performance Statewide Performance Relative to State

Medication Management for People with Asthma

Q3 2017 32% 31%

Mental Health Treatment Penetration

Q3 2017 47% 46%

Percent Homeless (ages 18-64) *

Q3 2017 4% 5%

Plan All-Cause Readmission*

Q3 2017 11% 14%

Substance Use Disorder Treatment Penetration (ages 18-64)

Q3 2017 31% 29%

Patients on High Dose Chronic Opioid Therapy

Data for these measures not yet available

Patients with Concurrent Opioid and Sedative Prescriptions Statin Therapy for Patients with Cardiovascular Disease

Q3 2017 80% 78%

Substance Use Disorder Treatment Penetration (Opioids)

Q3 2017 36% 46% Improvement over Self Gap to Goal

*lower rate indicates better performance

Pay for Performance (P4P) Measure Dashboard

Measurement Period: Oct 2016 – Sept 2017

Our Vision

A healthy southwest Washington region where all people have equitable access to quality whole person care and live in connected and thriving communities without barriers to wellness

Our Framework

Whole- Person Integrated Clinical Care Sustainable Large-Scale Impact Community- Clinical Linkages

Strategic Plan

CLINICAL PARTNERS

• Clinical Improvement
• Clinical Integration
• Targeted Learning Collaboratives

COLLECTIVE IMPACT SUPPORT

• Cross Sector Shared Learning
• Community Engagement System
• Equity Planning
• Community Resiliency Funding
• Addressing policy and systems

changes across care settings

• Evaluation of Transformation

COMMUNITY SERVING PARTNERS

• Funding Social Determinant

Partnerships (RFI)

• Targeted Learning Collaboratives

Community Based Care HUB

• Pathways
• Care Coordination

Whole- Person Integrated Clinical Care Sustainable Large-Scale Impact Community- Clinical Linkages

Sustainable-Large Scale impact Dashboard

Strategy Key Milestones Target Date Success Metric Status

Cross Sector Shared Learning

• Monthly Stakeholder Meetings Held

Ongoing In progress

• Opioid Learning Session: Successful dinner event for providers “The Uses of

Suboxone in a Practical Clinical Setting”

• Sept. 2018

Attendance: 40 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

• Jan. 2019

Assessment completed In progress

• Form local and regional community councils

March 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 Equity imbedded across policies, procedures and governance

Strategy Key Milestones Target Date Success Metric Status Equity Planning

• Hire Equity Manager and Equity Consultant team
• Dec. 2018
• Developed Equity Shared Learning Cohort and Curriculum

March 2019 April 2019 12/19

• ngoing

Curriculum developed Partners complete assessment and plans SWACH completes assessment and plan Trainings completed quarterly

• Support partners to equity assessment and plans
• Complete an internal assessment and plan
• 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

• 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

• Developing 3rd evaluation plan in partnership with CORE

Community Resiliency Funding

Sustainable-Large Scale impact Dashboard (Cont.)

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

• Oct. 2018

10+ applications In progress

• Establish review and matchmaking process and criteria
• Nov. 2018
• Invite Community Serving Organizations into a transformation Cohort

Nov.-Dec. 2018 Healthy Living Collaborative Initiatives

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

Ongoing Ongoing Ongoing

• CHW teams

launched into the community and stable

• A strong

network of peers, learning and taking action together In progress In progress

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

Community Health worker initiative

• Support growth of CHAPS network (Advocates, CHWs, Certified Peers, their organizations)

serving Southwest Washington, to improve holistic health outcomes for the Community Community HUB

• Board adopts pathways
• CTPs identify Klickitat and Skamania interest in Pathways model (rural engagement)
• Contract with CCS for HUB Technology and Technical Assistance
• Contract with Healthy Gen for CHW workforce development
• Pathways HUB 2-Day Strategic Planning to finalize
• Recruiting and begin training Community Care organizations
• Community HUB Go Live!

Reporting & Evaluation

• Pay for reporting mechanism established for each provider
• Evaluation plan established for prioritized initiatives

Community-Clinical Linkages Dashboard

Whole-Person Integrated Care Dashboard

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

• Integration of Physical and Behavioral Health Scale and Goals Established
• Value Based Payment Goals Established
• Success Metrics Established
• Workforce Needs Established
• Oct. 2018

Implementation Plan Complete In Process Cohort of Providers for Clinical Transformation

• Clinical Partner Assessment
• Review Transformation Plan (TP)

July 2018 Transformation Plan Developed Complete

• Clinical Transformation Plan developed disseminated and returned
• Aug. 2018

Transformation Plan Completed Complete

• Clinical Transformation Plan review
• Oct. 2018

Transformation Plan Mapping file In Process

• Established Cohort of Clinical Partners invited into a binding agreement to begin

workplan negotiations and Pay for Performance tied to transformation plans.

• Dec. 2018

Binding Agreements Pending

• Provider contracts/MOU executed
• Dec. 2018

Binding Agreements Pending

• TA plan developed for each participating provider
• Capacity to deliver TA Secure
• Dec. 2018

Binding Agreements Pending Learning Collaborative(s)

• Learning Collaborative process and curriculum developed

March 2019 Collaboratives Developed Pending

Board Conversation

Board Meeting Future Expectations

Thank You!

Barbe West, Executive Director