Healthier Washington & Paying for Value: Transforming Health in - - PowerPoint PPT Presentation

Healthier Washington & Paying for Value: Transforming Health in Washington State

MaryAnne Lindeblad Medicaid Director Washington State Health Care Authority

HCA: purchaser, innovator, convener

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HCA purchases health care for over 2.2 million people, with a $10 Billion annual spend.

2021

90%

state-financed

50%

commercial

Tools to accelerate VBP and health transformation

• 2014 legislation directing HCA to implement VBP strategies
• SIM Round 2 grant (Healthier Washington), 2015-2019
• Healthier Washington Medicaid Transformation (Section 1115 waiver), 2017-2021

Tools to accelerate VBP and health transformation

• 2014 legislation directing HCA to implement VBP strategies
• SIM Round 2 grant (Healthier Washington), 2015-2019
• Healthier Washington Medicaid Transformation (Section 1115 waiver), 2017-2021
• Medicaid (Apple Health)

– 1.9 million clients

• Public Employees Benefits

– 370,000 covered lives

• School Employees Benefits (2020)

– 144,000 more covered lives coming

What is Healthier Washington?

Using data to improve care Empowering the patient Supporting providers Ensuring an effective health care workforce Caring for the whole person Leveraging federal funds Focusing on communities Rewarding high-quality care

Healthier Washington’s overarching efforts

Payment drives system transformation

• Fragmented clinical and financial

approaches to care delivery

• Uncoordinated care and transitions
• Unengaged people left out of their
• wn health care decisions
• Variation in delivery system

performance, cost, and equity with no clinical or financial accountability and transparency

Status quo

• Integrated systems that pay for and

deliver whole person care

• Coordinated care and transitions
• Engaged and activated people who

are connected to the care they need and encouraged to take a greater role in their health

• Standardized performance

measurement with clinical and financial accountability and transparency for improved health

• utcomes

Transformed (value-based) system

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Examples of state VBP efforts

State Employees and Retirees Apple Health - Medicaid

• Accountable Care Program, ACO

model with up and downside risk to incentivize clinical and quality accountability

• Total Joint Replacement Bundle and

Center of Excellence

• Contracts with HCA require bidders

to offer substantially similar ACO program (risk sharing and care transformation approaches) to spread VBP in the marketplace

• 1% MCO premium withhold based on

quality and provider VBP arrangements

• Behavioral and physical (financial)

health integration in Southwest WA, statewide by 2020

• Exploring a value-based model for

rural settings

• Healthier Washington Medicaid

Transformation: regional VBP goals tied to incentive payments

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Incentives drive collaboration

Accountable Communities of Health

Regional organizations that:

• Address health issues

through local collaboration

• n shared goals.
• Better align resources and

activities that improve whole person health and wellness.

• Support local and

statewide initiatives such as Medicaid Transformation, practice transformation, health equity, and value- based purchasing.

Health is more than health care.

The 20/80 rule

Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper, State Quality Improvement Institute. Minnesota.

Addressing the other 80%

• Healthier Washington Medicaid Transformation

– Diversion intervention (measuring: % homeless, % arrested) – Support of ACES (adverse childhood experience intervention) – Support of community health workers

• New Medicaid eligibility categories

– Long-term services and supports

• Supporting unpaid family caregivers
• Supporting people who need long-term services and are at

risk of spending down to impoverishment

– Foundational community supports

• Helping those with complex health needs obtain and maintain

housing and employment

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Join the Healthier Washington Feedback Network: healthierwa@hca.wa.gov Learn more: www.hca.wa.gov/hw

10 The Healthier Washington initiative is supported by Funding Opportunity Number CMS‐1G1‐14‐001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.