Regional Health Improvement Plan Council May 15, 2018 Meeting - - PowerPoint PPT Presentation

Regional Health Improvement Plan Council

May 15, 2018

Meeting Objectives

• Review Community Engagement Efforts
• Receive updates on Policy Work
• Discuss next steps for equity accelerator framework
• Review and vote on charter changes
• Discuss Medicaid Transformation plans and timelines

Skamania Listening Session

• What is one take away from the summary?
• What is one potential application to our

work?

• What questions do you have after reading

the summary?

Proposed Community Engagement Plan

• 1. Establish Community Voices Council (CVC)
• 2. Community engagement is SWACH continually providing

information, actively listen, and reporting decisions/activities to “community groups” through actively participating in formal and informal activities, meetings and events.

• 3. SWACH will (co-)host Community Discussions on topics that

are relevant and will result in action-oriented planning.

1. . Community Voic ices Council

Community Voices Council

Klickitat (5) Skamania (5) Clark (10) RHIP-C Committees Board of Trustees Suggestions/recommendations:

• Ensure it represents entire region (Clark,

Klickitat, Skamania Counties).

• A majority of identified representatives will

be Medicaid enrollees.

• It will be inclusive of diverse perspectives and

seeking out who still needs to be heard.

• CVC will have representation in all elements
• f SWACH (RHIP-C, Board, Workgroups and

committees).

• CVC will have a Charter defining purpose,

activities, membership, etc.

• CVC will have an application process to

ensure diverse communities represented and ability/willingness to be engaged in purpose.

• Compensation for mileage or other costs.
• CVC is directly involved in all actions of

SWACH

• CVC meetings are open meetings.

• 2. Engaged with Communities
• There is not one community
• Community is defined by many things (geography, common culture,

common interests, common characteristics, etc.)

• Recognize there are many expressions of community: formal and

informal (natural, shared identity, common goals, sense of belonging)

• Continue engaging with formal community groups and seek out

identified community groups (formal and informal) to go to.

• SWACH creates a “lexicon” that supports communities

understanding Medicaid Transformation and all its elements.

• 3. Community Discussions
• This is a variation of SWACH hosting “Listening Sessions.”
• SWACH hosts Community Discussions that are topical, timely and

supportive of decision-making or addressing communities needs.

• Provides a shared-learning experience for SWACH and communities.
• Opportunities for building trust through between SWACH, “systems”

and communities.

• Ensure the listening translates into action congruent with

communities messages.

• Supports the critical value of transparency.

Questions/Recommendation

• Questions about Community Engagement Plan?
• Recommend this three part plan be accepted and

the SWACH staff and ad hoc Community Engagement Workgroup pursue formalizing Community Voices Council for RHIP-C and Board

• f Trustees approval.

Policy Updates

• Clark County Complete Streets
• Behavioral Health Enhancement Senate Bill

6032

Equity, Stigma, and Trauma Informed Accelerator Framework

• Updates on accelerator framework

Charter Review

• Recommendations on Changes
• Co-Chair potential nominations

Medicaid Transformation Project Overviews

• May 15, 2018

RHIP Council

12

Key Milestones

Activity Target Date

Status

Clinical Partner Assessment closed. COMPLETE

G

Funds flow model for DY2 – 3 (2018 – 2019) finalized. TBD

G

Provider partner payment (tied to assessment). 6/29/18

G

Develop Transformation Plan requirements and Tools for Regional Participants (draft distributed by June 11). 7/2/18

Y

Semi Annual Report #1 submitted to HCA. 7/31/18

G

Partners submit Transformation Plans. 8/17/18

G

Provider partner payment (tied to transformation plans). 10/1/18 G SWACH Implementation Plan submitted to HCA. 10/1/18

G

Provider contracts/MOU executed. 12/31/18

G

SWACH Dashboard: Medicaid Transformation May 2018

Success Metrics

Description Target Actual Comments Clinical Partner Assessment Participation 100% BH 84% PC 59% Extensions to 5/18 % indicates complete survey. Transformation Plans complete 100% N/A P4R HCA Measures being finalized For 2019 reporting 2A under HCA review

13 Overall Status

Area Status Notes By Care Setting Primary Care Y

Realigning primary care representation consistent with re- chartering Clinical Integration Committee

Behavioral Health Y

Realigning behavioral health representation consistent with re-chartering Clinical Integration Committee

ED Y

Little penetration from two ED departments as work has been focused on BH/PC settings.

CBO Y

Defining approach for CBO transformation plans to include CBOs in all planning and development.

By Project Clinical Integration G Opioid Response G

Three Opioid focused community events in May.

Chronic Care G Care Coordination Y

Contract with CCS for Pathways Hub technology and Healthy Gen for consulting. Align with 5 ACHs implementing Pathways.

Issues / Risks

Description Mitigation Changes from the State and risk that info will not flow to the ACH and providers timely SWACH coordinating with providers and stakeholders (e.g. providers, WHA, Governor’s office) Unknown of 3rd payer launching in Q1 2019 SWACH available to help providers navigate and align. Including potential new payers in SWACH meetings Consolidation of the market - health system affiliations, payer arrangements and impact to the behavioral health market. SWACH available as resource to support providers in making partnership and contracting decisions In jeopardy, intervention required No concerns to escalate Some risk, monitor closely G Y R

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

14

MEDICAID TRANSFORMATION PROJECTS

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

Health Information Exchange / Health Information Technology

Partners across the SWACH region have consistent communication and connectivity for improved whole-person, integrated care

Opioid Response

Reduce opioid drug misuse through cross sector collaboration in Clark, Skamania, Klickitat counties

Community Care Coordination

Individuals with health and/or social needs connect to quality, coordinated care interventions and services to improve their overall health outcomes

Bi-Directional Clinical Integration

Individuals receive Behavioral Health and Physical Health services in each setting along SAMSHAs Six Levels of Integration

Value Based Payment

Provide support to the region to transition from a volume based payment structure to a value based payment structure to promote whole person care

Workforce Development

Support the development of an empowered, compassionate, and sustainable workforce that is responsive to community health needs in our region

Trauma Informed Care Chronic Care

Provide support for effective complex care and disease management for targets utilizing CBOs and clinical providers to support interventions

Collaborative Shared Learning Reduction of Stigma Health Equity

DOMAIN ONE CARE SETTINGS

Emergency Department Behavioral Health Primary Care Community Based Organizations

CORNERSTONES

Community Engagement

Medicaid Transformation Project Overviews: Summary

15

Project Overview: Bi-Directional Clinical Integration SWACH Lead: Daniel Smith

Aim Statement

Individuals receive Behavioral Health and Physical Health services in each setting along SAMSHAs Six Levels of Integration

Target Population

All Medicaid beneficiaries (children and adults), particularly those at risk for behavioral health conditions, including mental illness and/or substance use disorder Issues / Risks

Description Mitigation Clinical Integration workgroup does not currently have representation from all involved parties. Plan to re-charter workgroup and membership by September Transformation Plan timeline is condensed Provider input at least three times during development. Build in extensions to deadlines as a contingency plan. Changes from the State and risk that info will not flow to the ACH and providers timely SWACH staying connected with HCA, legislature, WSHA, WA Academy of Pediatrics, Governor's office, and other ACH’s. Communicate changes to providers. Unknown of 3rd payer launching in 2019 SWACH available to help providers navigate and align. Including potential new payers in meetings in SWACH meetings Consolidation of the market - health system affiliations, payer arrangements and impact to the behavioral health market. SWACH available as resource to support providers in making partnership and contracting decisions

Approach and Tactics

Work with partner organizations to develop their transformation plans, which will support the regional implementation plan developed by SWACH to achieve end state Physical Health settings providing Behavioral Health services

• Universal Screening for behavioral health
• BH specialist as part of clinical team
• Data systems to track outcomes and population health
• Collaborative Care Model
• Key elements of Bree Collaborative Model
• Evidence Based treatment

Behavioral Health settings providing Physical Health services

• Universal Screening for physical health
• Medical services onsite or enhanced care link and shared

care planning with primary care

• Data systems to track outcomes
• Milbank Model of Care
• Key elements of Bree Collaborative Model
• Evidence Based treatment

Measures

Pay for Performance (P4P) Pay for Reporting (P4R)

• All-Cause Emergency Department (ED)

Visits

• Inpatient Hospital Utilization
• Follow up after ED visit for mental

health

• Follow up after hospitalization for

mental illness

• Follow-up after ED visit for alcohol or

drug dependence

• Mental health treatment penetration
• Percent homeless
• Plan All-Cause Readmissions
• Substance use disorder treatment

penetration

• Child and Adolescents’ Access to

Primary Care Practitioners

• Comprehensive Diabetes Care: Eye

Exam performed

• Comprehensive Diabetes Care: HbA1c

testing

• Comprehensive Diabetes Care:

Medical Attention for Nephropathy

• Medication Management for People

with Asthma (5-64 years)

• Antidepressant Medication

Management

• Assessment of

integration of physical and behavioral health care (MeHAF Site Self Assessment tool-under HCA review)

G

16

Project Overview: Bi-Directional Clinical Integration – Partner and Community Engagement Partner Engagement Clinical Integration Committee includes representatives from:

• Catholic Community Services
• Center for Community Health and Evaluation
• Child and Adolescent Clinic
• Children’s Center
• Community Health Plan of Washington
• Comprehensive Healthcare
• Daybreak Youth Services
• Klickitat Valley Health
• Kaiser
• Legacy Health Services
• Lifeline Connections
• Molina Healthcare
• NAMI SW Washington
• PeaceHealth
• Providence Health and Services
• Qualis
• Rose Clinic
• SeaMar Community Health Services
• Skamania County
• Skyline Hospital and Family Medicine
• The Vancouver Clinic

Community Engagement

• Our approach: Engage the community where

they are through:

• SWACH initiated community discussions
• Attendance at existing community groups
• Launch of a Community Voices Council

Stakeholder Review

• Regular updates will be shared with RHIP and

the Board

• RHIP will have opportunities to review and

provide input prior to taking major final products to the Board

• e.g. Transformation Plan, Implementation

Plan, Funds Flow, Workgroup Charters

17

Project Overview: Opioid Response SWACH Lead: Eric McNair Scott

Aim Statement

Reduce opioid drug misuse through cross sector collaboration in Clark, Skamania, Klickitat counties

Target Population

Medicaid beneficiaries, including youth, who use, misuse, or abuse prescription opioids and/or heroin Issues / Risks

Description Mitigation Waiting on process to fund initial pilot ideas which are ready to move forward; risk of partner disengagement if delayed Working on funds flow model and initial grant process Need plan to support and sustain momentum of Opioid task force, including definition of the role of SWACH staff Working with Public Health, ACES Action Alliance, and provider champions on longer term model

Approach and Tactics

Work with partner organizations to develop their transformation plans, which will support the regional implementation plan developed by SWACH to achieve end state Prevention Strategies

• Disposal and secure storage of opioids
• Use of PMP
• Training and support for providers
• TeleHealth (i.e. Project Echo)

OD Treatment Strategies

• Increased distribution of naloxone
• Increased access to naloxone

Treatment Strategies

• Team model of engagement and care
• Number of MAT providers in care settings outside of SUD

(Primary Care, Hospitals, ED, Specialists, etc)

• Increased MAT initiation sites (Primary Care, ED’s,

Hospitals, HRC, etc)

• Increased Tx access points in clinical and community

settings Recovery Strategies

• Increased peer support services
• Peer access in clinical settings

Measures

Pay for Performance (P4P) Pay for Reporting (P4R)

• All-Cause Emergency

Department (ED) Visits

• Inpatient Hospital

Utilization

• Patients on high-dose

chronic opioid therapy

• Patients with concurrent

sedatives prescriptions

• Substance use disorder

treatment penetration (opioids)

• Providers are trained on

guidelines on prescribing opioids for Pain

• Practice/clinic site has EHRs or
• ther systems that provide clinical

decision support for the opioid prescribing guidelines

• Mental health and SUD providers

deliver acute care and recovery services for people with OUDs

• ED has protocols in place for

providing overdose education, peer support and take-home naloxone to individuals seen for

• pioid overdose
• Organization site connects

persons to MAT providers

• Organization site received

technical assistance to organize or expand syringe exchange programs

G

18

Project Overview: Opioid Response – Partner and Community Engagement Partner Engagement Opioid Crisis Response Committee includes representatives from:

• Clark County
• Clark County Public Health
• Clark County Sheriff’s Office
• Columbia River Mental Health Services
• Community Health Plan of Washington
• Community Voices are Born
• Comprehensive Healthcare
• Cowlitz Tribal Treatment
• ESD112
• KLASAC
• Klickitat Valley Health
• League of United Latin American Citizens
• Lifeline Connections
• Molina Healthcare
• Northshore Medical
• PeaceHealth
• SeaMar Community Health Services
• Share Vancouver
• United Health Care
• Current email distribution includes 80 contacts
• Anticipate moving forward with an Opioid task force and close

alignment with the Clinical Integration Committee Community Engagement

• Our approach: Engage the community where

they are through:

• SWACH initiated community discussions
• Attendance at existing community groups
• Launch of a Community Voices Council
• Holding three events in May focused on:
• Opioid prevention
• Treatment
• Addressing stigma

Stakeholder Review

• Regular updates will be shared with RHIP and

the Board

• RHIP will have opportunities to review and

provide input prior to taking major final products to the Board

• E.g. Transformation Plan, Implementation

Plan, Funds Flow, Workgroup Charters

19

Project Overview: Chronic Care SWACH Lead: Daniel Smith

Aim Statement Provide support for effective complex care and disease management for targets utilizing CBOs and clinical providers to support interventions Target Population Medicaid beneficiaries (adults and children) with, or at risk for, arthritis, cancer, chronic respiratory disease (asthma), diabetes, heart disease, obesity and stroke, with a focus on those populations experiencing the greatest burden of chronic disease in the region. Issues / Risks

Description Mitigation Lack of central hub for chronic disease self management education Consider role of SWACH and potential community needs in implementation planning Ensuring alignment with current initiatives and current contracts Focus with providers on enhancing current interventions and supporting scaling to Medicaid

Approach and Tactics

Work with partner organizations to develop their transformation plans, which will support the regional implementation plan developed by SWACH to achieve end state Chronic Disease Self Management Education programs

• Partner commitment and resources to support patient

engagement

• Best practices for patient retention
• Central coordinating entity
• Provider, environment, and patient readiness
• Community clinical linkages to education and services

Community Paramedicine programs

• ED / Hospital diversion and community education
• Transition – follow up in community after acute episodes
• Best and highest use of EMS resources
• Community Health Worker developments

Measures

Pay for Performance (P4P) Pay for Reporting (P4R)

• All-Cause Emergency Department (ED)

Visits

• Inpatient Hospital Utilization
• Mental health treatment penetration
• Substance use disorder treatment

penetration

• Child and Adolescents’ Access to Primary

Care Practitioners

• Comprehensive Diabetes Care: Eye Exam

performed

• Comprehensive Diabetes Care: HbA1c

testing

• Comprehensive Diabetes Care: Medical

Attention for Nephropathy

• Medication Management for People with

Asthma (5-64 years)

• Antidepressant Medication Management
• Statin Therapy for Patients with

Cardiovascular Disease

• None

G

20

Project Overview: Chronic Care – Partner and Community Engagement Partner Engagement Chronic Care is included in the Clinical Integration Committee, which includes representatives from:

• Catholic Community Services
• Center for Community Health and Evaluation
• Child and Adolescent Clinic
• Children’s Center
• Community Health Plan of Washington
• Comprehensive Healthcare
• Daybreak Youth Services
• Klickitat Valley Health
• Legacy Health Services
• Lifeline Connections
• Molina Healthcare
• NAMI SW Washington
• PeaceHealth
• Providence Health and Services
• Qualis
• SeaMar Community Health Services
• Skamania County
• Skyline Hospital
• The Vancouver Clinic

Community Engagement

• Our approach: Engage the community where

they are through:

• SWACH initiated community discussions
• Attendance at existing community groups
• Launch of a Community Voices Council

Stakeholder Review

• Regular updates will be shared with RHIP and

the Board

• RHIP will have opportunities to review and

provide input prior to taking major final products to the Board

• E.g. Transformation Plan, Implementation

Plan, Funds Flow, Workgroup Charters

21

Project Overview: Community Care Coordination SWACH Lead: Louise Nieto

Aim Statement

Individuals with health and/or social needs connect to quality, coordinated care interventions and services to improve their overall health outcomes

Target Population

Medicaid beneficiaries (adults and children) with one or more chronic disease or condition (e.g. arthritis, cancer, chronic respiratory disease, diabetes, obesity, stroke), or mental illness/depressive disorders, or moderate to severe substance use disorder and at least one risk factor (e.g., unstable housing, food insecurity, high EMS utilization) Issues / Risks

Description Mitigation Shared services contract with CCS on behalf of multiple ACH’s Seeking collective alignment with other ACHs

• Program Evaluation
• Data
• Security
• Programmatic
• Policy and Advocacy

Track closely and participate in the process; expect this to result in more cost efficient contract Legal and technology expertise needed for Pathways Hub contracting process Collective alignment with ACHs for legal and technology resources. Formalize shared services agreements for IT security

Approach and Tactics

Work with partner organizations to develop their transformation plans, which will support the regional implementation plan developed by SWACH to achieve end state Pathways Community HUB

• Reduce duplication of care coordination efforts
• Measure and track outcomes
• Value Based Paying contracting with MCO’s and payors

Support Rural care coordination needs Support current coordination and referral efforts, e.g. 2-1-1

Measures

Pay for Performance (P4P) Pay for Reporting (P4R)

• All-Cause Emergency Department (ED)

Visits

• Inpatient Hospital Utilization
• Follow up after ED visit for mental health
• Follow up after hospitalization for mental

illness

• Follow-up after ED visit for alcohol or drug

dependence

• Mental health treatment penetration
• Percent homeless
• Plan All-Cause Readmissions
• Substance use disorder treatment

penetration

• None

Y

22

Project Overview: Community Care Coordination – Partner and Community Engagement Partner Engagement

Community Care Coordination Workgroup includes representatives from:

• 211 Info
• Area Agency on Aging and Disabilities
• Beacon Health Options
• Community Health Plan of Washington
• Community Voices are Born
• Council for the Homeless
• DSHS
• EOCF of Washington
• Free Clinic of SW Washington
• Klickitat Valley Health
• Legacy Health Services
• Molina Healthcare
• Northwest Justice Project
• PeaceHealth
• Providence Health and Services
• SeaMar Community Health Services
• Skamania County
• United Health Care
• Vancouver Housing Authority
• Engaged potential partner organizations and community on Pathways

Hub model in Fall 2017 through RFA and education sessions for Care Coordinating Agencies (CCA) and Referral Agencies (RA)

Community Engagement

• Our approach: Engage the community where

they are through:

• SWACH initiated community discussions
• Attendance at existing community groups
• Launch of a Community Voices Council

Stakeholder Review

• Regular updates will be shared with RHIP and

the Board

• RHIP will have opportunities to review and

provide input prior to taking major final products to the Board

• E.g. Transformation Plan, Implementation

Plan, Funds Flow, Workgroup Charters

5/14/2018 23

SWACH Clinical Partnering Providers MCO’s

ASSESSMENT

• Deploy a portfolio of current state assessment(s)

TRANSFORMATION PLANNING

• Develop Transformation Plan requirements and

Tools for Regional Participants

• Submit to HCA MTP Regional Implementation Plan
• Ensure partners meet Transformation Plan

requirements

• Support regional continuous improvement process
• Identify regional workforce shortages and capacity

building solutions

• Review local HIE/HIT assessment results
• Based on current state assessment results develop

regional strategy to address HIE/HIT TRANSFORMATION INVESTMENT PLANNING

• Review regional transformation plans to identify

regional capacity investments and implementation ASSESSMENT

• Complete portfolio of current state assessments

(HIE/HIT, PH and BH) TRANSFORMATION PLANNING

• Review and provide input into transformation plan

template and guidance

• Participate in transformation plan webinar
• Develop an organizational level plan to meet

transformation requirements to include identification of target populations, equity/stigma/Trauma Informed supports, partner development, continuous improvement plan, workforce and HIE/HIT needs.

• Ensure leadership sponsor is identified to

transformation plan milestones

• Submit Transformation Plan
• Ongoing active participation in Clinical Integration

Committee TRANSFORMATION BUDGET

• Identify initial transformation Plan Budget and

Capacity needs

• Support continuous improvement
• Support regional HIE/HIT strategy at the state level
• Support each provider to move into VBP contracts
• Support data needs for providers
• Performance metrics/measurement developments
• Assist providers to asses and develop a sustainable

business model to whole person care requirements and VBP

Roles: Transformation Planning-BH/PC

24

SWACH Dashboard: Operations May 2018 HR Finance Contracting IT Status

Yellow Yellow Green Green

Updates

Posted positions:

• Community

Engagement Coordinator

• Finance Director
• Contracted for interim

Communications Lead

• Contracting for AP/AR with

local company

• Reviewing organizational

roles and staffing models

• CEO search underway.

Candidate profile created

• Phase 2 Funds flow being

finalized

• Initial community

engagement for FIMC priorities

• Mid Adopter incentive

payments pending to support Klickitat County

• Interim Finance support

being provided by Pierce and will transition AP/AR to local contracted agency

• HCA Contract Amendment
• Point B SOW updated to

include additional capacity for transformation plan support

• VALO SOW executed for

Website redesign

• Contract IT support in place
• Updated, secure network

infrastructure (Wi-Fi) deployed in SWACH offices

• SharePoint collaboration

site in development

• Website redesign / updates

in progress

Issues / Risks

• Finance Director

application pool not as robust as expected. Potentially extend recruitment window

• Organizational needs

review needs further inputs

• Knowledge transfer from

Pierce to in house for AP/AR

Clinical Partner Assessment Update

• 39 completed assessments
• Assessment remaining open

through May 18th

• Will report back to RHIP in June.

83.3% 58.5% Behavioral Health organizations Physical Health / Primary Care practices

Current Response Rate

As of Friday, May 11th