RHIP Council Meeting September 18, 2018 Meeting Objectives General - - PowerPoint PPT Presentation

RHIP Council Meeting

September 18, 2018

Meeting Objectives

• General SWACH updates
• Introduction of new staff
• 2019 Policy agenda ideas
• Pathways Overview
• Amerigroup as a third-party administrator

New Sta Staff ff

• Barbe West – Executive Director
• Susan Crandall – Finance Director
• Jack Coleman – Communications

Director

• Jamie Smeland – Community

Engagement Manager

Ge Genera ral SW SWACH Up Updates

• Semi Annual Report – Completed
• Clinical Transformation Plans – Updates
• Implementation Plan – Update
• Community Based Organizations

Request for Information – Updates

Pol

• licy Ide

Ideas Brainstorm ideas for 2019 Policy agenda bring concrete ideas to the October meeting

Care Coordination & Pathways Hub Overview

Our Vision for Care Coordination

A stronger and more seamless system of care coordination in Southwest Washington.

Our Approach

Improving Coordination with Technology Care coordination is nearly impossible without shared technology. The Pathways Hub (HUB) is a nationally recognized solution. SWACH is partnering with regional and state-wide partners to pioneer the Pathways Community HUB model. Enhancing Access to Support and Resources Health is influenced by all sorts of factors. For example, housing, food and social

• support. SWACH’s vision is a care coordination workforce with real time access to a

wide range of knowledge and resources to help their clients get and stay healthy. We’re exploring a variety of tools and partnerships that support this vision. Engaging Underserved Communities Access to care coordination and resources varies widely depending on where you

• live. Rural areas often lack care coordinators and other services. SWACH is working

with local voices, healthcare providers and other partners to understand the gaps and identify solutions to serve our underserved communities.

Implementation Strategy

Board Approved CCS Software June 2018 CTPs identify Klickitat and Skamania interest in Pathways model SWACH Pathways Lead engage Rural Partners August 2018 Pathways 2- Day Strategic Planning September 26 & 27 Rural CCAs to be Identified ALL CCAs Trained January & February 2019 GO LIVE! March 2019

Pathways 101 Video

Pathways Community Hub Video

Community Based Care Coordination

Delivered in the home or other community setting Meet all possible client needs

Find | Treat | Measure

20 Standardized Pathways

• Adult Education
• Employment
• Health Insurance
• Housing
• Medical Home
• Medical Referral
• Medication Assessment
• Medication Management
• Smoking Cessation
• Social Service Referral
• Behavioral Referral
• Developmental Screening
• Developmental Referral
• Education
• Family Planning
• Immunization Screening
• Immunization Referral
• Lead Screening
• Pregnancy
• Postpartum

Systems Transformation

Standardized Model & Services Financial Sustainability Secure Information Coordination Health Equity Analysis

Pathways Advantages

Clients

• One coordinator

per-person or family

• Well trained &

supported coordinators

CCAs

• Platform &

partnerships

• Built-in quality

assurance & improvement

Payers

• Purchase client
• utcomes, not FTE
• Community led

delivery system

Pathways Community HUB Model

Payers

Shared Platform, Records & Planning

Local Referral Partners CCAs

HUB

SWACH Staff

Advisory board

• f all partners

Target Population:

• Behavioral Health
• Chronic Disease
• Additional Risk Factors

CCAs Serve:

• Clark County
• Klickitat County
• Skamania County

HUB

• Health & Human Services
• Housing
• Area Agency on Aging
• Medicare/
• Medicaid
• Managed Care
• State Agencies
• County Departments
• Private Health Plans
• Foundations
• Clinics
• FQHCs
• Hospitals
• Physicians

CCA CCA CCA

HUB: Processes Payments

• Medicare/Medicaid
• Managed Care
• State Agencies
• County Departments
• Private Health Plans
• Foundations
• Hospitals

CCA CCA CCA

HUB Processes: Payments

HUB

SWACH Implementation Approach

Pilot model to establish roots across the SWACH region Use early results to bring payers into the

• utcome marketplace

Rapidly scale-up Integrate with other care delivery systems & transformation projects Determine total client capacity & sustainable funding by 2022

Required Tactics Imbedded Into Each Initiative

✓ Value-Based Payment Assessment & Transition Plan ✓ Workforce Development Plan ✓ System for Population Health Management:

The expansion, evolution and integration of health information systems and technology This includes linkages to community-based care models. Health data and analytics capacity will need to be improved to support system transformation efforts, including combining clinical and claims data to advance VBP models

✓ Behavioral/PA Health Integration

• Comprehensive Regional Health Needs Inventory (RHNI)
• Community Voice
• VBP Contract Assessment & Development
• System for Population Health Management
• Bi-directional Workforce Development

Care Delivery Redesign Prevention & Health Promotion

✓ Addressing Opioid Use

• Comprehensive Regional Health Needs Inventory (RHNI)
• Community Voice
• VBP Contract Assessment & Development
• System for Population Health Management
• Bi-directional Workforce Development

ONE REQUIRED FROM BELOW:

• Community Care Coordination: (Pathways Model or Similar Evidenced Based

Approach)

• Transitional Care
• Diversion Interventions
• Comprehensive Regional Health Needs Inventory (RHNI)
• Community Voice
• VBP Contract Assessment & Development
• System for Population Health Management
• Bi-directional Workforce Development

ONE REQUIRED FROM BELOW:

• Chronic Disease Prevention & Control
• Oral Health
• Maternal Child & Health
• Comprehensive Regional Health Needs Inventory (RHNI)
• Community Voice
• VBP Contract Assessment & Development
• System for Population Health Management
• Bi-directional Workforce Development

1 2 3 4

Medicaid Transformation Demonstration - Snapshot

Endorsers of the Pathways Community HUB Model

The CMS Innovation Center

Muskegon Michigan: Year One - Chronic disease

Required Tactics Imbedded Into Each Initiative

✓ Value-Based Payment Assessment & Transition Plan ✓ Workforce Development Plan ✓ System for Population Health Management:

The expansion, evolution and integration of health information systems and technology This includes linkages to community-based care models. Health data and analytics capacity will need to be improved to support system transformation efforts, including combining clinical and claims data to advance VBP models

✓ Behavioral/PA Health Integration

• Comprehensive Regional Health Needs Inventory (RHNI)
• Community Voice
• VBP Contract Assessment & Development
• System for Population Health Management
• Bi-directional Workforce Development

Medicaid Transformation Demonstration - Snapshot Care Delivery Redesign Prevention & Health Promotion

✓ Addressing Opioid Use

• Comprehensive Regional Health Needs Inventory (RHNI)
• Community Voice
• VBP Contract Assessment & Development
• System for Population Health Management
• Bi-directional Workforce Development

ONE REQUIRED FROM BELOW:

• Community Care Coordination: (Pathways Model or Similar Evidenced Based

Approach)

• Transitional Care
• Diversion Interventions
• Comprehensive Regional Health Needs Inventory (RHNI)
• Community Voice
• VBP Contract Assessment & Development
• System for Population Health Management
• Bi-directional Workforce Development

ONE REQUIRED FROM BELOW:

• Chronic Disease Prevention & Control
• Oral Health
• Maternal Child & Health
• Comprehensive Regional Health Needs Inventory (RHNI)
• Community Voice
• VBP Contract Assessment & Development
• System for Population Health Management
• Bi-directional Workforce Development

1 2 3 4

• Better Health Together
• Cascade Pacific Action

Alliance

• North Central ACH
• North Sound ACH
• Pierce County ACH
• Southwest ACH

ACH Adopters of Pathways

Track and Measure Progress with Pathways

Name Medical Home Pregnancy Social Service

CHW A 5 2 10 CHW B 1 3 4 CHW C 9 15 18

Site Medical Home Pregnancy Social Service

Agency A 50 25 22 Agency B 64 17 35 Agency C 40 32 19

By Community Care Coordinator By Agency

• Care Coordinator
• Agency
• HUB
• Community
• Region
• State

Measure: Track Risk Reduction

Community HUB Example

Amerigroup as Third-Party Administrator

Amerigroup Washington

Foundational Community Supports Third Party Administrator

What is Foundational Community Supports

30

It is…

• Medicaid benefits for help

finding housing and jobs:

• Supportive Housing to find

a home or stay in your home

• Supported Employment to

find the right job, right now It isn’t…

• Subsidy for wages or room &

board

• For all Medicaid-eligible

people

What benefits are available through FCS?

Supp Supportiv tive hou housin ing he helps you

• u fi

find nd a a hom home or

• r stay

y in n your

• ur hom

home

➢ Housing assessments and planning to find the home that’s right for you ➢ Outreach to landlords to identify available housing in your community ➢ Connection with community resources to get you all of the help you need, when you need it ➢ Assistance with housing applications so you are accepted the first time ➢ Education, training and coaching to resolve disputes, advocate for your needs and keep you in your home

31

What benefits are available through FCS?

Supp Supported emp mplo loyment t hel helps s you

• u fi

find nd the he ri right t work,

• rk, ri

righ ght t no now

➢ Employment assessments and planning to find the right job for you, whenever you’re ready ➢ Outreach to employers to help build your network ➢ Connection with community resources to get you all of the help you need, when you need it ➢ Assistance with job applications so you can present your best self to employers ➢ Education, training and coach to keep you in your job

32

Who is eligible to receive FCS benefits?

33

FCS CS be bene nefits its ar are rese served for

• r pe

peop

• ple

le with the he gr greatest t ne need. d. To

• quali

qualify fy, you

• u mu

must: t:

1 2

Qualify for Medicaid Meet the requirements for complex needs

• You have a medical necessity related to mental health, substance

use disorder (SUD), activities of daily living, or complex physical health need(s) that prevents you from functioning successfully or living independently.

• You meet specific risk factors that prevent you from finding or

keeping a job or a safe home.

3

Be at least 18 years old (Supportive Housing)

• r 16 years old (Supported Employment)

Who is eligible to receive FCS benefits?

34

Supportive Housing risk factors Supported Employment risk factors

✓Frequent or lengthy homelessness ✓Frequent or lengthy stays in an

institutional setting (e.g. skilled nursing, inpatient hospital, psychiatric institution, prison or jail)

✓Frequent stays in adult residential care

settings

✓Frequent turnover of in-home caregivers ✓Predictive Risk Intelligence System

(PRISM)1 score of 1.5 or above

✓Housing & Essential Needs (HEN) and

Aged Blind or Disabled (ABD) enrollees

✓Difficulty obtaining or maintaining

employment due to age, physical or mental impairment, or traumatic brain injury

✓SUD with a history of multiple

treatments

✓Diagnosed mental health or SUD

requiring continued treatment

• 1. PRISM measures how much you use medical, social service, behavioral health

and long-term care services.

Amerigroup as the FCS TPA

We’re contracted with the HCA as the Third Party Administrator (TPA) of FCS and pr provid ide adm admin inis istr trati tive oversig ight t of:

• f:

➢Provider Network ➢Service Authorization ➢Claims payment and encounter tracking/reporting ➢Measuring outcomes and quality improvement ➢Sustainability Plan

35

Provider Network

A A FCS CS Provid ider r Network rk has has be been n built built acr acros

• ss Washin

ashington state

36

Provider Network

Currently Contracted FCS Providers in Clark County:

• Area Agency on Aging & Disabilities of Southwest WA
• Compass Career Solutions
• Columbia River Mental Health Services
• Community Services Northwest
• Consumer Voices are Born
• Lifeline Connections
• Share
• Washington Vocational Services

Enrollee Count

We ha have enr nroll

• lled over

r 1, 1,40 400 pe peop

• ple

le into FCS CS to to da date

• te. Cl

Clark rk Coun County ty remain ains unde underreprese sented, partic particularly ly in n su suppo pporti tive hou housin ing.

38

Referrals

Anyon

• ne can

an refer r a a pot potentia tial l enr nrolle llee to to the he FCS S pr prog

• gram

➢ Potential Enrollee ➢ Family member ➢ Provider ➢ Aging and Long-term Support Administration (ALTSA) ➢ Division of Behavioral Health & Recover (DBHR) Quick Ref efer erenc nce e Gu Guide de is a tool to quickly eval alua uate e if a poten ential enrollee ee may be eligibl ble e for Supp pportive e Hous using ng and/ d/or

• r Supp

ppor

• rted

ed Employment services. es.

39

Overview of Implementation

40

2017 2018

Program “Soft Launch”

January 2018

Building Provider Network + Automation

Current

Provider Contracting Began

December 2017

Amerigroup Announced as TPA

May 2017

FCS Protocol Approved

November 2017

FCS Websites + Provider Manual

FCS CS Reso sources availa ailable le at your

• ur fi

fing nger tips

➢ Amerigroup FCS Provider Website: https://providers.amerigroup.com/pages/wa- foundational-community-supports.aspx

➢ Provider Manual ➢ Assessment Forms ➢ Quick Reference Guide

➢ FCS Provider Map: https://www.easymapmaker.com/map/FCSProviders ➢ FCS Provider Resource Guide: https://www.hca.wa.gov/assets/program/FCS-provider-resource-

guide.pdf

➢ Amerigroup FCS Client Website: https://www.myamerigroup.com/washington-fcs/home.html

41

Amerigroup FCS Team

42

• Fou

Foundatio tional l Communit ity y Sup upports ts (FCS) ) Director

Torri Canda

• FC

FCS S Man anagers

Jacob Avery Leeza Lorence Joe Elder

• Qual

uality ity Proc

• cess Imp

mprovement t Man anag ager

Chelsea Coblentz

• FC

FCS S Coo

• ordin

inator

Kaila Binger

Amerig igroup Was ashin ington, Inc Inc. Third Party Administrator FCSTPA@Amerigroup.com Phone: 844.451.2828 Fax: 844.470.8859

Contact Us

Next Steps

• Moving to Action – Review action items

from agenda