a five-year plan for washington state inland northwest state of reform health policy conference...

A Five-Year Plan for Washington StateInland Northwest State of Reform Health Policy Conference

September 12, 2013

Nathan Johnson, HCA Division Director,

Health Care Policy

State State Health Health Care Care InnovatioInnovation n PlanningPlanning

Agenda

State Health Care Innovation State Health Care Innovation PlanningPlanning

How did we get here?

What have we learned?

Where are we going?

Q&A / Discussion

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*30% of expenditures attributed to wasteful spending, poor care delivery, excessive administrative costs, unnecessarily high prices and fraud

In Washington State, personal health care expenditures have grown from $3.8 billion in 1980 (7.3% GDP) to $45.4 billion in 2009 (13.6% GDP)

Nationally*, personal health care expenditures have grown from $217.1 billion (8.0%) to $2.1 trillion in 2009 (15.1% GDP)

HOW DID WE GET HERE?

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The Affordable Care ActWashington State Implementation Timeline



Why Washington Needs an Innovation Plan

With full implementation of ACA, 85% of Washington’s uninsured adults will have access to affordable coverage(N = approx. 727,000)

Assuring quality care that is affordable requires fundamental change in how health care is delivered

Extending access without such changes will not be financially sustainable

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The State Innovation Models initiative is a national effort and grant program of the Center for Medicare and Medicaid Innovation (CMMI) to identify and spread health practices that result in better health and better care at lower costs.

What are “SIM” and “SHCIP”?

SIM

SHCIP


Washington State was one of three states awarded a nearly $1 million model pre-testing grant to fund collaborative development of a five-year plan for health innovation. Other states have received “model design” grants, and are engaged in similar work. The effort is called: State Health Care Innovation Planning

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What SHCIP is…

An opportunity, with federal support, to refresh, and align key Washington strategies to improve health and healthcare delivery for our people and communities.

Positions us to apply for a Testing Grant, and potentially, $20-$60 million to support implementation of our multi-payer delivery system and payment reform model

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Test innovative payment and service delivery models with the potential to lower costs for Medicare, Medicaid and CHIP, while:

•Maintaining or improving quality of care

•Raising community health status

•Reducing long term health risks for federal beneficiaries

All of the above, for the rest of Washington State’s population.

•Refresh our approaches for health and health care improvement through evidence-driven approaches, innovation, collaboration and full use of the “levers” at our disposal.

SHCIP Objectives

CMMIFederal

Washington State

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Center for Medicare & Medicaid

Innovation

Project Oversight


Cabinet Level Representatives of:

Dept. of CommerceDept. of HealthDept. of Social & Health

ServicesGovernor’s Office of Health

Policy Health Care AuthorityHealth Information

ExchangeLabor & IndustriesOffice of Financial

ManagementOffice of the Insurance

CommissionerState Board of Community

& Technical Colleges

Multiple state agencies involved in project oversight


Karen MerrikinSHCIP Project Director

Hired from the private sector to lead the state planning process

Long-time veteran of health policy around payment and care delivery

Consultant Team

Coordinating the Work

Bree Collaborative Manatt Health Solutions Mercer Consulting

Consulting Partners Cedar River Group

Puget Sound Health Alliance Strategies 360 University of Washington Washington Park Consulting

CMMI MacColl Institute

State Health Care Innovation 5-Year Plan Five PhasesMajor Deliverable to CMMI


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Discovery Intensive & broad work on “As-Is” and “To Be”

Analysis Review of findings & identification of key components

Assessment & Feedback Assess identified components & gather feedback

Draft Draft plan complete by September 30

Plan Refinement & Finalization Refinement complete October – Mid-November

WHAT HAVE WE LEARNED?

“As-Is” environment In general, information gathered from various

“streams” of inquiry indicates there is support for improving Washington’s health system—thoughts vary on how

“To be” environment – the potential future

The process has and continues to help identify: Key focus areas and strategies for

transformation The “levers” to move transformation forward

(activities, tools, policies, legislative adjustments)

Performance measures needed to assess the value of the reforms


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All people in Washington achieve and maintain better health*

WHERE ARE WE GOING?

Draft Vision

Draft Broad Aim

By 2019, the people of Washington state will be healthier because our state has collectively shifted from a costly, disconnected non-system for health care to aligned health approaches focused on achievable targets for better care, lower costs, prevention and reduction of disparities.*

*Under review; not finalized


State Health Care Innovation Plan Draft Preliminary Outline

11-page document, but direction is changing by the day, as feedback is provided. Available at: http://www.hca.wa.gov/shcip/Documents/outline.pdf

Outlines specific components, following guidelines of the CMMI grant

Rough draft of the plan due to CMMI September 30

Available for review. Email your thoughts on the outline to: [email protected]

Transformational, focused strategies and tactics

Sharp financial analysis and evaluation plan

Clearly defined infrastructure needs

Commitment sought among key influencers

Strategic multi-year legislative and regulatory strategies

Project Priorities


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1. Promote well-being and eliminate systemic barriers to health and recovery for individuals at risk for or experiencing mental health and substance abuse challenges


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2. Multipayer, purchaser and provider transformation Payment approaches supporting

coordinated care Evidence-based care reducing

unwarranted variation Consumer engagement Infrastructure Strengthen purchaser alignment

and influence

Focus narrowed to drive the work

Two Streams of Focus for Transformation

1. Physical & Behavioral Health Aims

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Bi-directional seamlessness/integration of physical and behavioral health care and social supports for individuals with co-morbidities

Enhanced early disease prevention and mitigation throughout the lifespan – toward accountable communities of health.

The material on this page is considered DRAFT and is available for review and comment by key stakeholders.

2. Multipayer Aims

Three draft key objectives for health care delivery system transformation in Washington State:

Effective prevention and screening to improve health and avoid chronic disease and major acute conditions;

Effective chronic disease management, particularly for complex patients; and

Preferred use of lowest cost, highest quality care for acute conditions.

One common measure set needed for each objective to align efforts and evaluate progress on a statewide basis.

18The material on this page is considered DRAFT and is available for review and comment by key stakeholders.

19The material on this page is considered DRAFT and is available for review and comment by key stakeholders.

2. Multipayer AimsFour-part strategy is recommended to help achieve each of the three objectives.

1. Redesign healthcare delivery to reduce cost, improve quality and improve patient experience

2. Restructure healthcare payment systems to support and reward providers who deliver high-value care

3. Restructure healthcare benefit design to enable and encourage patients to improve their health and use high-value healthcare services

4. Educate and encourage state residents to improve their health and use high-value healthcare services

Important “headlines” include: Phase out fee-for-service payment; Give consumers clear financial incentives (through benefit

design)


ROW ROW TOGETHERTOGETHER

for a healthier for a healthier WashingtonWashington

A State Plan will help us…

Working together, providers, consumers, health plans, employers, state agencies, and other partners can transform health care to a system that better serves everyone.

Toward a Healthier Washington


Focused strategies & tactics are in analysis phase—nothing finalized

Outline of the draft plan is complete and being circulated for comment. Located at: http://www.hca.wa.gov/shcip/Pages/resources_and_documents.aspx

Sign up for the Feedback Network to receive updates: [email protected]

Register for October 15 webinar, 11 am – 12:30 pm https://

www2.gotomeeting.com/register/680518578

Next Steps

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Q & A / Discussion


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