Cascade Pacific Action Alliance

Maternal/Child Health Workgroup

October 25, 2017

Welcome & Introductions

Introduce yourself: Name, county, organization

Agenda for Today

Overall Plan

Discuss Draft Application & Address Gaps

Discuss Workplan & Address Gaps

Next Steps

Section I (ACH) Project Update

Finance Committee has been meeting and made recommendations to the Council and Board about funding allocations

Last week Council and Board met- decided to move forward on 6 projects and approved funding flows.

Section II (Project Specific Workgroup Activities)

August/September

• Identified target populations

• Discussed engaged providers via RFQ and high-volume Medicaid providers

• Identified Domain 1 assets and challenges (for Section I)

• Developing proposals- HMA and CPAA

October:

• Reviewing Draft Applications and Addressing Gaps

• Reviewing Draft Workplans and Addressing Gaps

• Refining proposals

November: Review project proposals

Draft Project Application: Gaps to be Addressed

How this project will support sustainable health system transformation for the target population

How ACH will ensure each project coordinates with and doesn’t duplicate existing efforts

Identifying the anticipated target population (specific numbers, which CPAA will develop)

Assets and challenges

Gaps to be Addressed: Lasting Impacts for Medicaid Beyond the Target Population

Increasing the capacity of providers to provide better sexual and reproductive health services is more easily sustainable as contraceptive care and sexual health screenings are already Medicaid-covered benefits.

We will work with the state and MCOs on how sexual and reproductive health care can be included in value-based payment contracts between a MCO and a provider.

We will also need to explore what types of providers patients are going to receive sexual and reproductive health care. If those patients seek these services from providers other than PCPs, we need to determine how easily those providers can enter into VBP contracts.

Because we will need to be creative in how we expand provider establishment and capacity, especially in rural areas, we will need to be creative in determining how these providers can be paid. Telehealth services, in particular, will present challenges related to PCP assignment and attribution of risk that we will need to try and overcome in 2018 or 2019 to be successful in investing in that type of capacity-building.

Gaps to be Addressed: How ACH will ensure each project coordinates with and doesn’t duplicate

An environmental scan to gather the existing MCH home visiting programs in all seven counties and barriers/challenges to expanding. In that scan, we also gathered information on referral pathways into home visiting programs to understand how clients get access to certain programs. This will help us determine improvement strategies for referrals.

What did the scan say?

Existing RMCH Projects from the RFQOrg Target Pop. Project Description

Arcora People at high risk for oral

disease, maternal/child health,

chronic disease (estimated #)

Integrate aspects of oral health into most MTD

projects where appropriate

Child &

Adolescent

Clinic

Children birth to 20 (estimated #) Add Behavioral Health Specialist to integrated

care team and continue collaboration with other

community partners

Child Care

Action Council

Pregnant mothers not eligible

for NFP, with risk factors

Expand existing home visiting services for

Parents As Teachers model

Nisqually

Tribal Health

Department

PMG clinical population

w/chronic disease

Improve overall health management and patient

engagement with care coordination. Specific

interest in partnering to improve Maternal Child

Health.

Providence

Medical Group

PMG clinical population

w/chronic disease

Improve overall health management and patient

engagement with care coordination. Specific

interest in partnering to improve Maternal Child

Health.

Existing Projects from the RFQOrganization Target Population Project Description

Sea Mar

Community

Health Centers

Sea Mar patients Provide integrated care and implement the Pathways care

coordination model

Health &

Social

Services in

Thurston,

Lewis and

Mason

First time mothers Expand available slots for NFP across three counties

Youth and

Family LINK

Mothers w/SUD,

other Maternal

Child Health

Referral hotline, Community Health Workers providing care

coordination, linkage with multiple care providers

Thurston

County Health

and Social

Services

South and NW areas

of county (estimated

#)

Expand geographic reach and hours of operation for SEP (need

to be clear about what is happening here- expanding primary

care and treating those engaged)?

Assets and Challenges

What are the assets the region brings to the project?

What are the challenges?

How do we address those challenges?

Assets

PTCPI Grant: child & adolescent clinic. Grant $

Some of the community colleges provider health care profession training

Surveys: BRFFS and Healthy Youth surveys

Depression screens

WAIIS – immunization registry. Child Profile.

OTHER ASSETS?

•

•

•

Challenges & Mitigation StrategiesChallenge Mitigation Strategy

Assuring metrics for well-child visits are

included in contracts

Training practices on revenue cycle

changes

Shortages of certain professions -

especially in rural areas

Incentives such a loan forgiveness or conditional scholarship

Family planning training, including LARC

Need more patient registriesStandardize EHRs

Nurse family partnerships and Home

Visiting data are not readily available.

Workplan Review

Visually Displaying the Work

Application must include logic model that depicts the work and tells our story

Medicaid Demonstration is only Part of the CPAA Work

Medicaid Demo Project

All Other CPAAProjects

Maternal and Child Health & Reproductive Health 10 Recommendations to Improve

Women’s HealthHome Visiting Program

Bright Futures

Bi-Directional Integration of Care & Primary Care Transformation

Collaborative Care Model

Medicaid Projects & Strategies

Chronic Disease Prevention and Control Chronic Care Model

Addressing the Opioid Use Public Health Crisis

Prevention, Treatment, Overdose Prevention, Recovery

Transitional CareINTERACT 4.0

Transitional Care ModelThe Care Transitions Intervention

Community Based Care CoordinationPathways Community HUB

Target Pop (Medicaid Clts) Project Outcomes

↓ util. (ED, I/P, readmits)

↑ opioid care (hi-dosetherapy, MAT)

↑ BH care & follow-up (post ED, post I/P)

↓ homelessness

↑ access – pediatric care/screenings

↑ chronic disease screenings

(diabetes, depression, asthma)

↑ maternal & reproductive screenings and care

↑ diabetic care (eyes, HbA1C, nephropathy)

CPAA Medicaid Demo Project Logic Model - Option 1

Having or at-risk for behavioral health conditions

In transition from intensive settings of care or institutional settings

Having or at risk for, arthritis, cancer, chronic respiratory disease, diabetes, heart disease, obesity and stroke

Women of reproductive age, pregnant women, mothers

Youth and adults who use, misuse, or abuse, prescription opioids and/or heroin

One or more chronic disease or condition and at least one risk factor

↑ MH or SUD screenings

↑ Rx management (anti-depressant, asthma, statin)

Next Steps

Next Meeting: November 29th, 2017

• Mother Joseph Conference Room, Providence Centralia

• 914 S. Scheuber Rd, Centralia, WA 98531

HMA and CPAA Staff working on Project Drafts

Posted in November for Review/Comment

Final Project Application to Council & Board for approval