working together for a healthier...
TRANSCRIPT
Better Health, Better Care, Lower Costs
Working Together for a Healthier Washington
Dorothy Teeter, HCA Director
Nathan Johnson, HCA Chief Policy Officer
All Alliance Meeting
June 9, 2015
By 2019, we will have a Healthier
Washington. Here’s how.
Better Health, Better Care, Lower Costs
Improve how we
pay for services
• Measure, improve and
report common
statewide performance
measures.
• As purchaser for Apple
Health and state
employees, drive
market toward value-
based models.
Ensure health
care focuses on
the whole person
• Integrate physical and
behavioral health care
in regions as early as
2016, with statewide
integration by 2020.
• Spread and sustain
effective clinical models
of integration.
• Make clinical and claims
data available to
securely share patient
health information.
Build healthier
communities
through a
collaborative
regional approach
• Fund and support
Accountable
Communities of Health.
• Use data to drive
community decisions
and identify community
health disparities.
Implementation tools:
State Innovation Models grant, state funding, potential 1115 Medicaid waiver, philanthropic support
Legislative support: HB 2572, SB 6312
The plan for a Healthier Washington
Strategy 1: Build healthier
communities through a
collaborative regional approach
Better Health, Better Care, Lower Costs
Accountable Communities of Health
“Regionally governed, public-private collaborative
tailored by region to align actions and initiatives
of a diverse coalition of players in order to
achieve healthy communities and populations.”
—State Health Care Innovation Plan
Better Health, Better Care, Lower Costs
No single sector can do it alone
• No single sector or organization in a
community can create transformative, lasting
change in health and health care alone
• Accountable Communities of Health (ACHs) will:
• Facilitate collaborative decision-making across
multiple sectors and systems
• Engage in state-community partnership to
achieve transformative results
Better Health, Better Care, Lower Costs
ACH boundaries and pilot ACHs
Pilots: Cascade Pacific: • Backbone Support –
CHOICE Regional Health Network
North Sound ACH: • Backbone Support –
Whatcom Alliance for Health Advancement
Aligning sectors, resources, and strategies around community and state priorities
Better Health, Better Care, Lower Costs
Partner in Purchasing
8
Payers and Delivery Systems within the Region
• Apple Health MCOs / BHOs
• PEB plans • NEW PEB ACP • Delivery Systems
and Providers
Value-Based Purchasing
Resources
Criteria & Designation
Shared Data
State Government
Shared Data
ACH
Hospital
Business
Education
Tribes
Public Health
Local Government
Food Systems
Philanthropy
Consumers
Social Services
Community & Faith-Based
Organizations
Transportation
Housing
Health Care Providers
Mutually
Reinforcing Membership
Health Plans
Better Health, Better Care, Lower Costs
ACH Timeline and Milestones
Pilot and Design Regions Selected
Q1 2015
• ACH staff hired
• Technical Assistance RFP and Selection
• Statewide ACH Leadership Convening
Q2 2015
• ACH Evaluation led by GHRI Begins
• ACH Designation Opportunities Leading to Statewide Designation
Q3-Q4 2015
ACHs are designated and continually evolving
2016 – 2018
Strategy 2: Ensure health care
focuses on the whole person
Better Health, Better Care, Lower Costs
Integrating Physical and Behavioral
Health
“Governor Jay Inslee has articulated a vision of full
integration of mental health, chemical
dependency and physical health care to improve
health, advance care quality and control costs.”
—Office of the Governor, November 2013
statement, A New Approach to Behavioral Health
Purchasing
Better Health, Better Care, Lower Costs
• Senate Bill 6312 integrates physical health,
mental health, and chemical dependency in a
managed care health system for Medicaid
clients by 2020.
• Regional Service Areas (RSAs) establish a
common regional purchasing approach.
• Shared savings incentives (payments targeted
at 10 percent of savings realized by state) in
Early Adopter regions begin in April 2016.
Integrating Physical and Behavioral
Health
Better Health, Better Care, Lower Costs
Regional Service Areas
A common regional purchasing approach:
• Recognizes that health and health care are local.
• Promotes shared accountability within each region
for the health and well-being of its residents.
• Empowers local and county entities to develop
bottom-up approaches to transformation that apply
to community priorities
• Aligned with Accountable Communities of Health
Better Health, Better Care, Lower Costs
Regional Service Areas
Better Health, Better Care, Lower Costs
Medicaid integration pathway
2020: Fully Integrated Managed
Care System Across the State
Behavioral Health
Organizations
Apple Health Managed Care
Plans 2016
Transition Period
Regional
Service Areas (RSAs)
Integrated Purchasing in “Early Adopter” RSAs, with shared savings incentives
2014 Legislative Action: 2SSB 6312 By January 1, 2020, the community behavioral health program must be fully integrated in a managed care health system that provides mental health services, chemical dependency services, and medical care services to Medicaid clients
Strategy 3: Improve how we pay
for services
Better Health, Better Care, Lower Costs
Four payment redesign models
• Model Test 1: Early Adopter of Medicaid Integration
Test how integrated Medicaid financing for physical and behavioral health
accelerates delivery of whole-person care
• Model Test 2: Encounter-based to Value-based
Test value-based payments in Medicaid for federally qualified health centers
and rural health clinics; pursue new flexibility in delivery and financial
incentives for participating Critical Access Hospitals
• Model Test 3: Puget Sound PEB and Multi-Purchaser
Through existing PEB partners and volunteering purchasers, test new
accountable network, benefit design, and payment approaches
• Model Test 4: Greater Washington Multi-Payer
Test integrated data platform capacity to allow providers to coordinate,
share risk and engage a sizeable population across multiple payers
Better Health, Better Care, Lower Costs
• Medicaid Regional Service Area designation in November 2014
• Counties requested early adopter transition to fully integrated managed care purchasing for medical, mental health and substance use disorder services
• Southwest WA (Clark, Skamania) formally committed to becoming Early Adopter region April 2016; Klickitat will transition by 2020
• North Central region considering options – decision to be made by Jun 15 • Broad collaboration on early adopter model design – fully integrated
managed care and regional crisis system
• Letters of interest to Early Adopter RFP in SW WA received from all Medicaid MCOs
• RFI on Behavioral Health Administrative Services Organization interest in managing crisis system in SW WA
• Common core performance measures selected for early adopter contracts
Payment Redesign
Model 1: Early Adopter
18
Payment Redesign - Model 1: Early Adopter
19 Contracts start 4-1-16
Fully Integrated Managed Care Contracts 2015 Dates
Medicaid contract reviewed by stakeholders (~1,000 comments) May 27
Non-Medicaid contract released for stakeholder comment Jun 4
MCOs RFP distributed Aug 6
MCO RFP responses due Sep 25
Successful MCO bidders announced Nov 2015
Crisis and Other Services Contract
Administrative Services Organization contract released for stakeholder comments
Aug 7
RFP distributed Sep 18
RFP responses due Nov 4
Successful bidders announced Nov 2015
Better Health, Better Care, Lower Costs
Payment Redesign
Model 2: Encounter to Value Overview
Federally Qualified Health Centers (FQHC) and
Rural Health Clinics (RHC)
• Scope:
– Develop alternative payment methodology (APM) that encourages the
use of team-based care models and moves from volume-based
reimbursement model to one tied to achievement of improved
outcomes.
– Payments will be predictable and comply with federal standards.
• Status:
– Building capacity and contracting for modeling expertise, assessing
clinic participation criteria and partnering with clinic systems in
discovery, design and development.
– Gathering and analyzing the landscape of current approaches and
application of APM in other states: CA, MD, MN and OR.
Better Health, Better Care, Lower Costs
Payment Redesign
Model 2: Encounter to Value cont.
Critical Access Hospitals (CAH)
• Scope:
– Payment approaches for CAHs that help meet changing community
needs and ensure sustainability
– Aligned to degree possible with RHCs due to strong affiliation with CAHs
– Looking at other state models and pilots as a framework for a new
delivery model
• Status:
– Working with the Washington Rural Health Access Preservation (WRHAP)
Initiative coordinated by the Washington State Hospital Association and
the Washington State Department of Health
– Have identified 11 - 14 CAHs for potential demonstration
– Have begun to outline potential models
Better Health, Better Care, Lower Costs 22
RFI
• Assessed WA market value-based readiness & capacity
• 13 Providers • 15 Health Plans • Everyone on the
value-based road. Some further along
WHA Tools & Support
- Purchaser Affinity Group ACO Checklist
- Community Checkup
- Alliance support for Innovation Grant
RFA
- Public Request for clinically integrated networks accountable for costs, quality, member experience - 6 submissions
ACP
2 Networks selected: • UW • PSHVN - Available to PEBB
members in Puget Sound region starting 1/1/16
Payment Redesign
Model 3: Accountable Care Program
“Without a strong, purchaser-driven countervailing force, value-based payment reform often reverts to a ‘least common denominator,’ low-risk model.” - WHA, blog
Better Health, Better Care, Lower Costs
Payment Redesign
Model 3: Accountable Care Program
• Best in class design
• High-quality and timely services at a lower cost
• Integrated physical, mental, and substance abuse
• Financial and clinical accountability for a defined population
• Competitive bidding process and negotiations resulted in two
ACP vendors
• University of Washington Accountable Care Network
• Puget Sound High Value Network LLC
• Initially offered in five counties (Snohomish, King,
Kitsap, Pierce and Thurston)
• Plan to expand purchaser participation in accountable care
networks, starting in 2017, using WHA Purchaser Affinity Group
ACO Checklist
Better Health, Better Care, Lower Costs
ACP Value Based Reimbursement
PEBB ACP
None of this can happen without
some key foundational elements
Better Health, Better Care, Lower Costs
Support providers across the state to effectively
coordinate care, increase capacity, and adapt to
value-based reimbursement strategies.
• Help providers with integration of physical and
behavioral health.
• Help providers move from volume to value-based
care.
• Help build broader community clinical linkages in
service of the whole person.
Practice Transformation Support Hub
Better Health, Better Care, Lower Costs
Measurement and transparency
• Measures must be transparent for consumers,
providers, and purchasers to ensure improved
quality and informed decision making
• HCA will leverage measures to provide
transparency to statewide reporting on cost and
quality performance.
Better Health, Better Care, Lower Costs
Learning and evaluation
• Continuous rapid-cycle
evaluation to learn,
adjust, and improve in
real time.
• Evaluation led by the
University of Washington.
Check
Act
Plan
Do
Join the Healthier
Washington
Feedback
Network:
Learn more:
www.hca.wa.gov/hw
The project described was 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.