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Transforming Whatcom Health Care A Case Study July 28, 2011 Larry A. Thompson Executive Director

Transforming Whatcom Health Care A Case Study July 28, 2011 Larry A. Thompson Executive Director Whatcom Alliance for Healthcare Access. WAHA PROGRAMS AND INTIATIVES. Access Counseling Services (insurance and direct to care) Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine

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Transforming Whatcom Health Care A Case Study July 28, 2011 Larry A. Thompson Executive Director

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  1. Transforming Whatcom Health Care A Case Study July 28, 2011 Larry A. Thompson Executive Director Whatcom Alliance for Healthcare Access

  2. WAHA PROGRAMS AND INTIATIVES • Access Counseling Services (insurance and direct to care) • Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine • Whatcom Project Access • Nonpartisan analysis for decision makers …Communities Connect • Convene community leaders, system stakeholders and elected officials Health Insurance & Care Connection Health Policy Education

  3. WHATCOM ALLIANCE FOR HEALTHCARE ACCESS (WAHA) • Whatcom health leadership since 2002 • Access Mission: • Serves about 4% (9,000 people) of the population annually • Stewardship Mission (Policy) • Transforming Whatcom Health Care Project • Long community history of collaboration

  4. WHAT IS THE CASE FOR CHANGE?

  5. Association between Medicare spending and quality ranking -- U.S. States Baicker and Chandra, Health Affairs, web exclusives

  6. Source: International Federation of Health Plans 2010 report (www.ifhp.com)

  7. A COMMUNITY PROCESS Providers (30) Transforming Whatcom Health Care Consumers (6) Business (6) Local Government (4) Insurance (4)

  8. SOME OF THE PARTICIPATING ORGANIZATIONS • PeaceHealth St. Joseph Medical Center • PeaceHealth Medical Group • Northwest Regional Council • Family Care Network • Regence Blue Shield • Group Health Cooperative • Interfaith Community Health Center • Sea Mar Community Health Center • Mount Baker Planned Parenthood • St. Luke’s Foundation • Mt. Baker Imaging • Brigid Collins Family Support Center • Northwest Justice Project • Bellingham-Whatcom Chamber of Commerce and Industry • Whatcom Counseling and Psychiatric Clinic • Whatcom County Medical Society • Whatcom County • City of Bellingham

  9. PROJECT TASK FORCES Project Steering Committee Delivery System Task Force Information Systems Task Force Financial Issues Task Force Consumer Task Force

  10. Improving Improving Each Population Patients’ Experience Health Of Care Reducing Per Capita Costs

  11. GUIDING PRINCIPLES FOR A FUTURE HEALTH SYSTEM • Governance should be community based • Health is a lot more than medical care • Future system must be transparent and accountable • IT should help us do better • Keep administration simple and non-redundant

  12. GUIDING PRINCIPLES FOR A FUTURE HEALTH SYSTEM • Financial incentives should reward quality and efficiency • Providers must be better organized • All need to be served • Integrated, coordinated care is critical • Care delivery will be patient centered

  13. FUTURE WHATCOM HEALTH SYSTEM Patient: All services are centered on the patients’ needs Medical Home (PCMH): The primary care provider team that maintains an ongoing relationship with the patient and assures access to needed care Medical Neighborhood (ACO): A group of providers working as a team with the goal of improving quality and improving value for patients Community Health Environment: The determinants of health such as behavior patterns, social circumstances, environmental exposures, and genetics COMMUNITY HEALTHENVIRONMENT MEDICAL NEIGHBORHOOD (ACO) MEDICAL HOME (PCMH) PATIENT

  14. Whatcom Community Health Association (WCHA) • Plans the health system and aggregates dollars from various sources to support care delivery Accountable Care Organization – Whatcom County • Organizes providers to integrate care around best practice care models. • Accountable to the WCHA for cost and quality ORGANIZATIONAL MODEL OF THE WHATCOM COUNTY HEALTH CARE SYSTEM: TWO LEVELS

  15. Potential organizational composition of ACO-W and its relationship to other parts of the health system

  16. Building Blocks • Certified Patient Centered Medical Homes • 6 Point Community Care Management System • IT Infrastructure: • EMRs • HIE • Patient Portals • Care Coordination System • Analytics • New Health Plan Contracts • Global Budgets

  17. DELIVERY SYSTEM REFORM • Patient-Centered Medical Homes • Improved Care Coordination

  18. ALL PATIENTS SHOULD HAVE A MEDICAL HOME • The medical home is a team of providers who have a whole person orientation • All medical homes meet the NCQA criteria • Patients have access to care when they want/need it • Medical homes provide for self-care and link to community resources • Medical homes demonstrate continuous quality improvement

  19. Mental Health/Behavioral Health Integration • 4 quadrants approach • PMPM and case management fees • Payment in mixed providers sites • Private Sector Therapists

  20. A CARE COORDINATION SYSTEM • One inclusive system, not 20 silos

  21. CARE COORDINATION SYSTEM • Uses clinical data to assess needs • Is built upon Patient-Centered Medical Homes • Includes a case management system for the very ill • Aids transitions between settings • Supports patients and families as they engage in improving their own healthcare • Includes an IT-based care tracking solution

  22. Population Management and Care Coordination Level 3 • Complex comorbidity • Access multiple providers and settings • Case management utilized • Identified through predictive models • PCMH in the loop but not principal care coordinator Level 2 • Identified by predictive modeling • Generally 1 or more chronic conditions • Often transitioning care settings: hospital to home, nursing home to hospital, etc. • May benefit from patient activation • May benefit from disease management protocol • Managed mainly in PCMH but may access community care coordinator 5% of the population Level 3 15% of the Population Level 2 Level 1 • Many patients need logistical assistance from a referral coordinator • Some patients need access to disease management programs • Some patients will choose self-care activities • Some patients will need referral to community resources 80% of the Population Level 1 Adapted from Kaiser Permanente

  23. IT VISION • FUTURE SYSTEM • The same clinical information is available to all doctors and providers across the country. • Aggregate clinical and financial data is available and is used to continuously improve care and increase efficiency. • All patients understand they can access their clinical information and understand the community resources that can empower them to managetheir own health care. • TODAY • Groups of doctors and hospitals keep their own records. • Data is kept by individual organizations and is unavailable for making care improvements • Some patients have access to their clinical information and use it to make health improving decisions.

  24. HEALTH INFORMATION TODAY

  25. HEALTH INFORMATION TOMORROW

  26. KEY EXISITING IT GAPS About 35% of practices lack complying EMRs. Local system lacks interoperability. Patient portal capability spotty. System-level analytic capability non-existent.

  27. HEALTH CARE FINANCIAL REFORM We can’t go on this way! Payment methods drive the delivery of care Change will be gradual, but we must make a start

  28. TODAY’S DOCTOR • I get paid according to the number of services I provide. TOMORROW’S DOCTOR • I get paid according to the health outcomes I produce and the efficiency of my practice.

  29. MEDICARE SPENDING FOR BENEFICIARIES WITH FIVE OR MORE CHRONIC CONDITIONS Robert Wood Johnson Foundation, The Synthesis Project

  30. GENERAL TIMELINE FOR CREATING AN ACCOUNTABLE CARE COMMUNITY 12/2010 7/2011 7/2011 – 6/2012 Phase I Initiate Stakeholder Build initial PCMH, Feasibility “Go/No Go” Care Coordination, & Assessments decision IT capabilities 7/2012 7/2012-6/2014 7/2014 Initial Small Continue Demo Project Pilot('s) building (10,000+ launches infrastructure enrollees)

  31. Building Blocks • Patient Centered Medical Home Collaborative • Care Coordination System Build • Data Warehousing Software • MS/SU care delivery and financial integration

  32. Candidate Populations for Early • (mid 2012) Limited Pilot Projects • Dual Eligibles (Medicare/Medicaid) • PeaceHealth Self Insured’s • Individual Insurance Coverage

  33. SUMMARY • Among the area’s health care leadership, the following beliefs are prevalent: • The current health care system is not sustainable. • This community has learned a great deal in the past 25 years and is now poised to move forward more aggressively. • The highest probability of creating a sustainable system is to build it from the ground up here locally. 36

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