In This Presentation I Will:

1. Accountable Communities of Health:What are They andWhat Are Our Options?September 26, 2014Barry Kling, MSPHAdministrator,Chelan-Douglas Health District

2. In This Presentation I Will: Summarize HCA’s statements on what an Accountable Community of Health (ACH) is. Review the plans of 4 other communities who are working to develop an ACH in their areas. Discuss our ACH and non-ACH options.

3. ACHs as described in SHCIP Washington will designate no more than nine regional service areas…within naturally occurring communities of health. These regional service areas will drive accountability for health by defining the structure for health and community linkages, be a foundational component of a State “Health in All Policies” approach, and serve as new Medicaid service areas for physical and behavioral health. This approach recognizes health care is local and aims to empower local and county entities to develop bottom-up approaches to transformation that apply to community priorities and environments, guided and supported by stategoals and supporting resources.

4. ACHs in the SHCIP, continued ACH is a regionally governed, public-private collaborativethat supports mutually aligned actions across sectors and systems. ACH participants are envisioned to include public health, health, housing, and social service providers; risk-bearing entities; county and local government; education; philanthropy partners; consumers; Tribes; and other critical actors within a region. Organizational and governance structures will not be dictated at the State level...however, no single entity or sector may dominate.

5. ACHs in the SHCIP, continued ACHs are not intended to: Be a one-size-fits-all approach. Add “approval” layers or act as a regulatory body. Supplant government entities, such as local public health jurisdictions. Divert state general funds otherwise going to local entities.

6. ACHs in the SHCIP, continued ACH Responsibilities: Partner in Medicaid purchasing Develop a region-wide health assessment and a regional health improvement plan. Drive accountability for results through voluntary compacts. Act as a forum for harmonizing payment models, performance measures, and investments. Health coordination and workforce development.

7. ACHs in the SHCIP, continued State Responsibilities to ACHs: Funding and technical support. “Health in All Policies” across multiple state agencies, align state agency activity across regions. Engage ACHs in Medicaid procurement design, assessment, and meaningful oversight. Health Mapping Partnership designed with local leaders; data and tools needed to support community hot-spotting efforts and cross-sector policy decisions.

8. ACHs in the SHCIP, continued State Responsibilities to ACHs: “Best in class” transformation support tools through a combination of regional and statewide resources and learning. Explore new financing tools and seed funding for cross-sector innovation in partnership with regional partners. Check and adjust as experience is gained.

9. ACHs in the SIM Grant Washington will invest in Accountable Communities of Health (ACHs) that will develop a sustainable presence in their communities and partner with the state to achieve the project’s goals. ACHs will provide the organizational capacity for local communities to implement the plan for population health, link community supports with practice transformation, and enhance local data collection and analytic aptitude. To ensure return on this investment, ACHs will be held accountable for performance results and rapid-cycle learning and improvement.

10. ACH timeline in the SIM Grant

11. Seven-Region Straw Man (SHCIP)

12. ACH Planning in SIM Grant

13. Next: Four ACH Initiatives North Sound Accountable Community of Health – Whatcom, Skagit, Snohomish, San Juan and Island Counties King County Region ACH Better Health Together – Spokane, Pend Oreille, Stevens, Ferry, Lincoln, Adams and Whitman Counties Southwest Washington Regional Health Alliance – Clark, Skamania and Klickitat Counties

14. North Sound ACH Whatcom Alliance for Health Advancement Thanks to Larry Thompson, Executive Director Whatcom Alliance for Health Advancement, for this information.

15. North Sound ACH Regional Challenges: Building trust and confidence across region. What’s an ACH and what can it do for me? Managing the scale and logistics. ACH Planning Outcomes Work together across sectors Regional plan with manageable number of actionable priorities Deep and wide community engagement.

16. North Sound ACH Early Initiatives: Care Transitions: Improve transitions from hospital to community to reduce readmissions. 2400 pts served over 2 years 38% reduction in readmits among pts served Intensive Case Management for Hot Spotter Population: Improve health, reduce expenses for 500 most expensive pts. 7 months experience as of September 2014 ER visits down 68% Hospital admissions down 88% Incarcerations down 83%

17. King County Region ACH How might ACH advance things we’re already working on in King County region, such as . . . Adults with complex behavioral & health conditions making frequent use of King County jail Communities of Opportunity - a place-based initiative to improve health, social, racial, and economic factors Physical/behavioral health integration Care transitions efforts Expanding housing and health partnerships, with a focus on community health worker partnerships and on increasing supportive housing Community health assessment activities - King County Hospitals for a Healthier Community, Community Health Indicators, Communities Count Thanks to Janna Wilson, Public Health – Seattle & King County, for this information.

19. King County ACH, continued

20. Results, King County Childhood Obesity Initiative

21. Better Health Together – Spokane Area Thanks to Alison Carl White, Executive Director, Better Health Together, for this information.

22. What IS an Accountable of Community Health? A diverse public private collaboration that aligns voluntary action to meet local needs A way to attract and leverage new resources for the local region A synthesizer of data to prioritize local action A practical “Connector” of multi-sector partners to the State for feedback on implementation decisions to ensure local level alignment

23. Key Goals of Planning Grant Conduct 7 county engagement activities to identify strengths, lessons learned and emerging best practices Develop strategic plan, governance structure and agree on a regional scorecard Create a “Community Health Plan”

24. Our Approach Leadership Council helped us identify the right stakeholders and leaders Conducting Key Community Interviews and Focus Groups across 7 counties Gathering of 125 regional health and community leaders to build our Collective Agenda for Health Leadership Council synthesizes findings and recommends priority strategies and activities for ACH plan Determine viability of pilot application

25. Our Structure

26. 2 years from now we will: • Improved 2 health outcomes across our community • Created 3 system improvements that allow better care for our community • Saved dollars and reinvested it in health prevention and system improvements

27. SW Washington Regional Health Alliance Clark, Skamania and Klickitat Counties Developing a model for complete integration, which includes using community health workers as a community based prevention strategy. Will pilot the model with a population of high utilizers with comorbidities in mental health, substance use disorder and chronic physical conditions, such as diabetes and chronic respiratory disease.  Comprehensive regional community health needs assessment as well as a plan to map out services, gaps and community assets. Thanks to Alan Melnick, Director and Health Officer, Clark County Public Health, for this information.

28. SWWA Regional Health Alliance Strategic Goals We will fulfill our mission by serving as the ACH for the SWWA region. In this role, the RHA hopes to accomplish the following specific goals: • Improve the health of our population • Establishment of population health outcomes based metrics and achieve 100% compliance by 2020 • Improve the experience of care for our population • Establishment of access metric and achieve 100% compliance by 2020 • Reduce the per capita costs of care for our population • Establishment of PMPM and achieve 100% compliance by 2020

29. RHA System Role

30. RHA Work Groups Triple Aim --- Address Social Determinants of Health

31. Governance • ACH Pilot • Integration model • Quality and access measures • RHA alignment and role clarification for Early Adopter and Medicaid Integration • Infrastructure to monitor performance; incentive structures • Infrastructure to achieve RHA mission; e.g. staff, board, contracting, etc. • Needs assessment & system map • ACH pilot • Evaluation model • Integrated HIE/analytics platform • Identification of ACH pilot target population • IT/IS gap analysis • Data sharing, health information exchange, performance analysis platforms • Performance incentive model • Reinvestment of cost savings in services • Communication/ alignment w/ State • Legislative drafts if needed • RHA strategies in alignment w/ State • Legislative outreach strategy • Community/consumer engagement platform • Stakeholder communication and outreach strategies • Performance incentive model • Community/consumer engagement model • Sustainability strategy • Incentive alignment w/ State alternative pmt. • Legislation for RHA mission if applicable • Performance incentive model aligned w/ State alternate payment system RHA Roadmap: By Work Group Plan (2014-2015) Develop/Test (2015-2016) Implement/Evaluate (2016-2020) • Communications & Outreach • Clinical • Finance • Technology, Analytics & Reporting • Policy

32. SWWA RHA Board of Directors: • President-Jon Hersen- Vice President Legacy Health System Healthcare Transformation • Vice President- Jared Sanford – Executive Director for Lifeline Connections • Secretary-Vanessa Gaston, Director Clark County Community Services • Treasurer- Cindy Robertson – Administrator for NorthShore Medical Group • Kevin Barry- Director Klickitat County Public Health • Kirby Richards– Director Skamania County Community Health • Di Lacey – Director for Strategy, Innovation & Development PeaceHealth • Kevin Witte- Associate Vice President, Corporate & Continuing Education-Clark College • Ma'ataLatu- Director of Provider Relationsfor Coordinated Care Corporation • Alan Melnick-Public Health Officer and Director for Clark County Public Health • David Kelly – Executive Director SWWA Area Agency on Aging & Disability • Karen Lee – CEO for Columbia United Providers • Dian Cooper – CEO for Cowlitz Family Health Center • Steve Kutz- Deputy Director Cowlitz Tribe Health & Human Services • Sharon Crowell, MD – Board Chair, The Vancouver Clinic • Brad Berry – Executive Director for Consumer Voices Are Born • Erin Hafer – Manager for New Program Integration, Community Health Plan of WA • Laurel Lee – Chief Operating Officer for Molina Healthcare of WA • Andy Silver – Executive Director for Council for the Homeless • Frederico Cruz-Uribe – VP of Clinical Affairs, SeaMar • Duane Rogers - North Service Area Director for Kaiser Permanente • Rick Weavers – CEO, Comprehensive Mental Health/Representative from Greater Columbia RSN • Connie Mom-Chhing – CEO, SWBH RSN

33. Observations on these ACH efforts: They are further along in the sense that they’ve decided they definitely want to become HCA-designated ACHs. Their populations are larger than ours. Some have developed boards, governance plans and workgroups. Some have already implemented successful health improvement initiatives. But they’re still dealing with many of the same start-up issues we have. Risk-bearing not in the plans.

34. Some ACH Options Eventually, we’ll be part of an ACH. We could attempt to create a North Central Washington ACH. But we would probably need other NCW counties to have sufficient population for HCA. We could propose this to the other NCW counties. Would have to decide whether to try to be one of the first two ACH early adopter regions. We could try to join with another ACH effort such as Spokane’s. Or we could let the ACH situation develop and see where we end up.

35. But an ACH is not the only issue. Whatever we or HCA do about ACH coverage for this area, we have a valuable collaboration here. Aside from the ACH issue, we could decide to move forward together on important health care and population health improvements. We could attract additional funding when possible, but begin with existing resources. If funding does become available from ACA savings, we’d be well positioned to use it – whatever our ACH status.

36. Initiatives by health collaboratives: Mental Health Integration Diabetes care coordination High utilizer care coordination Obesity in children Health in All Policies Housing initiatives ACEs or trauma-informed initiatives Community Health Workers Community health assessments & plans …and others.

37. What if… We became a Healthy Community Collaborative. We acted as a coordinating body for a set of Workgroups, each of which took responsibility for a health initiative. Each Workgroup would have staff assigned to it by participating organizations. For example, public health and/or ESD would assign a professional staff member to support the Childhood Obesity Workgroup. Not to run it, to support it. To make sure it was well organized and used best practices. Each Workgroup would have actionable goals and measures. We can do this with or without an NCW ACH

38. So…2 questions for our round table discussions: Become a Healthy Community Collaborative? To ACH or not to ACH? This discussion will shape a draft plan we’ll consider in Session Three.

39. Thanks for listening.Contact Information:Barry Kling, AdministratorChelan-Douglas Health District200 Valley Mall ParkwayEast Wenatchee, WA 98802509-886-6480barry.kling@cdhd.wa.gov