Accountable Communities of Health: What are They and What Are Our Options? September 26, 2014 Barry Kling, MSPH Administrator, Chelan-Douglas Health District. In This Presentation I Will:. Summarize HCA’s statements on what an Accountable Community of Health (ACH) is.
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Accountable Communities of Health:What are They andWhat Are Our Options?September 26, 2014Barry Kling, MSPHAdministrator,Chelan-Douglas Health District
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.
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.
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.
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.
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.
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.
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.
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.
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
Whatcom Alliance for Health Advancement
Thanks to Larry Thompson, Executive Director Whatcom Alliance for Health Advancement, for this information.
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.
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%
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.
Thanks to Alison Carl White, Executive Director, Better Health Together, for this information.
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
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”
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
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.
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:
Determinants of Health
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.
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.
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.
Mental Health Integration
Diabetes care coordination
High utilizer care coordination
Obesity in children
Health in All Policies
ACEs or trauma-informed initiatives
Community Health Workers
Community health assessments & plans
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
Become a Healthy Community Collaborative?
To ACH or not to ACH?
This discussion will shape a draft plan we’ll consider in Session Three.
Thanks for listening.Contact Information:Barry Kling, AdministratorChelan-Douglas Health District200 Valley Mall ParkwayEast Wenatchee, WA firstname.lastname@example.org