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Advancing Health through Accountable Communities: A Conversation with States

Thursday, July 14, 2016 12:30-2:00pm Eastern

For audio, please listen through your speakers or dial:

(855) 850-0622, use Conference ID: 30594887

Generously supported by the Robert Wood Johnson Foundation

Agenda

12:30-12:40pm ET Welcome, Introductions, and Overview •  Jill Rosenthal, Senior Program Director, NASHP

12:40-1:30pm ET Panel Discussion Moderator: Jill Rosenthal, NASHP Panelists: •  Sarah Kinsler, Vermont •  Barbara Masters, California •  Chase Napier, Washington State •  Rosemarie Rodriguez-Hager, Minnesota

1:30-2:00pm ET Questions and Answers •  Jill Rosenthal, NASHP

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Status of ACH Models State Number

of ACHs Planned

State Entities Leading ACH Initiative

Funding Allocated to Each ACH

Relevant State Delivery System Reform Levers

California 6 •  Health and Human Services •  Private foundations including:

Community Partners, The California Endowment, Blue Shield Foundation of California, Kaiser Permanente, and Sierra Health Foundation

•  $250,000 for Year 1 (2016-17) •  $300,000 per year for Years 2-3

(2017-19)

•  Two SIM Design Initiatives

Minnesota 15 •  Department of Health •  Department of Human Services

•  $370,000 total for 2 years (2015-16)

•  SIM Testing Initiatives

Vermont Up to 14 •  Department of Health •  Health Care Innovation Project

Team (SIM)

•  $230,000 total dedicated to the Peer Learning Lab for 12-14 months (not to individual ACHs)

•  SIM Testing Initiative •  Pending Medicaid 1115

Demonstration

Washington 9 •  Health Care Authority •  Department of Health •  Department of Social and

Health Services

•  $150,000 allocated through state legislation over 1 year (2015) for 2 Pilot ACHs

•  $100,000 from SIM award over one year (2015) for 7 Design ACHs

•  $810,000 from SIM award for remainder of SIM (2016-2019) for 9 ACHs Post-Designation

•  SIM Testing Initiative •  State Legislation** •  Pending Medicaid 1115

Demonstration

http://nashp.org/state-levers-to-advance-accountable-communities-for-health/

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Why ACHs?

•  States are focused on achieving the Triple Aim of improved care, reduces costs, and better health.

•  Accomplishing the Triple Aim requires population health initiatives that engage communities in addressing the social factors influencing health.

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What are ACHs?

•  Locally driven models that unite an array of key stakeholders to achieve sustainable improvements in health outcomes.

•  Common ACH elements: •  Individual and population-based health promotion

interventions •  Shared vision and goals among partners •  Multi-sector partnerships •  Established governance structure or leadership •  Backbone or integrator organization •  Identified community engagement activities/interventions •  Ability to perform basic financial and administrative functions •  Sustainability planning

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Why are states involved?

•  There are state and local roles in establishing key ACH components (e.g. governance structures, geographic boundaries, financing mechanisms, priority conditions and target populations)

•  Population health is a key component of delivery system reform

•  State resources can be leveraged to support, sustain and spread ACH models

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Today’s Panel

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How does your state’s ACH model fit into larger delivery

system reform?

Tell us what your state is doing at www.nashp.org/statereforum

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The Minnesota Accountable Health Model Accountable Communities for Health

•  In 2011, MDH funded community care teams (CCTs) to pilot implementation of community and provider partnerships around care coordination

•  2010 - Development of Minnesota’s Medicaid ACOs – Integrated

Health Partnerships •  Accountable Communities for Health (ACH) are innovative strategies

to meet the clinical and social needs of a defined population through person-centered, coordinated care across a range of providers.

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Building a High-Performing Health System for Vermont

Big  Goal:  Integrated  Health  System  able  to  

achieve  the  Triple  Aim  

All-­‐Payer  Model  (Next  Gen-­‐type  ACO):  •  Way  to  pursue  goal  of  integrated  

system  for  certain  services  and  providers.  

•  Enables  Medicare,  Medicaid,  and  Commercial  payers  to  align  value-­‐based  payments  for  health  care.  

Medicaid  Pathway:  •  Way  to  pursue  goal  of  integrated  

system  for  services  and  providers  outside  of  All-­‐Payer  Model.  

•  Enables  Medicaid  to  align  value-­‐based  payment  models  with  All-­‐Payer  and  ACO  design.  

Complementary  Delivery  System  Reform  and  TransformaAon  Efforts,  including…  •  Blueprint  for  Health  (mulL-­‐payer  

paLent-­‐centered  medical  homes)  •  Community  Health  Teams  (CHTs)  •  CHT  Extensions  –  Hub  &  Spoke,  

Support  and  Services  at  Home  (SASH)  •  Regional  Governance  (Unified  

Community  CollaboraLves)  •  Provider  Learning  CollaboraLves  •  Accountable  CommuniAes  for  Health  

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Vermont: Supporting Regional Innovation

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Let’s Get Healthy California Task Force December 2012

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•   SecLon  2703  Health  Homes      •   SecLon  1115  Waiver:    Ø   Whole  Person  Care  Pilots      

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California Accountable Communities for Health Initiative

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Washington’s vision for creating healthier communities and a more sustainable health care system:

Improving how we pay for services

Ensuring health care focuses on the whole

person

Building healthier communities through a collaborative regional

approach

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What is your state’s framework for community

health improvement?

Tell us what your state is doing at www.nashp.org/statereforum

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IntervenAon/Program   Time  Frame  (short-­‐long)  

Clinical  services   • Improve  adherence  to  diabetes  care  guidelines  in  primary  care  • Health  educaLon  and  coaching  for  diabeLcs  and  at-­‐risk  populaLons    

Short-­‐Medium  

Community  and  Social  Services  &  Resources  

• Chronic  disease  self-­‐management  community  programs  • YMCA  Diabetes  PrevenLon  Program  (DPP)    

Short  

Clinical-­‐Community  Linkages  

• IntegraLon  of  community  health  workers  in  care  teams  to  work  with  residents  • Referral  systems  between  clinical  and  community  program  

Medium  

Public  Policy  &  Systems  Changes  

• Policies  implemenLng  naLonal  nutriLon  standards  in  school  meals  • Health  plan  incenLves  to  encourage  implementaLon  of  diabetes  care  guidelines  

Long  

Environmental    Changes  

• Business-­‐resident  partnership  to  increase  full  service  grocery  outlets,  community  gardens  &  famers  markets  • Walking  and  biking  paths  

Medium  and  Long  

Portfolio of interventions - SAMPLE: DIABETES

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Community Health Improvement in Vermont: Population Health and Prevention Strategies on Three Levels

�  Traditional Clinical Approaches focus on individual health improvement for patients who use clinician-based services

�  Innovative Patient Centered Care and/or Community Linkages include community services for individual patients

�  Community-Wide Strategies focus on improving health of the overall population or subpopulations

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Can you give an example of an intervention that would

be unique to an ACH?

Tell us what your state is doing at www.nashp.org/statereforum

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ACH Case Study in Washington: Cascade Pacific Action Alliance

Approach: •  Early identification of needs/risk •  Assessment and referral •  Coordination between community-

based interventions and treatment services

Youth Behavioral Health Coordination Project Goal: Decrease number of school-aged youth with unmet behavioral and physical health needs

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ACH Intervention in Minnesota

�  Unity Family Health Care ACH – Care Coordination model to mitigate substance abuse focused on senior population

�  Partnership includes hospital, ACO, public health, social services, law enforcement, local pharmacies, the school district, and substance abuse prevention coalition.

�  Early results ¡  Reductions in Medicaid claims for narcotics ¡  Narcotic claims reduced $439,674

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What is your state’s plan for financing and sustaining

ACHs?

Tell us what your state is doing at www.nashp.org/statereforum

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Healthier  Washington  System  Supports  •  InformaAon  Technology  /  Infrastructure  •  Data  and  Measurement  •  Workforce  Development  •  PracAce  TransformaAon  •  Payment  Redesign      

Health  and  Recovery  Care  

Community  Factors   Public

Health

Nutritious Food

Transportation

Employment

Education

Crisis Intervention

Family Support

Criminal Justice

Housing Built

Environment Substance

use disorder

Physical Health

Long-Term Care

Mental Health

Oral Health

Developing and sustaining a coordinated system…

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Backbone  organizaLon  

   PorRolio  of  mutually  reinforcing  intervenAons  Clinical            Community-­‐Clinical  Linkage            Community  Programs            Policy    &  Systems          Environment                                          

                                   &  Social  Services  

       Timeframe  of  IntervenAon                          Short  term                                                                                                                              Medium  term                                                                                      Long  term  

IdenLfy  savings  across  providers,  systems  &  sectors  for  potenLal  

reinvestment  

Wellness  Fund  

Sustain-­‐      ability    Plan  

Accountable Community for Health

Selected  Health  Issue:  •   Health  need  •   Chronic  condiLon  •   Set  of  related      condiLons  •   Community  condiLon  

Braiding  exisLng  funding  &  programs  for  intervenLons    

Social    Services    

Business  &  Labor  

Community  agencies  &    residents  

EducaLon  sector  

Health  care  sector  

Public  health  

Other  govt.  

agencies  

Community  CollaboraAve  and  Governance    

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•  Vehicle for attracting resources o  Public o  Private o  Health care savings

•  Support the ACH infrastructure, e.g. backbone

•  Support for interventions—especially upstream prevention activities—for which few resources exist

Wellness Fund

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Sustaining ACHs

� Advocating beyond Medicaid ACOs � Possible legislative allocations � Program Alignment

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Financing and Sustaining ACHs in Vermont

�  Current: ACH Peer Learning Lab is technical assistance to interested regions to facilitate visioning, provide an additional framework and set of tools, and engage a broader group of partners. ¡  Regions have significant flexibility in whether and how they explore and

implement this model – a key feature of many of Vermont’s past reforms.

�  Future: Key goal of the Peer Learning Lab is to gather lessons learned to inform future State decision-making: ¡  Unified Community Collaboratives expected to continue as core regional

governance; ¡  Next steps in context of All-Payer Model, Medicaid Pathway, and other

care delivery transformation efforts.

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Please describe challenges

your state has faced in implementing ACHs. What

are the next steps?

Tell us what your state is doing at www.nashp.org/statereforum

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Vermont’s ACH Implementation Challenges

�  Vermont is on the verge of transformative change with All-Payer Waiver and Medicaid Pathway.

�  Health reform fatigue and competing priorities at the community and provider levels.

�  Emphasis on local control has resulted in significant variation across communities – a strength and a challenge!

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EvaluaLon  Challenges    

Grantees  are  building  their  ACHs  on  exisLng  collaboraLons  and  infrastructure,  although  there  are  common  elements    Six  grantees  are  focusing  on  different  health  issues:  trauma/violence,  asthma,  and  cardiovascular  disease/obesity  

Different  backbones:  public  health  departments,  non-­‐  profit  intermediary,  hospital/health  care  coaliLon

Achieving  outcomes  in  three  years,  parLcularly  with  regard  to  prevenLon-­‐related  acLviLes  

Assessing  the  cumulaLve/synergisLc  impact  of  a  por`olio  of  intervenLons  

For  more  informaLon,  contact:  CACHImgr@CommunityPartners.org    30

Challenges

� ACHs are not required to have an attributable population

� Population Health

� Community Engagement

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Challenges and Opportunities:

•  Connecting community supports and upstream health improvement activities to the transformation efforts within the health care system.

•  Authentically engaging and empowering community members and consumers.

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Question and Answer

Submit your questions in the chat box on the left

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Webinar slides and recording will be posted to the NASHP website in the coming days.

Resources

NASHP Reports •  State Levers to Advance Accountable Communities for Health

http://nashp.org/state-levers-to-advance-accountable-communities-for-health/ •  In the Zone: State Strategies to Advance Health Equity by Investing in

Community Health http://nashp.org/in-the-zone-state-strategies-to-advance-health-equity-by-investing-in-community-health/

State ACH Resources •  California Accountable Communities for Health Initiative

http://www.communitypartners.org/cachi-overview •  Minnesota Accountable Communities for Health

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=SIM_ACH

•  Vermont Accountable Communities for Health Peer Learning Lab http://healthcareinnovation.vermont.gov/sites/hcinnovation/files/Resources/ACH%20Peer%20Learning%20Lab%20Recruitment%20Packet%201%2015%202016.pdf

•  Washington Accountable Communities of Health http://www.hca.wa.gov/hw/Pages/communities_of_health.aspx

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Thank you!

Please complete our evaluation.

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Continue the discussion online at: http://www.nashp.org/statereforum