board of trustees medicaid transformation...reduce opioid drug misuse through cross sector...
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Project OverviewsMay 11, 2018
Board of TrusteesMedicaid Transformation
19/21/2018
9/21/2018 2
MEDICAID TRANSFORMATION PROJECTS
VisionA healthy southwest
Washington region where all people have equitable access to quality whole person care and live in connected and thriving communities without barriers to wellness
Health Information Exchange / Health Information Technology
Partners across the SWACH region have consistent communication and connectivity for improved whole-person, integrated care
Opioid ResponseReduce opioid drug misuse through cross sector
collaboration in Clark, Skamania, Klickitat counties
Community Care CoordinationIndividuals with health and/or social needs connect
to quality, coordinated care interventions and services to improve their overall health outcomes
Bi-Directional Clinical IntegrationIndividuals receive Behavioral Health and Physical Health services in each setting along SAMSHAs Six
Levels of Integration
Value Based PaymentProvide support to the region to transition from a volume based payment structure to
a value based payment structure to promote whole person care
Workforce DevelopmentSupport the development of an
empowered, compassionate, and sustainable workforce that is responsive to
community health needs in our region
Trauma Informed Care
Chronic CareProvide support for effective complex care and
disease management for targets utilizing CBOs and clinical providers to support interventions
Collaborative Shared LearningReduction of StigmaHealth Equity
DOM
AIN
ON
E
CARE SETTINGS
Emergency Department
Behavioral Health
Primary Care
Community Based Organizations
CORN
ERST
ON
ES
Community Engagement
Medicaid Transformation Project Overviews: Summary
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Project Overview: Bi-Directional Clinical Integration SWACH Lead: Daniel Smith
Aim Statement Individuals receive Behavioral Health and Physical Health services in each setting along SAMSHAs Six Levels of Integration
Target Population
All Medicaid beneficiaries (children and adults), particularly those at risk for behavioral health conditions, including mental illness and/or substance use disorder
Issues / Risks
Description Mitigation
Clinical Integration workgroup does not currently have representation from all involved parties.
Plan to re-charter workgroup and membership by September
Transformation Plan timeline is condensed Provider input at least three times during development. Build in extensions to deadlines as a contingency plan.
Changes from the State and risk that info will not flow to the ACH and providers timely
SWACH staying connected with HCA, legislature, WSHA, WA Academy of Pediatrics, Governor's office, and other ACH’s. Communicate changes to providers.
Unknown of 3rd payer launching in 2019 SWACH available to help providers navigate and align. Including potential new payers in meetings in SWACH meetings
Consolidation of the market - health system affiliations, payer arrangements and impact to the behavioral health market.
SWACH available as resource to support providers in making partnership and contracting decisions
Approach and Tactics
Work with partner organizations to develop their transformation plans, which will support the regional implementation plan developed by SWACH to achieve end state
Physical Health settings providing Behavioral Health services• Universal Screening for behavioral health• BH specialist as part of clinical team• Data systems to track outcomes and population health• Collaborative Care Model• Key elements of Bree Collaborative Model• Evidence Based treatment
Behavioral Health settings providing Physical Health services• Universal Screening for physical health• Medical services onsite or enhanced care link and shared
care planning with primary care• Data systems to track outcomes• Milbank Model of Care• Key elements of Bree Collaborative Model• Evidence Based treatment
Measures
Pay for Performance (P4P) Pay for Reporting (P4R)
• All-Cause Emergency Department (ED) Visits
• Inpatient Hospital Utilization• Follow up after ED visit for mental
health• Follow up after hospitalization for
mental illness• Follow-up after ED visit for alcohol or
drug dependence• Mental health treatment penetration• Percent homeless• Plan All-Cause Readmissions• Substance use disorder treatment
penetration• Child and Adolescents’ Access to
Primary Care Practitioners• Comprehensive Diabetes Care: Eye
Exam performed• Comprehensive Diabetes Care: HbA1c
testing • Comprehensive Diabetes Care:
Medical Attention for Nephropathy• Medication Management for People
with Asthma (5-64 years)• Antidepressant Medication
Management
• Assessment of integration of physical and behavioral health care (MeHAF Site Self Assessment tool-under HCA review)
G
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Project Overview: Bi-Directional Clinical Integration – Partner and Community Engagement
Partner Engagement
Clinical Integration Committee includes representatives from:• Catholic Community Services• Center for Community Health and Evaluation• Child and Adolescent Clinic• Children’s Center• Community Health Plan of Washington• Comprehensive Healthcare• Daybreak Youth Services• Klickitat Valley Health• Kaiser • Legacy Health Services• Lifeline Connections• Molina Healthcare• NAMI SW Washington• PeaceHealth• Providence Health and Services• Qualis• Rose Clinic• SeaMar Community Health Services• Skamania County• Skyline Hospital and Family Medicine• The Vancouver Clinic
Community Engagement
• Our approach: Engage the community where they are through:
• SWACH initiated community discussions• Attendance at existing community groups• Launch of a Community Voices Council
Stakeholder Review
• Regular updates will be shared with RHIP and the Board
• RHIP will have opportunities to review and provide input prior to taking major final products to the Board
• e.g. Transformation Plan, Implementation Plan, Funds Flow, Workgroup Charters
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Project Overview: Opioid Response SWACH Lead: Eric McNair Scott
Aim Statement Reduce opioid drug misuse through cross sector collaboration in Clark, Skamania, Klickitat counties
Target Population
Medicaid beneficiaries, including youth, who use, misuse, or abuse prescription opioids and/or heroin
Issues / Risks
Description Mitigation
Waiting on process to fund initial pilot ideas which are ready to move forward; risk of partner disengagement if delayed
Working on funds flow model and initial grant process
Need plan to support and sustain momentum of Opioid task force, including definition of the role of SWACH staff
Working with Public Health, ACES Action Alliance, and provider champions on longer term model
Approach and Tactics
Work with partner organizations to develop their transformation plans, which will support the regional implementation plan developed by SWACH to achieve end state
Prevention Strategies• Disposal and secure storage of opioids• Use of PMP• Training and support for providers• TeleHealth (i.e. Project Echo)
OD Treatment Strategies• Increased distribution of naloxone• Increased access to naloxone
Treatment Strategies• Team model of engagement and care• Number of MAT providers in care settings outside of SUD
(Primary Care, Hospitals, ED, Specialists, etc)• Increased MAT initiation sites (Primary Care, ED’s,
Hospitals, HRC, etc)• Increased Tx access points in clinical and community
settings
Recovery Strategies• Increased peer support services• Peer access in clinical settings
Measures
Pay for Performance (P4P) Pay for Reporting (P4R)
• All-Cause Emergency Department (ED) Visits
• Inpatient Hospital Utilization
• Patients on high-dose chronic opioid therapy
• Patients with concurrent sedatives prescriptions
• Substance use disorder treatment penetration (opioids)
• Providers are trained on guidelines on prescribing opioids for Pain
• Practice/clinic site has EHRs or other systems that provide clinical decision support for the opioid prescribing guidelines
• Mental health and SUD providers deliver acute care and recovery services for people with OUDs
• ED has protocols in place for providing overdose education, peer support and take-home naloxone to individuals seen for opioid overdose
• Organization site connects persons to MAT providers
• Organization site received technical assistance to organize or expand syringe exchange programs
G
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Project Overview: Opioid Response – Partner and Community Engagement
Partner Engagement
Opioid Crisis Response Committee includes representatives from:• Clark County• Clark County Public Health• Clark County Sheriff’s Office• Columbia River Mental Health Services• Community Health Plan of Washington• Community Voices are Born• Comprehensive Healthcare• Cowlitz Tribal Treatment• ESD112• KLASAC• Klickitat Valley Health• League of United Latin American Citizens• Lifeline Connections• Molina Healthcare• Northshore Medical• PeaceHealth• SeaMar Community Health Services• Share Vancouver• United Health Care• Current email distribution includes 80 contacts • Anticipate moving forward with an Opioid task force and close
alignment with the Clinical Integration Committee
Community Engagement
• Our approach: Engage the community where they are through:
• SWACH initiated community discussions• Attendance at existing community groups• Launch of a Community Voices Council
• Holding three events in May focused on:• Opioid prevention • Treatment• Addressing stigma
Stakeholder Review
• Regular updates will be shared with RHIP and the Board
• RHIP will have opportunities to review and provide input prior to taking major final products to the Board
• E.g. Transformation Plan, Implementation Plan, Funds Flow, Workgroup Charters
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Project Overview: Chronic Care SWACH Lead: Daniel Smith
Aim Statement Provide support for effective complex care and disease management for targets utilizing CBOs and clinical providers to support interventions
Target Population
Medicaid beneficiaries (adults and children) with, or at risk for, arthritis, cancer, chronic respiratory disease (asthma), diabetes, heart disease, obesity and stroke, with a focus on those populations experiencing the greatest burden of chronic disease in the region.
Issues / Risks
Description Mitigation
Lack of central hub for chronic disease self management education
Consider role of SWACH and potential community needs in implementation planning
Ensuring alignment with current initiatives and current contracts
Focus with providers on enhancing current interventions and supporting scaling to Medicaid
Approach and Tactics
Work with partner organizations to develop their transformation plans, which will support the regional implementation plan developed by SWACH to achieve end state
Chronic Disease Self Management Education programs• Partner commitment and resources to support patient
engagement• Best practices for patient retention• Central coordinating entity• Provider, environment, and patient readiness• Community clinical linkages to education and services
Community Paramedicine programs• ED / Hospital diversion and community education• Transition – follow up in community after acute episodes• Best and highest use of EMS resources• Community Health Worker developments
Measures
Pay for Performance (P4P) Pay for Reporting (P4R)
• All-Cause Emergency Department (ED) Visits
• Inpatient Hospital Utilization• Mental health treatment penetration• Substance use disorder treatment
penetration• Child and Adolescents’ Access to Primary
Care Practitioners• Comprehensive Diabetes Care: Eye Exam
performed• Comprehensive Diabetes Care: HbA1c
testing • Comprehensive Diabetes Care: Medical
Attention for Nephropathy• Medication Management for People with
Asthma (5-64 years)• Antidepressant Medication Management • Statin Therapy for Patients with
Cardiovascular Disease
• None
G
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Project Overview: Chronic Care – Partner and Community Engagement
Partner Engagement
Chronic Care is included in the Clinical Integration Committee, which includes representatives from:• Catholic Community Services• Center for Community Health and Evaluation• Child and Adolescent Clinic• Children’s Center• Community Health Plan of Washington• Comprehensive Healthcare• Daybreak Youth Services• Klickitat Valley Health• Legacy Health Services• Lifeline Connections• Molina Healthcare• NAMI SW Washington• PeaceHealth• Providence Health and Services• Qualis• SeaMar Community Health Services• Skamania County• Skyline Hospital• The Vancouver Clinic
Community Engagement
• Our approach: Engage the community where they are through:
• SWACH initiated community discussions• Attendance at existing community groups• Launch of a Community Voices Council
Stakeholder Review
• Regular updates will be shared with RHIP and the Board
• RHIP will have opportunities to review and provide input prior to taking major final products to the Board
• E.g. Transformation Plan, Implementation Plan, Funds Flow, Workgroup Charters
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Project Overview: Community Care Coordination SWACH Lead: Louise Nieto
AimStatement
Individuals with health and/or social needs connect to quality, coordinated care interventions and services to improve their overall health outcomes
Target Population
Medicaid beneficiaries (adults and children) with one or more chronic disease or condition (e.g. arthritis, cancer, chronic respiratorydisease, diabetes, obesity, stroke), or mental illness/depressive disorders, or moderate to severe substance use disorder and at least one risk factor (e.g., unstable housing, food insecurity, high EMS utilization)
Issues / Risks
Description Mitigation
Shared services contract with CCS on behalf of multiple ACH’s
Seeking collective alignment with other ACHs • Program Evaluation• Data • Security• Programmatic• Policy and Advocacy
Track closely and participate in the process; expect this to result in more cost efficient contract
Legal and technology expertise needed for Pathways Hub contracting process
Collective alignment with ACHs for legal and technology resources. Formalize shared services agreements for IT security
Approach and Tactics
Work with partner organizations to develop their transformation plans, which will support the regional implementation plan developed by SWACH to achieve end state
Pathways Community HUB• Reduce duplication of care coordination efforts• Measure and track outcomes• Value Based Paying contracting with MCO’s and payors
Support Rural care coordination needs
Support current coordination and referral efforts, e.g. 2-1-1
Measures
Pay for Performance (P4P) Pay for Reporting (P4R)
• All-Cause Emergency Department (ED) Visits
• Inpatient Hospital Utilization• Follow up after ED visit for mental health• Follow up after hospitalization for mental
illness• Follow-up after ED visit for alcohol or drug
dependence• Mental health treatment penetration• Percent homeless• Plan All-Cause Readmissions• Substance use disorder treatment
penetration
• None
Y
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Project Overview: Community Care Coordination – Partner and Community Engagement
Partner EngagementCommunity Care Coordination Workgroup includes representatives from:• 211 Info• Area Agency on Aging and Disabilities• Beacon Health Options• Community Health Plan of Washington• Community Voices are Born• Council for the Homeless• DSHS• EOCF of Washington• Free Clinic of SW Washington• Klickitat Valley Health• Legacy Health Services• Molina Healthcare• Northwest Justice Project• PeaceHealth• Providence Health and Services• SeaMar Community Health Services• Skamania County• United Health Care• Vancouver Housing Authority
• Engaged potential partner organizations and community on Pathways Hub model in Fall 2017 through RFA and education sessions for Care Coordinating Agencies (CCA) and Referral Agencies (RA)
Community Engagement
• Our approach: Engage the community where they are through:
• SWACH initiated community discussions• Attendance at existing community groups• Launch of a Community Voices Council
Stakeholder Review
• Regular updates will be shared with RHIP and the Board
• RHIP will have opportunities to review and provide input prior to taking major final products to the Board
• E.g. Transformation Plan, Implementation Plan, Funds Flow, Workgroup Charters
Opioid Taskforce
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Community Care Coordination
Clinical Integration Chronic Disease Opioid
SWACH Workgroup Structure
Current State –Project Workgroups
Potential Future State for Implementation –Shared Learning Collaboratives
Clinical Integration
Community Care
Coordination
LINKAGES
Key Milestones
Activity Target Date Status
Clinical Partner Assessment closed. COMPLETE G
Funds flow model for DY2 – 3 (2018 – 2019) finalized. TBD G
Provider partner payment (tied to assessment). 6/29/18 G
Develop Transformation Plan requirements and Tools for Regional Participants (draft distributed by June 11).
7/2/18 Y
Semi Annual Report #1 submitted to HCA. 7/31/18 G
Partners submit Transformation Plans. 8/17/18 G
Provider partner payment (tied to transformation plans). 10/1/18 G
SWACH Implementation Plan submitted to HCA. 10/1/18 G
Provider contracts/MOU executed. 12/31/18 G
SWACH Dashboard: Medicaid Transformation May 2018
Success Metrics
Description Target Actual Comments
Clinical Partner Assessment Participation
100% BH 69%PC 52%
Extensions to 5/18% indicates complete survey.
Transformation Plans complete
100% N/A
P4R HCA Measures being finalized
For 2019 reporting2A under HCA review 12
Overall Status
Area Status Notes
By C
are
Sett
ing
Primary Care Y Realigning primary care representation consistent with re-chartering Clinical Integration Committee
Behavioral Health Y Realigning behavioral health representation consistent with re-chartering Clinical Integration Committee
ED Y Little penetration from two ED departments as work has been focused on BH/PC settings.
CBO Y Defining approach for CBO transformation plans to include CBOs in all planning and development.
By P
roje
ct
Clinical Integration G
Opioid Response G Three Opioid focused community events in May.
Chronic Care G
Care Coordination Y Contract with CCS for Pathways Hub technology and Healthy Gen for consulting. Align with 5 ACHs implementing Pathways.
Issues / Risks
Description Mitigation
Changes from the State and risk that info will not flow to the ACH and providers timely
SWACH coordinating with providers and stakeholders (e.g. providers, WHA, Governor’s office)
Unknown of 3rd payer launching in Q1 2019 SWACH available to help providers navigate and align. Including potential new payers in SWACH meetings
Consolidation of the market - health system affiliations, payer arrangements and impact to the behavioral health market.
SWACH available as resource to support providers in making partnership and contracting decisions
In jeopardy, intervention requiredNo concerns to escalate Some risk, monitor closelyG Y
R
Vision A healthy southwest Washington region where all people have equitable access to quality whole person care and live in connected and thriving communities without barriers to wellness
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SWACH Dashboard: Operations May 2018
HR Finance Contracting IT
Status Yellow Yellow Green Green
Updates Posted positions: • Community
Engagement Coordinator
• Finance Director• Contracted for interim
Communications Lead• Contracting for AP/AR
function with local company
• Reviewing organizational roles and staffing models
• Phase 2 Funds flow being finalized
• Initial community engagement for FIMC priorities
• Mid Adopter incentive payments pending to support Klickitat County
• Interim Finance support being provided by Pierce and will transition AP/AR to local contracted agency
• HCA Contract Amendment• Point B SOW updated to
include additional capacity for transformation plan support
• VALO SOW executed for Website redesign
• Contract IT support in place• Updated, secure network
infrastructure (Wi-Fi) deployed in SWACH offices
• SharePoint collaboration site in development
• Website redesign / updates in progress
Issues / Risks • Finance Director application pool not as robust as expected. Potentially extend recruitment window
• Organizational needs review needs further inputs
• Knowledge transfer from Pierce to in house for AP/AR
149/21/2018
Recommendationsto the Board
• Nominate Klickitat County representative
RECENT DECISIONS
Workgroup RHIP Board
• Re-Charter Clinical Integration Committee by 9/1
• Input for transformation plan at three different points
• Data and Learning Workgroup under review
• Opioid Workgroup under review• Care Coordination workgroup
under review
• Review and make recommendations for charter update
• Approved funds flow for Phase I-Transformation Planning and Assessments
Recommendations and Decisions
Measure Date SWACH Performance
Statewide Performance
Relative to State
All-cause Emergency Department Utilization (per 1,000 member months) * MY 2017 53 50
Antidepressant Medication Management – Acute MY 2017 51% 49%
Antidepressant Medicaid Management – Continuation MY 2017 36% 33%
Child and Adolescent Access to Primary Care (12-24 months) MY 2017 89% 93%
Child and Adolescent Access to Primary Care (2-6 years) MY 2017 81% 84%
Child and Adolescent Access to Primary Care (7-11 years) MY 2017 86% 89%
Child and Adolescent Access to Primary Care (12-19 years) MY 2017 86% 90%
Comprehensive Diabetes Care: Eye Exam MY 2017 38% 31%
Comprehensive Diabetes Care: HbA1c Testing MY 2017 83% 84%
Comprehensive Diabetes Care: Medical Attention for Nephropathy MY 2017 86% 86%
Follow up after Discharge from ED for Alcohol or Other Drug Dependence (7 day) MY 2017 31% 23%
Follow up after Discharge from ED for Alcohol or Other Drug Dependence (30 day) MY 2017 40% 31%
Follow up after Discharge from ED for Mental Health (7 day) MY 2017 58% 60%
Follow up after Discharge from ED for Mental Health (30 day) MY 2017 72% 71%
Follow up after Hospitalization for Mental Health (7 day) MY 2017 84% 80%
Follow up after Hospitalization for Mental Health (30 day) MY 2017 91% 87%
Inpatient Hospital Utilization (per 1,000 member months) * MY 2017 63 65
Pay for Performance (P4P) Measure DashboardMeasurement Period: July 2016 – June 2017 (MY 2017)
Legend
Data Sources
Data sources used include:Healthier Washington Data Dashboard + RDA Measure Decomposition Reports
SWACH performance is at or above statewide
SWACH performance is below statewide
SWACH is the lowest performing ACH region
15
May 2018
Improvement over Self
Gap to Goal
*lower rate indicates better performance
Legend
About P4P Measures
The first year ACHs will be held accountable for P4P measures is CY 2019. Performance in CY 2019 will be compared to baseline (CY 2017). Official ACH baseline performance will be calculated for CY 2017; the state intends to release baseline results in October 2018. Official improvement targets and benchmarks for measures will also be released in October 2018. SWACH performance reported here is preliminary.
Benchmarks for gap to goal measures will likely be the national Medicaid 90th percentile; ACHs must close the gap between baseline and benchmarks by 10%. Targets for improvement over self measures will be based on 1.9% improvement from baseline.
Future updates of the P4P Measure Dashboard will include official baseline and benchmarks / improvement targets. The P4P Measure Dashboard will be updated quarterly where possible; however, some measures are only available annually or semi-annually.
SWACH performance is at or above statewide
SWACH performance is below statewide
SWACH is the lowest performing ACH region
16
May 2018
Measure Date SWACH Performance
Statewide Performance
Relative to State
Medication Management for People with Asthma MY 2017 34% 31%
Mental Health Treatment Penetration MY 2017 47% 46%
Percent Homeless * MY 2017 4% 5%
Plan All-Cause Readmission* MY 2017 11% 14%
Substance Use Disorder Treatment Penetration MY 2017 31% 28%
Patients on High Dose Chronic Opioid Therapy
Data for these P4P measures are not yet available. Patients with Concurrent Opioid and Sedative Prescriptions
Statin Therapy for Patients with Cardiovascular Disease
Substance Use Disorder Treatment Penetration (Opioids)
Improvement over Self
Gap to Goal
*lower rate indicates better performance
Pay for Performance (P4P) Measure DashboardMeasurement Period: July 2016 – June 2017 (MY 2017)
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SWACH Partnering Providers MCO’sASSESSMENT• Deploy a portfolio of current state assessment(s)
TRANSFORMATION PLANNING• Develop Transformation Plan requirements and
Tools for Regional Participants • Submit to HCA MTP Regional Implementation Plan• Ensure partners meet Transformation Plan
requirements• Support regional continuous improvement process• Identify regional workforce shortages and capacity
building solutions • Review local HIE/HIT assessment results • Based on current state assessment results develop
regional strategy to address HIE/HIT
TRANSFORMATION INVESTMENT PLANNING• Review regional transformation plans to identify
regional capacity investments and implementation
ASSESSMENT• Complete portfolio of current state assessments
(HIE/HIT, PH and BH)
TRANSFORMATION PLANNING• Review and provide input into transformation plan
template and guidance• Participate in transformation plan webinar• Develop an organizational level plan to meet
transformation requirements to include identification of target populations, equity/stigma/Trauma Informed supports, partner development, continuous improvement plan, workforce and HIE/HIT needs.
• Ensure leadership sponsor is identified to transformation plan milestones
• Submit Transformation Plan• Ongoing active participation in Clinical Integration
Committee
TRANSFORMATION BUDGET• Identify initial transformation Plan Budget and
Capacity needs
• Support continuous improvement • Support regional HIE/HIT strategy at the state level• Support each provider to move into VBP contracts• Support data needs for providers• Performance metrics/measurement developments• Assist providers to asses and develop a sustainable
business model to whole person care requirements and VBP
Roles: Transformation Planning