health reform in washington state: where we’ve been and where we’re headed
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Daniel Lessler, MD, MHA, FACP, Chief Medical Officer, Washington Health Care AuthorityTRANSCRIPT
Health Reform in Washington State: Health Reform in Washington State: Where We’ve Been and Where We’re HeadedWhere We’ve Been and Where We’re Headed
Latino Health ForumOctober 9, 2014
Daniel Lessler, MD, MHA, FACPChief Medical OfficerHealth Care Authority
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Single Door to Find Coverage – Began Oct 2013Single Door to Find Coverage – Began Oct 2013
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NEW 2018 TARGETS
Garfield
Thurston
Grays Harbor
Mason
Jefferson
Clallam
WhatcomSan Juan
Island
Kitsap
Skagit
Snohomish
King
Pierce
LewisPacific
Wahkiakum Cowlitz
Clark
Skamania
Yakima
Klickitat
Kittitas
ChelanDouglas
Okanogan Ferry Stevens Pend Oreille
Grant
Benton
Franklin
Walla Walla
Adams
Lincoln Spokane
Whitman
Columbia
Asotin
Medicaid Expansion Enrollment Targets for January 1, 2018
Total New Adult Clients = 326,447*
Target for January 1, 2018 = 252,576Percent of 2018 Target Met
Statewide = 129%Between October 1, 2013 and June 5, 2014
Percent of goal metADULT
CLIENT COUNT1,018
11,1952,061
27,90511,970
20289,841
4,35610,22936,630
1852,7145,9061,9181,013
28,8941,2713,7672,591
19,8091,147
4554,4342,955
9672,268
6762,946
724,2424,1055,5858,206
42016,091
4,148387
2,1941,674
*109 additional clients do not map to Washington counties.
SOURCE: Washington State Health Care Authority, June 10, 2014 – based on 2012 estimates.
ON TRACK
OFF PACE
Under 70%70 to 79%80 to 89%90 to 99%100% or higherLEGEND
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29%
* The Hispanic category includes all enrollees who indicated they are of Hispanic origin regardless of their race.
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Apple Health (New Adults) Enrollment by Race/Ethnicity, through Sep 11, 2014
Health Care ReformHealth Care Reform
• With implementation of the Affordable Care Act, HCA will purchase care for approximately 2 million Washington residents.
• We must move ahead with coverage improvements, but they will be unsustainable if we do not change the cost of care.
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Budget Challenges – the Washington View
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EXISTING DESIGN NOT SUSTAINABLE
Medicaid delivery system silos
Fragmented service delivery - integrated care requires infrastructure & capacity development
Incentives & reimbursement structures not aligned to achieve outcomes or value – for purchasers, payers, providers & communities
Further home & community service balancing needed for supported seniors & individuals with a disability
Social determinants of health – attention to “prevention” needed in the broadest sense
Challenges in Access to Care and Services
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State Health Care Innovation PlanState Health Care Innovation Plan• 8 month planning process• 12 state agencies• More than 100 meetings & public presentations• Hundreds of thought leaders engaged through the
state• Dozens of hospitals, clinics, community organizaitons• 770+ Feedback Network members• Funding from CMMI
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Goal - a healthier Washington
Pay for value and outcomes instead of volume of services
Integrate physical and behavioral health to address the needs of the whole person
Empower communities to improve health and better link with health delivery
Critical Legislation Enacted in 2014
•E2SHB 2572 – Purchasing reform, greater transparency, empowered communities
•2SSB 6312 – Integrated whole-person care; purchasing and delivery system reform
Potential for Federal Financing10
http://www.hca.wa.gov/shcip/Documents/SHCIP_InnovationPlan.pdf
State Health Care Innovation Plan - Transformation by 2020
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Future alternative payment methodology that supports innovation and rewards improved health outcomes over volume of services delivered – see: http://www.hca.wa.gov/Pages/leg_reports.aspx.
Current System
Based on volume not valuePerformance measurement (and
data) difficult to obtainAdministratively onerous to clinics
and StatePayment system/financing not
predictableLittle accountability with no
shared savingsInhibits innovative approaches to
care (e.g., group visits, telemedicine, integrated/ coordinated care)
Multiple payment methodologies implemented in response to legislative direction
Future System
Based on value not volume (incentives tied to health outcomes)
State-wide performance measures based on data
Administrative simplification for clinics and state
Prospective/predictable budgeting for clinics and state
Accountability clear with opportunities to share in savings
Rewards innovative approaches to care (e.g., group visits, telemedicine, integrated/ coordinated care)
Sustainable payment methodology grounded in principles developed through collaborative process with a shared vision
The Bridge Challenge:Transition Support/Capacity Building
Systems for tracking services and
total cost of careData capacity improvementsModernized service delivery, with
EHR ramp-upCooperative support and incentives
for practice transformationIncreased uniformity of paymentWorkforce flexibility and training
Transition to Increased Performance Risk
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Behavioral Health Integration
• Integrated funding with shared resources• Leadership support for integration as driving
model of operations• Physical and behavioral health needs treated
collaboratively for all persons• Consistent communication and collaboration• Roles and cultures that blur or blend
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State Health Care Innovation State Health Care Innovation PlanPlan
Accountable Communities of Health (ACH)
Collectively impact health through regionally driven priorities and solutions
Medicaid purchasing alignment
Develop a region-wide health assessment and regional health improvement plan
Driver of accountability for results
Forum for harmonizing payment models,
performance measures and investments
Health coordination and workforce development
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•Leverages public purchasing to share accountability for performance results across delivery systems•Empowers “local” innovation - payment models, performance measures, workforce development, health care coordination with community services & support and investments – and engages communities in local priorities•Enhances opportunities for cross agency efforts around common populations (especially those with high-cost, multiple, health and social service system needs)•Builds on lessons from current regional endeavors – health homes, RSNs, community-based organizations, service referral patterns, etc.
Why regional service areas?
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Whole Health Silo BustingWhole Health Silo Busting
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A Healthier A Healthier WashingtonWashington: The Big Picture: The Big Picture
Federal Grant of $92.4 million requested end of July 2014 Anticipated late-October announcement for 1/1/2015 start date
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QUESTIONS?QUESTIONS?
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Daniel Lessler, MD, MHAChief Medical OfficerHealth Care Authority