Greater Columbia Accountable Community of Health

1. Greater Columbia Accountable Community of Health Yakima Valley Conference of Governments 10-19-16

2. Building healthier communities through a collaborative regional approach Washington State vision for creating healthier communities and a more sustainable health care system by: Improving how we pay for services Ensuring health care focuses on the whole person Better Health, Better Care, Lower Costs 2

3. Healthier Washington recognizes that health is more than health care. Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper, State Quality Improvement Institute.. Minnesota. Better Health, Better Care, Lower Costs 3

4. Healthier Washington is more than the State Innovation Models(SIM) grant… • 2014 Legislation: • House Bill 2572 • Senate Bill 6312 Medicaid TransformationPotential demonstrationproject within Medicaid SIM Grant: $65 million over 4 yearsfrom the federal government Better Health, Better Care, Lower Costs 7

5. Accountable Communities of Health Healthier Washington is bringing together providers, social service organizations, health plans, hospitals, county governments, tribes, and others through nine regional Accountable Communities of Health (ACHs). ACHs will support communities in making informed decisions on health needs and priorities. Better Health, Better Care, Lower Costs 9

6. A Forum for regional collaborative decision making

7. Community Empowerment & Accountability Accountable Communities of Health (ACHs) will: • Provide a multi-sector voice for delivery system reform, shared health improvement goals and regional purchasing strategies. • Serve as a forum for regional collaborative decision-making to accelerate health system transformation, focusing on social determinants of health, clinical-community linkages, and whole person care. • Accelerate physical and behavioral health care integration through financing and delivery system adjustments, starting with Medicaid.

8. Medicaid Transformation Better Health, Better Care, Lower Costs 10

9. Medicaid Transformation Better Health, Better Care, Lower Costs 12

10. Washington’s Medicaid Transformation GoalsAchieving the Triple Aim • Reduce avoidable use of intensive services and settings • Improve population health • Accelerate the transition to value-based payment • Ensure that Medicaid per-capita cost growth is below national trends Better Health, Better Care, Lower Costs 10

11. Waiver Initiatives Initiative 1 Initiative 2 Initiative 3 Transformation through Accountable Communities of Health Enable Older Adults to Stay at Home; Delay or Avoid the Need for More Intensive Care Targeted Foundational Community Supports Delivery System Reform Benefit: Medicaid Alternative Care (MAC) Benefit: Supportive Housing • Community based option for Medicaid clients and their families • Services to support unpaid family caregivers • Individualized, critical services and supportsthat will assist Medicaid clients to obtain and maintain housing. The housing-related services do not include Medicaid payment for room and board. • Each region, through its Accountable Community of Health, will be able to pursue projects that will transform the Medicaid delivery system to serve the whole person and use resources more wisely. Benefit: Tailored Supports for Older Adults (TSOA) Benefit: Supported Employment • For individuals “at risk” of future Medicaid LTSS not currently meeting Medicaid financial eligibility criteria • Primarily services to support unpaid family caregivers • Services such as individualized job coaching and training, employer relations, and assistance with job placement. Transformation Projects Medicaid Benefits/Services

12. Transformation Framework The framework is a high-level overview of the strategies necessary to achieve the desired outcomes under each domain. Domains • Domain 1: Health Systems Capacity Building* • Workforce and non-conventional service sites • Primary care models • Data collection and analytic capacity • * All Domain 1 projects must demonstrate a direct connection to Domains 2 or 3 • Domain 2: Care Delivery Redesign • Bi-directional integration of care • Care coordination • Care transitions • Domain 3: Prevention and Health Promotion • Chronic disease prevention and/or management • Maternal and child health 12

13. Medicaid Population: Greater Columbia ACH

14. Greater Columbia Governance Structure

15. Accountable Community of Health (ACH) History • 7/2014 – Launch of “Communities of Health” (COH) • 1/13/2016 - State Designation Achieved “Accountable Community of Health” • 7/29/16 – Submitted Regional Health Improvement Plan • 8/8/16 – SIM Project Approved

16. Backbone Organization BFCHA Carol Moser Aisling Fernandez Eastern WA University Dr. Patrick Jones Board of Directors Healthcare Provider Mental Health Provider Public Health FQHC Hospital CBO/FBO Social Services Local Government GCBH Executive Director Ken Roughton Catholic Family and Child Services Darlene Darnell SE WA Aging and Long Term Care Lori Brown Sunnyside Community Hospital Brian Gibbons Comprehensive Mental Health Ed Thornbrugh Tri-Cities Community Health Martin Valadez Yakima Memorial Hospital Eddie Miles Columbia County Martha Lanman Education Philanthropy Managed Care Housing Business Tribes Public Safety Consumer Transportation Coordinated Care Andrea Tull Three Rivers Community Foundation Carrie Green People for People Madelyn Carlson Northwest Justice Project Jefferson Coulter ESD 123 Les Stahlnecker Yakama Nation Frank Mesplie Kittitas Fire John Sinclair Yakima Neighborhood Health Rhonda Hauff TBD

17. Greater Columbia Accountable Community of Health Collective Impact Model Committees Board of Directors Backbone Organization for Greater Columbia Accountable Community of Health Executive Committee Nominating Committee Finance Committee By-Laws Committee Communications Committee Priority Workgroups and Committees Leadership Council Care Coordination Behavioral Health Healthy Youth & Equitable Communities Diabetes & Obesity Oral Health Assessment & Planning Committee Strategic Issues Committee Data Com Partners/Sectors Public Health Hospital FQHC Healthcare Provider Mental Health Provider CBO/FBO Social Services Local Government Education Philanthropy Managed Care Housing Business Tribes Public Safety Consumer Transportation Other Community Members

18. Guiding Principles

19. Overarching Strategies in RHIP

20. Access to exercise opportunities:Lower than the State!

21. Dental Workforce Shortages Untreated dental disease can lead to serious health effects including pain, infection, and tooth loss. Although lack of sufficient providers is only one barrier to accessing oral health care, much of the country suffers from shortages.

22. Median Household Income, 2016

23. Shortage of Mental Health Providers

24. State Innovation Model (SIM) Project • Care Transitions: Coordinating the medical and social services needed to improve patients' likelihood of readmitting to the hospital within 30 days of their last hospital stay. • Working with Consistent Care Services, the Pilot will identify 40 patients (25 Kadlec, 15 Trios) and transition their care into their home with follow-up visits from WSU Nursing students.

25. For more information, contact: Carol Moser cmoser@greatercolumbiaach.orgWebsite:www.greatercolumbiaach.org Thank you!