King County Integration Workgroup August 22, 2011

1. King County Integration WorkgroupAugust 22, 2011 Dale Jarvis, CPAdale@djconsult.net

2. Discussion Topics • Dale’s abridged presentation to the Healthcare Cabinet • Lessons from Other States and Regions • Central Oregon – where it all began on the West Coast • Vermont and Camden NJ – where it all began on the East Coast • Eastern WA and SW WA Planning Ideas • California’s Planning Ideas • Health Foundations Partnership

3. The Role of Regional Health Alliances in Washington State Healthcare Reform Dale Jarvis, Managing Consultant dale@djconsult.net206-613-3339

4. It started with a Discussion in Southwest Washington Last Summer We already know how to fix the healthcare system: • Medical Homes and • Accountable Care Organizations • Supported by Payment Reforms

5. But what about folks in the Safety Net? • For many children, families, and adults in the safety net, good healthcare is not enough • Consider a mom with depression and diabetes • Add to this scenario the facts that she is the head of household of a family of three, has lost her job, is experiencing domestic violence and she and her children are on the brink of homelessness

6. A Key Part of the Equation: Addressing the Social Determinants of Health • There is a distinct relationship between an individual’s health status and the social and environmental conditions in which he or she lives • The US healthcare system is not currently structured to address these problems, separating healthfrom human services

7. A New Vision: The “Healthcare Neighborhood” The Next Generation Safety Net Healthcare System • The Fulton County Georgia (Atlanta area) Neighborhood Union Primary Care Partnership’s One Stop Shopping: • Well patient care • Sick-patient care • OB/GYN services • Travel immunization services • Communicable disease intervention • WIC/nutrition education • Oral health services • Behavioral health services • A day center for parents receiving services • Employment assistance • Disability and vocation rehabilitation services • Foreclosure prevention services • Housing assistance • A reading room/information center that offers ESL classes • A farmer’s market • A community garden • A walking trail

8. Which requires the Customization of the Patient-Centered Medical Home as well as the Accountable Care Organization

9. The Current “Wiring Diagram” just doesn’t work…

10. But, what about the unfolding HCA design? HCA Design • All Medicaid enrollees move into managed care • RSNs intact for now (may change by 2014) • Payment reform pilots • ACO pilots ? Expansion of managed care

11. Stealing the Best Ideas: Regional Improvement Efforts

12. Two-Part Idea: • A Regional Health Alliance to organize the payors/funders to create a supportive payment and regulatory system • In order to support organizing the delivery system into accountable systems of care

13. Key RHA Tasks • Community-wide needs assessment and improvement plan • Multi-Payer “virtual” budget development • Community health improvement projects/hot spotting • Multi-Payer payment, contracting, and performance measure models • Person-Centered Healthcare Home development support • Local ACO development support • Support Patient Registry, EHR, Health Information Exchange development • Community-wide performance measurement

14. Organizing the New Healthcare Ecosystem in Washington State

15. Lessons: Central Oregon – where it all began on the West Coast

20. Lessons: Vermont and Camden NJ – where it all began on the East Coast

21. Vermont Blueprint for HealthThe Healthcare System of the Future? • Key Ingredients: • Medical Homes • Community Health Teams • Mental Health Providers • Public Health Prevention • Accountable Care Organizations 21

22. Camden, NJ: Hot Spotting

23. Hot Spotting orCOMSTAT Comes to Healthcare • We have the tragedy of a murder to thank for the development of a practice we now know as case spotting. • Brenner became involved. Searched for better ways to deploy police resources. • COMPSTAT- mapping crime hot spots and concentrating police resources there.

24. Hot Spotting • Turned the idea towards the analysis of patient flow and healthcare expenditure patterns. • Studied where ambulances picked up patients with fall injuries. Found one facility that sent far more elderly to the ER with serious falls than any other. (57 in 2 years= $3 million in costs)

25. Hot Spotting/Case Spotting • COMPSTAT >> HEALTHSTAT • Two most expensive city blocks, 900 people, accounted for 4000 hospital visits, 200 hundred million in healthcare costs over a 5 year period. • 1% of 100,000 people used 30% of costs

26. Lessons: Eastern and SW WA Planning

27. Washington RHA Activity

28. RHA Structure & Key Tasks

31. Draft Timeline

32. Next Steps

33. Lessons: California’s Home Runs

34. How to get paid for integrated care

35. Modeling Demand, Revenue, Costs, and Cost Offsets

36. Health Foundations Partnership

37. Partial List of Foundations • Bill & Melinda Gates Foundation • Building Changes • Community Foundation of Southwest Washington • Empire Health Foundation • Group Health Foundation • Kaiser Foundation • Legacy Health Foundation • Murdock Foundation • Northwest Health Foundation • Pacific Hospital and Preservation and Development Authority • PeaceHealthSouthwest Foundation • Providence Foundation • Regence Foundation • St. Luke’s Foundation • Washington Dental Service Foundation • Washington Health Foundation • Yakima Valley Community Foundation

38. Partnership Plan Ideas • Organize the Foundations into a Health Funders Partnership • Develop a strategy to help Washington State succeed at healthcare reform and become the healthiest state in the nation; ideas discussed: • Matching dollars for federal funds for state projects • Regional Health Alliance seed money • Accountable Care Organization seed money

39. Google and then Read this Paper

40. Questions and Comments?