Health and Human Services Transformation Response to King County Council Motion 13768

1. Health and Human Services TransformationResponse to King County Council Motion 13768 April 25, 2013 MIDD Oversight Committee

2. King County Motion Requirements • Calls for County Executive to develop a plan for an integrated, accountable system of health, human services, and community-based prevention • Vision and goals • Implementation strategies and plan • Coordination with existing policies • Performance measurement • Strategic investments and financing options

3. Project Status • Completed • Consultants engaged • Stakeholder panel:3 of 4 meetings • Learning session (Vermont, Oregon) • Vision, goals, principles • Fundamental design elements laid out • Work Remaining • Implementation plan details • Hear and work through issues of concern to Panel • Finish writing the plan • Community input on draft (early May) • Transmit to Council

4. Transformation Panel Members • Heidi Albritton (City of Seattle) • Tizzy Bennett (Children’s Hospital) • Jane Beyer (DSHS) • Jim Blanchard (Auburn Youth Resources) • Colleen Brandt-Schluter (SeaTac) • Lisa Cohen (WA Global Health) • Shelley Cooper-Ashford (Center for Multicultural Health) • Merril Cousin (Coalition Against DV) • Deanna Dawson (Sound Cities) • David Downing (Youth Eastside Svs) • Bill Hallerman (Catholic Comm Svs) • Jeff Harris, MD (UW) • Patricia Hayden (YWCA) • Ron Jackson (Evergreen Tx Services) • Hyeok Kim (InterIm) • Brian Knowles (Bailey Boushay) • Emily Leslie (City of Bellevue) • Dan Lessler, MD (Harborview) • Sara Levin (United Way) • Julie Lindberg (Molina) • Marilyn Mason-Plunkett (Hopelink) • Mark Okazaki (Neighborhood House) • Nathan Phillips (South King Council of Human Services) • Terry Pottmeyer (Friends of Youth) • Adrienne Quinn (Medina) • Kelly Rider (Housing Development Consortium) • Mark Secord (Neighborcare) • Janet St. Clair (ACRS) • Diane Sosne (SEIU) • Margaret-Lee Thompson (Parent Advocate, Developmental Disabilities)

5. Health & Human Services Evolution • Healthy population centered; further shift of $ upstream • Health & well-being of the individual tied to health of community • Greater focus on social determinants of health • Seamless integration of all services & supports • Robust reporting of quality and outcomes • Pay for value, not volume • Beginning to shift $ upstream – more focus on prevention • High impact strategies • Still minimal integration • Initial reporting of quality & outcomes • Sick care & crisis focus: little $ for prevention • Uncoordinated services not well integrated • Minimal reporting of quality and outcomes • Pay for volume, not value

6. Broad Vision Individuals & Families at the Center… Case management Clinical preventive services Medical & dental care Youth & Family support Mental health & substance abuseservices Job training Long-term services & supports Crisis Intervention Spiritual Financial support . . . And more Developmental disability services Subsidized housing Food banks Info & Referral

7. : High Risk Care Model . . . in the context of their community Affordable, safe, quality housing Early childhood policies Healthy environments Coordinated, efficientsystems Access to living wage jobs Case management Clinical preventive services Medical & dental Youth & Family support Strong, vibrantneighborhoods Mental health & substance abuseservices Access to parks and places forexercise Job training Access to quality education Long-term services & supports Crisis Intervention Spiritual Financial support . . . And more Access to healthy foods (food security) Developmental disability services Housing subsidies Food banks Recovery-orientedenvironments Info & Referral . . . And more Tobacco-free environments

8. Accountability Mechanisms Accountability Through Compacts (Collective Impact) Accountability Through Contracts Group of funders agrees to coordinate RFPs to create 20 supportive housing units, to help end chronic homelessness Individual/Client Level Interventions Funder contracts with a housing program (such as # of clients who retain in housing for 12 months) A group of partners form a coalition to reduce obesity in a neighborhood. Each partner takes different types of actions (funding, policy, etc). Community Level Interventions Funder contracts with an entity for the successful implementation of a safe routes to schools program.

9. Key Design Feature Fewersilos among “individual” delivery level and “community” level work. Instead: a single, supportive structure to integrate across domains for planning, measurement, financing strategies, accountability.

10. A Way to Improve Overall HHS System Performance & Accountability Improve system performance for all by focusing first on those people & places who most need that system to perform well. Leads to improved outcomes for those with the worst outcomes now – and a reduction in disparitiesAnd tells us how well the system overall is doing (sentinel marker – a sort of watchperson)

11. Individual-level Initial Focus • Fast-moving system changes - opportunities to coordinate in new ways for even more value & better client service • Some shared goals, investors, initiatives, & demonstrations already in play • Near-term opportunities to coordinate with State Medicaid • Risk of working at cross-purposes if we don’t do anything • Can’t achieve outcomes unless multiple sectors get aligned 1. Improve outcomes for high need, high risk adults

12. Community-level Initial Focus 2. Improve outcomes for high need, high risk communities • We have place-based initiatives to build upon (how do we make less ad hoc?) • Approach for tackling racial/ethnic and geographic inequities – and measuring change • Strategies must come from the community, be locally owned • Outcomes depend on multiple sectors getting aligned

13. Sample Outcomes That Would Tell Us If the System is Working Better For this group of high risk people, achieve: • Improved housing stability • Improved health status • Reduced CJ involvement • Reduced avoidable hospital ED use • Improved client satisfaction with quality of life • Reduced population-level health disparities For these communities, achieve: • Improved housing • Increased employment • Reduced ACES scores (adverse childhood experiences) • Increased life expectancy

14. Funding and financing strategies • Make best use of existing resources by defining outcomes and aligning resources to support the identified outcomes • Leverage the opportunities provided under the Affordable Care Act • Set the Stage for New Resources

15. Next Steps Next StepsGet organized Leading to . . . Purposeful motion Today

16. 2013 Budget Proviso

17. 2013 Budget Proviso • Due to Council June 26, 2013 • Assessment report and implementation plans “shall be on the integration of the department of community and human services and public health-Seattle & King County” • Goals of this change (from budget preamble): • Create a new integrated model that provides more effective and efficient services • Addresses unnecessary duplication of services • Identifies associated cost savings

18. 2013 Budget Proviso • The Assessment report shall include: • Potential reorganization options, including an option for integrating the two departments into one department • Summary of potential impacts of each potential reorganization option • Summary of potential impacts to clients, providers, and the community • Summary of potential impacts to federal and state contracts and revenue streams, including reporting requirements

19. More information: http://www.kingcounty.gov/exec/HHStransformation.aspx Betsy Jones, King County Office of Executive Dow Constantinebetsy.jones@kingcounty.gov Susan McLaughlin, King County Dept. of Community and Human Services susan.mclaughlin@kingcounty.gov Janna Wilson, Public Health-Seattle & King County janna.wilson@kingcounty.gov