Jenny Hamilton, MSG Project Manager, Washington State Health Care Authority

1. WA State Role in Developing Accountable Care OrganizationsNASHP Annual State Health Policy ConferenceOctober 5, 2011 Jenny Hamilton, MSG Project Manager, Washington State Health Care Authority

2. The “Why” and “What” for WA State • State budgets – driven by health purchasing costs & revenue shortfalls • Health system status quo unsustainable • Leveraging state roles as purchaser, regulator, & licensor • Facilitator/convener for payment reforms with multiple payers • Governor’s 4% challenge & request for federal flexibility – Health Innovation for Washington Hamilton

3. Key State Roles in ACO Development* • Developing new data capability • Designing & promoting new payment models • Fostering use of accountability measures • Identifying & promoting systems of care • Supporting a continuum of care & role of medical/health home models * from NASHP report “On the Road to Better Value: State Roles in promoting ACOs”, February 2011 Hamilton

4. Developing New Data Capability • Governor’s five point plan (2005) includes data transparency • Medicaid Predictive Risk Intelligence System (PRISM) • Puget Sound Health Alliance (PSHA) Community Checkup • HITECH coordination, HIE development • All payer claims database? Hamilton

5. New Payment Models • Multiple payer, payment reform pilot • Public private collaboration (7 health plans, 8 practices, 25,000 patients) • Performance outcomes (reductions in avoidable ER use & avoidable hospitalization) • Key challenges • Consolidation of public purchasing (HCA) • ACA opportunities • Health Innovation for Washington requests for federal flexibility Hamilton

6. Fostering Accountability Measures • Puget Sound Health Alliance – resource use measures – Dartmouth Atlas frame • Multi-payer pilot outcomes • Consolidated state health purchasing & self funded plan third party administrator (e.g., eValue8) • Beacon community coordination • Discussions with Oregon – focus on metrics Hamilton

7. Systems of Care & Health Home Models • Primary care health homes & new legislation • ACA funding – planning for dual eligibles integration/shared savings & health homes • Expansion of Boeing Intensive Outpatient Care Program (IOCP) model with public employees and other purchasers • Legislation for ACO pilot design • Organic interest in regional health authorities Hamilton

8. Opportunities & Lessons • Build on/acknowledge previous experience • Be realistic about time-lines & expectations • Payment reform much harder than envisioned • Challenge to health system status quo (technical, political, etc.) – data are key • Stakeholdering time-consuming but critical • Coordination of ACA opportunities essential • Private sector opportunities & collaboration Hamilton 8

9. Additional Resources • PSHA community checkup: http://www.wacommunitycheckup.org/ • ACO legislation (ESSB 6522) & pilot: http://apps.leg.wa.gov/documents/billdocs/2009-10/Pdf/Bills/Session%20Law%202010/6522-S.SL.pdf http://www.hca.wa.gov/accountable_care.html • Multi-payer medical home pilot: http://www.hca.wa.gov/medical_homes.htm • Governor Gregoire’s health reform site:http://www.governor.wa.gov/news/news-view.asp?pressRelease=1469&newsType=1 • Health Innovation for Washington:http://www.governor.wa.gov/priorities/healthcare/default.asp Hamilton

10. Questions? " When you come to a fork in the road ....Take it “ Yogi Berra Hamilton