Accountable Communities of Health:

Examples

November 13, 2014Jefferson Ketchel, MA RS

Administrator,Grant County Health District

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In This Presentation I Will:

Review HCA’s statements on what is an Accountable Community of Health (ACH).

Review the plans of 4 other communities who are working to develop an ACH in their areas.

Discuss ACH and non-ACH options.

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ACHs as described in SHCIP Washington will designate no more than nine regional

service areas…within naturally occurring communities of health.

These regional service areas will drive accountability for health by defining the structure for health and community linkages, be a foundational component of a State “Health in All Policies” approach, and serve as new Medicaid service areas for physical and behavioral health.

This approach recognizes health care is local and aims to empower local and county entities to develop bottom-up approaches to transformation that apply to community priorities and environments, guided and supported by state goals and supporting resources.

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ACHs in the SHCIP, continued ACH is a regionally governed, public-private

collaborative that supports mutually aligned actions across sectors and systems.

ACH participants are envisioned to include public health, health, housing, and social service providers; risk-bearing entities; county and local government; education; philanthropy partners; consumers; Tribes; and other critical actors within a region.

Organizational and governance structures will not be dictated at the State level...however, no single entity or sector may dominate.

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ACHs in the SHCIP, continued

ACHs are not intended to: Be a one-size-fits-all approach. Add “approval” layers or act as a

regulatory body. Supplant government entities, such as

local Boards of Health. Divert state general funds otherwise going

to local entities.

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ACHs in the SHCIP, continued

ACH Responsibilities: Partner in Medicaid purchasing Develop a region-wide health assessment

and a regional health improvement plan. Drive accountability for results through

voluntary compacts. Act as a forum for harmonizing payment

models, performance measures, and investments.

Health coordination and workforce development.

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ACHs in the SHCIP, continued

State Responsibilities to ACHs: Funding and technical support. “Health in All Policies” across multiple

state agencies, align state agency activity across regions.

Engage ACHs in Medicaid procurement design, assessment, and meaningful oversight.

Health Mapping Partnership designed with local leaders; data and tools needed to support community hot-spotting efforts and cross-sector policy decisions.

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ACHs in the SHCIP, continued

State Responsibilities to ACHs: “Best in class” transformation support

tools through a combination of regional and statewide resources and learning.

Explore new financing tools and seed funding for cross-sector innovation in partnership with regional partners.

Check and adjust as experience is gained.

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ACHs in the SIM Grant Washington will invest in Accountable Communities of

Health (ACHs) that will develop a sustainable presence in their communities and partner with the state to achieve the project’s goals.

ACHs will provide the organizational capacity for local communities to implement the plan for population health, link community supports with practice transformation, and enhance local data collection and analytic aptitude.

To ensure return on this investment, ACHs will be held accountable for performance results and rapid-cycle learning and improvement.

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ACH timeline in the SIM Grant

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Seven-Region Straw Man (SHCIP)

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ACH Planning in SIM Grant

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RSA Designation

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Next: Four ACH Initiatives North Sound Accountable Community of

Health – Whatcom, Skagit, Snohomish, San Juan and Island Counties

King County Region ACH Better Health Together – Spokane, Pend

Oreille, Stevens, Ferry, Lincoln, Adams and Whitman Counties

Southwest Washington Regional Health Alliance – Clark, Skamania and Klickitat Counties

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North Sound ACH Whatcom Alliance for Health Advancement

15Thanks to Larry Thompson, Executive Director Whatcom Alliance for Health Advancement, for this information.

North Sound ACH

Regional Challenges: Building trust and confidence across region. What’s an ACH and what can it do for me? Managing the scale and logistics.

ACH Planning Outcomes Work together across sectors Regional plan with manageable number of

actionable priorities Deep and wide community engagement.

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Early Initiatives: Care Transitions: Improve transitions from hospital

to community to reduce readmissions. 2400 pts served over 2 years 38% reduction in readmits among pts served

Intensive Case Management for Hot Spotter Population: Improve health, reduce expenses for 500 most expensive pts. 7 months experience as of September 2014 ER visits down 68% Hospital admissions down 88% Incarcerations down 83%

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North Sound ACH

King County Region ACH How might ACH advance things we’re already

working on in King County region, such as . . . Adults with complex behavioral & health conditions making

frequent use of King County jail Communities of Opportunity - a place-based initiative to improve

health, social, racial, and economic factors Physical/behavioral health integration Care transitions efforts Expanding housing and health partnerships, with a focus on

community health worker partnerships and on increasing supportive housing

Community health assessment activities - King County Hospitals for a Healthier Community, Community Health Indicators, Communities Count

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Thanks to Janna Wilson, Public Health – Seattle & King County, for this information.

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King County ACH, continued

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Results, King County Childhood Obesity Initiative

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Better Health Together – Spokane Area

22Thanks to Alison Carl White, Executive Director, Better Health Together, for this information.

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What IS an Accountable of Community Health?

A diverse public private collaboration that aligns voluntary action to meet local needs

A way to attract and leverage new resources for the local region

A synthesizer of data to prioritize local action A practical “Connector” of multi-sector partners to the

State for feedback on implementation decisions to ensure local level alignment

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Key Goals of Planning Grant

Conduct 7 county engagement activities to identify strengths, lessons learned and emerging best practices

Develop strategic plan, governance structure and agree on a regional scorecard

Create a “Community Health Plan”

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Our Approach Leadership Council helped us identify the right

stakeholders and leaders Conducting Key Community Interviews and Focus

Groups across 7 counties Gathering of 125 regional health and community

leaders to build our Collective Agenda for Health Leadership Council synthesizes findings and

recommends priority strategies and activities for ACH plan

Determine viability of pilot application

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Regional Council

Broad based gathering of regional stakeholders to identify needs, promising practices and emerging best practices

Leadership Council

30-40 CEO/VP/Director level representatives of stakeholders meet to synthesize community needs and recommend priorities

Board of Directors

15 member board that ensures effective organizational governance of policy, fiscal, and mission

Better Health Together Staff Team

operationalizes and leads agreed up on goals and strategies

Our Structure

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2 years from now we will:

• Improved 2 health outcomes across our community

• Created 3 system improvements that allow better care for our community

• Saved dollars and reinvested it in health prevention and system improvements

SW Washington Regional Health Alliance

Clark, Skamania and Klickitat Counties Developing a model for complete integration, which

includes using community health workers as a community based prevention strategy.

Will pilot the model with a population of high utilizers with comorbidities in mental health, substance use disorder and chronic physical conditions, such as diabetes and chronic respiratory disease. 

Comprehensive regional community health needs assessment as well as a plan to map out services, gaps and community assets.

28Thanks to Alan Melnick, Director and Health Officer, Clark County Public Health, for this information.

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SWWA Regional Health Alliance

Strategic Goals

We will fulfill our mission by serving as the ACH for the SWWA region. In this role, the RHA hopes to accomplish the following specific goals:• Improve the health of our population

o Establishment of population health outcomes based metrics and achieve 100% compliance by 2020

• Improve the experience of care for our populationo Establishment of access metric and achieve 100% compliance

by 2020• Reduce the per capita costs of care for our population

o Establishment of PMPM and achieve 100% compliance by 2020

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RHA System Role

ProvidersPayers and Providers

Purchasers and Consumer Reps Consumers

Regional Health Alliance

Healthy Living CollaborativeFacilitators

Integration

RHA Clinical

Workgroup

HLC Community

Linkages Workgroup

ACH Pilot Team

ACH Pilot

Early Adopter

Alignment

WA Healthcare Authority

Trans-formation

Hub

Early Adopter

System service

mapping

Region-wide needs

assessmentACH Model

SWWA System

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RHA Work Groups

Governance

Clinical

Technology, Analytics & Reporting

Policy

Finance

Communications & Outreach

Triple Aim---

Address Social Determinants of Health

Governance

Clinical

Technology, Analytics & Reporting

Policy

Finance

Communications & Outreach

• RHA alignment and role clarification for Early Adopter and Medicaid Integration

• Infrastructure to monitor performance; incentive structures

• Infrastructure to achieve RHA mission; e.g. staff, board, contracting, etc.

• Needs assessment & system map

• ACH pilot • Evaluation model

• Performance incentive model

• Reinvestment of cost savings in services

• ACH Pilot • Integration model • Quality and access

measures

• Identification of ACH pilot target population

• IT/IS gap analysis

• Integrated HIE/analytics platform

• Data sharing, health information exchange, performance analysis platforms

• RHA strategies in alignment w/ State

• Legislative outreach strategy

• Communication/ alignment w/ State

• Legislative drafts if needed

• Legislation for RHA mission if applicable

• Sustainability strategy• Incentive alignment w/

State alternative pmt.

• Performance incentive model aligned w/ State alternate payment system

• Performance incentive model

• Stakeholder communication and outreach strategies

• Community/consumer engagement platform

• Community/consumer engagement model

Plan(2014-2015)

Develop/Test(2015-2016)

Implement/Evaluate(2016-2020)

RHA Roadmap: By Work Group

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SWWA RHA Board of Directors:

o President-Jon Hersen- Vice President Legacy Health System Healthcare Transformation

o Vice President- Jared Sanford – Executive Director for Lifeline Connectionso Secretary-Vanessa Gaston, Director Clark County Community Serviceso Treasurer- Cindy Robertson – Administrator for NorthShore Medical Groupo Kevin Barry- Director Klickitat County Public Health o Kirby Richards– Director Skamania County Community Health o Di Lacey – Director for Strategy, Innovation & Development PeaceHealth o Kevin Witte- Associate Vice President, Corporate & Continuing Education-Clark Collegeo Ma'ata Latu- Director of Provider Relations for Coordinated Care Corporationo Alan Melnick-Public Health Officer and Director for Clark County Public Healtho David Kelly – Executive Director SWWA Area Agency on Aging & Disabilityo Karen Lee – CEO for Columbia United Providerso Dian Cooper – CEO for Cowlitz Family Health Centero Steve Kutz- Deputy Director Cowlitz Tribe Health & Human Serviceso Sharon Crowell, MD – Board Chair, The Vancouver Clinico Brad Berry – Executive Director for Consumer Voices Are Borno Erin Hafer – Manager for New Program Integration, Community Health Plan of WAo Laurel Lee – Chief Operating Officer for Molina Healthcare of WAo Andy Silver – Executive Director for Council for the Homelesso Frederico Cruz-Uribe – VP of Clinical Affairs, SeaMaro Duane Rogers - North Service Area Director for Kaiser Permanenteo Rick Weavers – CEO, Comprehensive Mental Health/Representative from Greater

Columbia RSNo Connie Mom-Chhing – CEO, SWBH RSN

Observations on these ACH efforts: They are further along in the sense that

they’ve decided they definitely want to become HCA-designated ACHs.

Their populations are larger than ours. Some have developed boards, governance

plans and workgroups. Some have already implemented successful

health improvement initiatives. But they’re still dealing with many of the same

start-up issues we have. Risk-bearing not in the plans.

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Some ACH Options Eventually, we’ll be part of an ACH.

We could attempt to create a North Central Washington ACH.

Or we could let the ACH situation develop and see where we end up.

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But an ACH is not the only issue.

Whatever we or HCA do about ACH coverage for this area, we want to have collaboration.

Aside from the ACH issue, we could decide to move forward together on important health care and population health improvements.

We could attract additional funding when possible, but begin with existing resources.

If funding does become available from ACA savings, we’d be well positioned to use it – whatever our ACH status.

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Initiatives by health collaboratives: Mental Health Integration Diabetes care coordination High utilizer care coordination Obesity in children Health in All Policies Housing initiatives ACEs or trauma-informed initiatives Community Health Workers Community health assessments & plans …and others.

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What if… We became a Healthy Community Collaborative. We acted as a coordinating body for a set of

Workgroups, each of which took responsibility for a health initiative.

Each Workgroup would have staff assigned to it by participating organizations. For example, public health and/or ESD would assign a

professional staff member to support the Childhood Obesity Workgroup. Not to run it, to support it.

To make sure it was well organized and used best practices. Each Workgroup would have actionable goals and measures.

We can do this with or without an NCW ACH

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So…2 questions for discussion:

Become a Healthy Community Collaborative?

To ACH or not to ACH?

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Thanks for listening.

Contact Information:

Jefferson Ketchel, AdministratorGrant County Health District

1038 W Ivy #1Moses Lake, WA 98837

509-766-7960 X28jketchel@granthealth.org

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