P4R Overview

Objectives and Key Parameters

➢ Set list of metrics for DY 3 through DY 5

➢ 6 month reporting periods, beginning 2019

➢ ACHs determine data collection approach that works best for their region

➢ ACHs report data in a State-provided workbook

➢ ACHs are not assessed on performance on these P4R metrics – region receives credit based on collection and submission of P4R metric information by the deadline

State provides measure

specifications and ACH reporting workbook

ACH determines data collection approach

Practice/CBO site provides P4R data to

ACHs

ACH aggregates site-level P4R data and

reports to State

State summarizes P4Rdata, which informs

ACH monitoring reports

Key Parameters

P4R metrics provide more detailed information to HCA and ACHs on partnering provider-level implementation progress

Evolution of P4R Metrics

HCA has been reviewing metrics to determine applicability, relevance and feasibility and developing additional guidance and a streamlined ACH reporting tool

Metrics (subject to refinement based on pre-testing)

Practice/Clinic Site—Project 2A

Assessment of integration of physical and behavioral health care (MeHAFSite Self Assessment tool)

Practice/Clinic Site—Project 3A

Providers are trained on guidelines on prescribing opioids for Pain

Practice/clinic site has EHRs or other systems that provide clinical decision

support for the opioid prescribing guidelines

Mental health and SUD providers deliver acute care and recovery services for

people with OUDs

ED has protocols in place for providing overdose education, peer support

and take-home naloxone to individuals seen for opioid overdose

CBO—Project 3A

Organization site connects persons to MAT providers

Organization site received technical assistance to organize or expand syringe

exchange programs

Key Changes

✓ Eliminated a number of metrics duplicative to information that may be collected through other efforts

✓ Eliminated “All Project” metrics

✓ Revised 2A metric and aligned with existing Healthier Washington Practice Transformation Hub tool widely in use across the state

✓ Edited several metrics for clarity

✓ Two domains:

1) Integrated services and patient and family services (12 characteristics)

2) Practice/organization (9 characteristics)

✓ Each domain has a set of characteristics to rate on a scale of 1 to 10 depending on the level of integration or patient-centered care achieved.

4

Maine Health Access Foundation (MeHAF)

The Maine Health Access Foundation (MeHAF) developed the Site Self Assessment (SSA) Survey to assess levels of primary and behavioral care integration

5

Participants Record Item-Level Responses

Provider Pre-Testing P4R Metrics

HCA is seeking ACHs’ partnership to pre-test P4R metrics andinform additional refinement of P4R metrics by May

Identify 2 partnering provider organizations candidates to test P4R metrics by April 20th

▪ Across ACHs, seeking interview candidates that will represent diversity of characteristics:

✓ Size/Setting: Rural, Small, Large/Mixed

✓ Provider Type: Primary Care, Mental Health Counseling/Treatment, Substance Use Disorder Counseling/Treatment, Community Based Organization

▪ Send 2 primary partnering provider organization candidates and 1 back-up partnering provider organization candidate and which characteristics are applicable to medicaidtransformation@hca.wa.govby Friday, April 20th.

Outreach to 2 partnering provider organizations candidates to test P4R metrics by April 27th

▪ Manatt will share provider outreach materials with ACHs

▪ Manatt may ask for your support in identifying additional, specific types of organizations to ensure representation of the characteristics listed above across ACHs

Participate in provider interview▪ Manatt will facilitate provider interviews, summarize findings and identify areas for clarification and

refinement

▪ HCA will further refine P4R metrics based on feedback

1

2

3

ROLE CLARITY SLIDE

Ad hoc committee vs. future investment and

waiver committee roles

Equitable•Balances equity to all partners with an intended impact

Sustainable• Commits to a long-term vision,

established by foundational infrastructure that is adaptable over time

Transformative•Builds capacity through collaboration across settings while committed to the long-term vision and remaining adaptable

Transparent•Promotes a simple, easy-to-understand model that is adaptable over time and meets special terms and conditions (STC) requirements

Locally responsive• Meets the needs of the Southwest ACH

locality

Funds Flow Guiding Key Principles

Four High Level Funds Flow Categories

ACH AdminCommunity Resiliency

FundRegional Capacity

InvestmentsTransformation Plan

Implementation

• Administrative operating

expenses of SWACH

• Legal

• Financial

• Facilities

• Equipment

• Funds for ACH to make regional

investments that support

partners for specific purposes

including workforce, health IT /

HIE, training, and other

infrastructure funds.

• Funds will be used to promote

large scale transformation and

sustainability across the region.

• Funds paid directly to partners

to plan for and achieve DSRIP

goals and overall

transformation.

• Assessments

• Transformation plans

• Partnership support

• Implementation

support

• Funds investments impacting

upstream factors and

innovative solutions.

How Many Dollars Are There?

$8.7M

FIMC

$?Community

Resiliency Fund

$721,217 – Year 1 (10%)

$? – Year 2

$? – Year 3

$? – Year 4

$? – Year 5

Projects

$7.2M

Year 1

$1.8M

(25%)

$9.2M

Year 2

$?

$7.8M

Year 3

$?

$7.3M

Year 4

$?

$5.9M

Year 5

$?

$4M

(55%)

$? $? $? $?

% to the Community

Resiliency Fund

Regional Capacity Investments

Partners Transformation Plans/Implementation

To support

bi-directional integration across

Clark, Skamania, and Klickitat

Counties

ACH Admin

Year 1 =

$721,217

(10%)

Year 1 Transformation Plan Implementation

$2.3M Implementation

Equity/Stigma Incentive Pool

Partnership Agreements Incentive Pool

Implementation Agreements

$1.7M Planning

Assessments

Transformation Plan

Clinical Partner Assessment closed 4/19/18 COMPLETE

Develop Transformation Plan requirements and Tools for Regional Participants (draft by June 11) 7/2/18

Partner commitments made (commitment requirements in development) 7/31/18

Partners submit Transformation Plans 8/17/18

Clinical Integration Committee re-chartering complete 9/1/18

SWACH implementation plan submitted to HCA 10/1/18

Establish Clinical Integration implementation cohorts (based upon partners with similar transformation plans) 12/31/018

Provider contracts/MOU executed 12/31/18

Promote whole person health and wellness within Clark, Skamania, and Klickitat counties, including focus on integration of physical and behavioral health, care for chronic disease, and addressing the opioid epidemic. Individuals receive Behavioral Health and Physical Health services in each setting and community care linkages are developed.

Bi-Directional Clinical Integration Committee

Objectives

Issue: Clinical Integration workgroup does not currently have representation from all involved parties. Resolution: Plan to re-charter workgroup and membership by September

Risk: Changes from the State and risk that info will not flow to the ACH and providers timely. Mitigation: SWACH staying connected with HCA, legislature, WSHA, WA Academy of Pediatrics, Governor's office, and other ACH’s. Communicate changes to providers.

Risk: Unknown of 3rd payer launching in 2019. Mitigation: SWACH available to help providers navigate and align. Including potential new payers in meetings in SWACH meetings.

Risk: Consolidation of the market - health system affiliations, payer arrangements and impact to the behavioral health market. Mitigation: SWACH available as resource to support providers in making partnership and contracting decisions

Issues/Risks

Decisions Success Metrics

Milestones Target date Status

Description Target Actual Comments

Clinical Partner Assessment Participation 100%

Transformation Plans complete 100%

P4R HCA Measures being defined For 2019 reporting

Target date in jeopardy; intervention required No concerns about target dateTarget date at some risk; monitor closely

Provider reporting system/structure for partners and SWACH Determine Funds flow at partnering provider level-Phase 2 of Funds Flow Pre-Manage implementation for second cohort of behavioral health providers

Bi-Directional Clinical Integration Committee ROLE MATRIX

Transformation PlanDRAFT

ACH Partnering Providers MCO

ASSESSMENT:• Deploy a portfolio of current state assessment(s)

TRANSFORMATION PLANNING:• Develop Transformation Plan requirements and Tools for

Regional Participants • Submit to HCA MTP Regional Implementation Project Plans• Ensure partners meet Transformation Plan requirements• Support regional continuous improvement process• Identify regional workforce shortages and capacity building

solutions • Review local HIE/HIT assessment results • Based on current state assessment results develop regional

strategy to address HIE/HIT

TRANSFORMATION INVESTMENT PLANNING• Review regional transformation plans to identify regional

capacity investments and implementation dollars

ASSESSMENT: • Complete portfolio of current state assessments (HIE/HIT, PH and BH)

TRANSFORMATION PLANNING:• Review and provide input into transformation plan template and guidance• Participate in transformation plan webinar• Develop an organizational level plan to meet transformation requirements

to include identification of target populations, equity/stigma/Trauma Informed supports, partner development, continuous improvement plan, workforce and HIE/HIT needs.

• Ensure leadership sponsor is identified to transformation plan milestones

• Submit Transformation Plan

TRANSFORMATION BUDGET:• Identify initial transformation Plan Budget and Capacity needs

• Support continuous improvement • Support regional HIE/HIT strategy at the

state level• Support each provider to move into VBP

contracts• Support data needs for providers• Performance metrics/measurement

developments• Assist providers to asses and develop a

sustainable business model to whole person care requirements and VBP

Individuals receive Behavioral Health and

Physical Health services in each setting

along SAMSHAs Six Levels of Integration

Physical Heath settings providing Behavioral Health

services

Universal Screening

BH specialist as part of clinical team

Data systems to track outcomes and Pop. Health

Management

Collaborative Care Model

Behavioral Health settings providing Physical Health

services

Universal Screening for physical health

Medical services on site

Enhanced coordination and collaboration with PC

Value Based Purchasing

Community Care Coordination via Pathways

Data systems for Population Health

Management

Workforce Development

Performance Measurements

Increased Screening for BH Needs in Primary

Care SettingsPRIMARY DRIVERS

SECONDARY DRIVERS CHANGE IDEAS

Increased Screening for Physical Health needs in

BH Settings

Standardized Protocols and procedures for close

loop referrals

Integrated team based services

Enhanced coordination with CBOs

Standardized HIE protocols

Performance Based Contracting

Bi-Directional Clinical Integration

Evidence Based Treatment

Integration Learning Collaboratives

Version: 8/22/2018

REDUCE OPIOID DRUG MISUSE

THROUGH CROSS SECTOR

COLLABORATION IN CLARK,

SKAMANIA, KLICKITAT COUNTIES

Prevention

StrategiesOutcomes

Primary DriversSecondary

Drivers

Change Concepts

Version: 8/22/2018

Treatment

Strategies

Training and Support for Providers

Peer Support Services as central to maximize

engagement and support of persons with

OUD

Collaboration / partnership across health care

and community settings

Recovery

Strategies

OD Treatment

Strategies

Culture shift to treatment of OUD as a chronic

brain disease

Trauma Informed Care Framework for Care

Providers

Use of PMP

Telehealth (i.e. Project Echo)

Disposal and Secure Storage of Opioids MTP project overlap with Bi-directional

Integration, Care Coordination, Chronic

Disease Management

Number of MAT Providers in care

settings outside if SUD (Primary,

Hospitals, ED, Specialists etc)

Team model of engagement and care

Increased Peer Support Services

Increased Distribution of Naloxone

Increased Access to Naloxone

Increased MAT initiation sites (Primary

Care, ED’s, Hospitals, HRC, etc)

Increased Tx Access Points in Clinical

and Community Settings

Peers Access in Clinical Settings

Health Equity Framework for Care Providers

Reimbursement Transition to VBP

Training and Technical Assistance

Leverage Data for Rapid Cycle Continuous

Improvement

Address and Reduce Stigma

SWACH Driver Diagram for Opioid Response