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Advancing Health through Accountable Communities: A Conversation with States
Thursday, July 14, 2016 12:30-2:00pm Eastern
For audio, please listen through your speakers or dial:
(855) 850-0622, use Conference ID: 30594887
Generously supported by the Robert Wood Johnson Foundation
Agenda
12:30-12:40pm ET Welcome, Introductions, and Overview • Jill Rosenthal, Senior Program Director, NASHP
12:40-1:30pm ET Panel Discussion Moderator: Jill Rosenthal, NASHP Panelists: • Sarah Kinsler, Vermont • Barbara Masters, California • Chase Napier, Washington State • Rosemarie Rodriguez-Hager, Minnesota
1:30-2:00pm ET Questions and Answers • Jill Rosenthal, NASHP
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Status of ACH Models State Number
of ACHs Planned
State Entities Leading ACH Initiative
Funding Allocated to Each ACH
Relevant State Delivery System Reform Levers
California 6 • Health and Human Services • Private foundations including:
Community Partners, The California Endowment, Blue Shield Foundation of California, Kaiser Permanente, and Sierra Health Foundation
• $250,000 for Year 1 (2016-17) • $300,000 per year for Years 2-3
(2017-19)
• Two SIM Design Initiatives
Minnesota 15 • Department of Health • Department of Human Services
• $370,000 total for 2 years (2015-16)
• SIM Testing Initiatives
Vermont Up to 14 • Department of Health • Health Care Innovation Project
Team (SIM)
• $230,000 total dedicated to the Peer Learning Lab for 12-14 months (not to individual ACHs)
• SIM Testing Initiative • Pending Medicaid 1115
Demonstration
Washington 9 • Health Care Authority • Department of Health • Department of Social and
Health Services
• $150,000 allocated through state legislation over 1 year (2015) for 2 Pilot ACHs
• $100,000 from SIM award over one year (2015) for 7 Design ACHs
• $810,000 from SIM award for remainder of SIM (2016-2019) for 9 ACHs Post-Designation
• SIM Testing Initiative • State Legislation** • Pending Medicaid 1115
Demonstration
http://nashp.org/state-levers-to-advance-accountable-communities-for-health/
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Why ACHs?
• States are focused on achieving the Triple Aim of improved care, reduces costs, and better health.
• Accomplishing the Triple Aim requires population health initiatives that engage communities in addressing the social factors influencing health.
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What are ACHs?
• Locally driven models that unite an array of key stakeholders to achieve sustainable improvements in health outcomes.
• Common ACH elements: • Individual and population-based health promotion
interventions • Shared vision and goals among partners • Multi-sector partnerships • Established governance structure or leadership • Backbone or integrator organization • Identified community engagement activities/interventions • Ability to perform basic financial and administrative functions • Sustainability planning
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Why are states involved?
• There are state and local roles in establishing key ACH components (e.g. governance structures, geographic boundaries, financing mechanisms, priority conditions and target populations)
• Population health is a key component of delivery system reform
• State resources can be leveraged to support, sustain and spread ACH models
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Today’s Panel
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How does your state’s ACH model fit into larger delivery
system reform?
Tell us what your state is doing at www.nashp.org/statereforum
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The Minnesota Accountable Health Model Accountable Communities for Health
• In 2011, MDH funded community care teams (CCTs) to pilot implementation of community and provider partnerships around care coordination
• 2010 - Development of Minnesota’s Medicaid ACOs – Integrated
Health Partnerships • Accountable Communities for Health (ACH) are innovative strategies
to meet the clinical and social needs of a defined population through person-centered, coordinated care across a range of providers.
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Building a High-Performing Health System for Vermont
Big Goal: Integrated Health System able to
achieve the Triple Aim
All-‐Payer Model (Next Gen-‐type ACO): • Way to pursue goal of integrated
system for certain services and providers.
• Enables Medicare, Medicaid, and Commercial payers to align value-‐based payments for health care.
Medicaid Pathway: • Way to pursue goal of integrated
system for services and providers outside of All-‐Payer Model.
• Enables Medicaid to align value-‐based payment models with All-‐Payer and ACO design.
Complementary Delivery System Reform and TransformaAon Efforts, including… • Blueprint for Health (mulL-‐payer
paLent-‐centered medical homes) • Community Health Teams (CHTs) • CHT Extensions – Hub & Spoke,
Support and Services at Home (SASH) • Regional Governance (Unified
Community CollaboraLves) • Provider Learning CollaboraLves • Accountable CommuniAes for Health
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Vermont: Supporting Regional Innovation
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Let’s Get Healthy California Task Force December 2012
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• SecLon 2703 Health Homes • SecLon 1115 Waiver: Ø Whole Person Care Pilots
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California Accountable Communities for Health Initiative
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Washington’s vision for creating healthier communities and a more sustainable health care system:
Improving how we pay for services
Ensuring health care focuses on the whole
person
Building healthier communities through a collaborative regional
approach
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What is your state’s framework for community
health improvement?
Tell us what your state is doing at www.nashp.org/statereforum
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IntervenAon/Program Time Frame (short-‐long)
Clinical services • Improve adherence to diabetes care guidelines in primary care • Health educaLon and coaching for diabeLcs and at-‐risk populaLons
Short-‐Medium
Community and Social Services & Resources
• Chronic disease self-‐management community programs • YMCA Diabetes PrevenLon Program (DPP)
Short
Clinical-‐Community Linkages
• IntegraLon of community health workers in care teams to work with residents • Referral systems between clinical and community program
Medium
Public Policy & Systems Changes
• Policies implemenLng naLonal nutriLon standards in school meals • Health plan incenLves to encourage implementaLon of diabetes care guidelines
Long
Environmental Changes
• Business-‐resident partnership to increase full service grocery outlets, community gardens & famers markets • Walking and biking paths
Medium and Long
Portfolio of interventions - SAMPLE: DIABETES
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Community Health Improvement in Vermont: Population Health and Prevention Strategies on Three Levels
� Traditional Clinical Approaches focus on individual health improvement for patients who use clinician-based services
� Innovative Patient Centered Care and/or Community Linkages include community services for individual patients
� Community-Wide Strategies focus on improving health of the overall population or subpopulations
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Can you give an example of an intervention that would
be unique to an ACH?
Tell us what your state is doing at www.nashp.org/statereforum
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ACH Case Study in Washington: Cascade Pacific Action Alliance
Approach: • Early identification of needs/risk • Assessment and referral • Coordination between community-
based interventions and treatment services
Youth Behavioral Health Coordination Project Goal: Decrease number of school-aged youth with unmet behavioral and physical health needs
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ACH Intervention in Minnesota
� Unity Family Health Care ACH – Care Coordination model to mitigate substance abuse focused on senior population
� Partnership includes hospital, ACO, public health, social services, law enforcement, local pharmacies, the school district, and substance abuse prevention coalition.
� Early results ¡ Reductions in Medicaid claims for narcotics ¡ Narcotic claims reduced $439,674
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What is your state’s plan for financing and sustaining
ACHs?
Tell us what your state is doing at www.nashp.org/statereforum
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Healthier Washington System Supports • InformaAon Technology / Infrastructure • Data and Measurement • Workforce Development • PracAce TransformaAon • Payment Redesign
Health and Recovery Care
Community Factors Public
Health
Nutritious Food
Transportation
Employment
Education
Crisis Intervention
Family Support
Criminal Justice
Housing Built
Environment Substance
use disorder
Physical Health
Long-Term Care
Mental Health
Oral Health
Developing and sustaining a coordinated system…
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Backbone organizaLon
PorRolio of mutually reinforcing intervenAons Clinical Community-‐Clinical Linkage Community Programs Policy & Systems Environment
& Social Services
Timeframe of IntervenAon Short term Medium term Long term
IdenLfy savings across providers, systems & sectors for potenLal
reinvestment
Wellness Fund
Sustain-‐ ability Plan
Accountable Community for Health
Selected Health Issue: • Health need • Chronic condiLon • Set of related condiLons • Community condiLon
Braiding exisLng funding & programs for intervenLons
Social Services
Business & Labor
Community agencies & residents
EducaLon sector
Health care sector
Public health
Other govt.
agencies
Community CollaboraAve and Governance
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• Vehicle for attracting resources o Public o Private o Health care savings
• Support the ACH infrastructure, e.g. backbone
• Support for interventions—especially upstream prevention activities—for which few resources exist
Wellness Fund
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Sustaining ACHs
� Advocating beyond Medicaid ACOs � Possible legislative allocations � Program Alignment
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Financing and Sustaining ACHs in Vermont
� Current: ACH Peer Learning Lab is technical assistance to interested regions to facilitate visioning, provide an additional framework and set of tools, and engage a broader group of partners. ¡ Regions have significant flexibility in whether and how they explore and
implement this model – a key feature of many of Vermont’s past reforms.
� Future: Key goal of the Peer Learning Lab is to gather lessons learned to inform future State decision-making: ¡ Unified Community Collaboratives expected to continue as core regional
governance; ¡ Next steps in context of All-Payer Model, Medicaid Pathway, and other
care delivery transformation efforts.
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Please describe challenges
your state has faced in implementing ACHs. What
are the next steps?
Tell us what your state is doing at www.nashp.org/statereforum
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Vermont’s ACH Implementation Challenges
� Vermont is on the verge of transformative change with All-Payer Waiver and Medicaid Pathway.
� Health reform fatigue and competing priorities at the community and provider levels.
� Emphasis on local control has resulted in significant variation across communities – a strength and a challenge!
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EvaluaLon Challenges
Grantees are building their ACHs on exisLng collaboraLons and infrastructure, although there are common elements Six grantees are focusing on different health issues: trauma/violence, asthma, and cardiovascular disease/obesity
Different backbones: public health departments, non-‐ profit intermediary, hospital/health care coaliLon
Achieving outcomes in three years, parLcularly with regard to prevenLon-‐related acLviLes
Assessing the cumulaLve/synergisLc impact of a por`olio of intervenLons
For more informaLon, contact: [email protected] 30
Challenges
� ACHs are not required to have an attributable population
� Population Health
� Community Engagement
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Challenges and Opportunities:
• Connecting community supports and upstream health improvement activities to the transformation efforts within the health care system.
• Authentically engaging and empowering community members and consumers.
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Question and Answer
Submit your questions in the chat box on the left
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Webinar slides and recording will be posted to the NASHP website in the coming days.
Resources
NASHP Reports • State Levers to Advance Accountable Communities for Health
http://nashp.org/state-levers-to-advance-accountable-communities-for-health/ • In the Zone: State Strategies to Advance Health Equity by Investing in
Community Health http://nashp.org/in-the-zone-state-strategies-to-advance-health-equity-by-investing-in-community-health/
State ACH Resources • California Accountable Communities for Health Initiative
http://www.communitypartners.org/cachi-overview • Minnesota Accountable Communities for Health
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=SIM_ACH
• Vermont Accountable Communities for Health Peer Learning Lab http://healthcareinnovation.vermont.gov/sites/hcinnovation/files/Resources/ACH%20Peer%20Learning%20Lab%20Recruitment%20Packet%201%2015%202016.pdf
• Washington Accountable Communities of Health http://www.hca.wa.gov/hw/Pages/communities_of_health.aspx
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Thank you!
Please complete our evaluation.
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Continue the discussion online at: http://www.nashp.org/statereforum