PIP Presentation. March 13, 2018

Transcription

1 a PIP Presentation March 13, 2018

2 Public Comment

3 Strategic Improvement Strategy 3

4 Accelerating Change and Sustainability Improvement Methodology Change Package Focus Areas 4

5 Science of Improvement The science of improvement is an applied science that emphasizes innovation, rapid-cycle testing in the field, and spread in order to generate learning about what changes, in which contexts, produce improvements. It is characterized by the combination of expert subject knowledge with improvement methods and tools. 5

6 Model for Improvement 6

7 Accelerating Change and Sustainability Improvement Methodology Change Package Focus Areas 7

8 Describe the Transformed System Change Concepts general ideas used to stimulate specific, actionable steps that lead to improvement Patient-Centered Medical Home o Engaged leadership o Quality improvement strategy o Empanelment o Continuous and team based healing relationships o Organized, evidence based care o Person/family engagement o Enhanced access o Care coordination 8

9 Accelerating Change and Sustainability Improvement Methodology Change Package Focus Areas 9

10 Focus Areas from Rules of Engagement Behavioral Health Integration Opioid Misuse Treatment Chronic Disease Management Maternal and Child Health Oral Health Integration Diversion Transitions 10

11 Investments & Resources Strategic Alliance Partnership with the Institute for Healthcare Improvement (IHI) Improvement Advisor Professional Development training o MultiCare o CHI Franciscan o CHC Tacoma o Tacoma Pierce County Health Department o Metropolitan Development Council o Comprehensive Life Resources o HopeSparks w/pierce County ACH 11

12 More Resources and Investments Life Qi Project Management Tool Wa Portal Learning Community Pierce County ACH Improvement Advisor staff Partnership with Qualis-Hub 12

13 Assessment and Action Plan System Change Concept Behavioral Health Integration Opioid Misuse Treatment Chronic Disease Management Maternal & Child Health Leadership Engagement Quality Improvement Strategy Empanelment Team-Based Care Organized, Evidence- Based Care From the Rules of Engagement Person/Family Engagement Enhanced Access Care Coordination 13

14 Kathleen Clark Director of Strategic Improvement Pierce County ACH

15 Funds Flow & Sustainability 15

16 Distribution of Funds Project Incentive Funds (Y1 Y5) ACH DSRIP Systems Capacity management Building Fund Pay out to partners (Regional investments) Community resiliency fund In February, the Waiver & Investments Committee will recommend process, payment guidelines and payment methodology. 16

17 How Many Dollars Are There? $9.9M FIMC $11M Year 1 $17M Year 2 Projects $14M Year 3 $13M Year 4 $11M Year 5 $6.6M Community Resiliency Fund To support bi-directional integration across Pierce County Oct 2017 Board approves allocating half of the money to trust account for the Pierce County Governing Board to distribute Mar 2018 ACH to receive first year payment of $3.9M To regional infrastructure $4.9M To Partners $5.6M $4.3M $3.9M $3.7M $4.0M $8.1M $7.0M $6.6M $5.2M 10% to the Community Resiliency Fund 7.5% to Admin + 1.5% to B & O = 9% $1.1M Year 1 $1.7M Year 2 $1.4M Year 3 $1.3M Year 4 $1.1M Year 5 17

18 Year 1 Distributions to Partners 91% out to the Community Total Incentive Funding: $14.9M Administration $1.1M $13.80 $1.10 FIMC Funds to Pierce County Resiliency Fund to support Community Partners Strategic Improvement Investments Pathways HUB Investment (including direct payments to Partner CCAs) Payments to Partners/Project Funds HIE/HIT Other Regional Investments Initial Investments - Capacity Building Investment ($28,750) Community Health Worker Collaborative of Pierce County - Tacoma Pierce County Department of Health (CHNA/CHA)($2,050) $1.6M $1.5M $1.0M $1.5M $4.0M $2.9M $1.3M 7.5% to Admin + 1.5% to B & O = 9% 18

19 2018 Funds Flow Overview $4.0M to Partners $4.9M to Regional Infrastructure $1.1M to Community Resiliency Fund $3.9M FIMC TIMELINE: February 14 th : Initial estimate from the HCA of 2017 Project Incentives. February 15 th : Waivers & Investments Committee reviewing and providing recommendation to the Board for Year 1 Funds Flow Methodology February 20th: Board reviews Year 1 Funds Flow March 20th: Full Board approval of Year 1 Funds Flow March: First payments to Partners for completing Regional Inventory and Letter of Intent May: Payments to Partners for COMPLETION of portfolio of assessments. June: Payments to Partners for action plan COMPLETION 19

20 What s the Work of Interested MTP Participants in 2018? 1 Complete Portfolio of Assessments 2 Develop Individual Implementation Action Plans 3 Complete Binding Partnership Agreements HIT/HIE Organizational Current State Assessment of the Partner Organization Transformation Assessment Receive Implementation Change Package Tools Settings AIM Problem Partnerships Equity Outcomes Measures Change Ideas Initial resources required Details of this agreement/contract is dependent on state guidance. Complete your individual Partner agreements 20

21 Funds Flow Methodology Guiding Principles Flexible Able to flexibly change over time, by partner size and accepted project risk Equitable Balances equity and fairness to all partners with intended impact Locally responsive Meets the needs of the locality even within the same provider (i.e. urban versus rural) Compliant Meets criteria in the Special Terms and Conditions (STCs) Simple Transparent and clear methodology that is easy to understand Collaborative Motivates and encourages partnerships and the right behaviors Sustainable Promotes long term transformation Adopted by W&I Committee as part of KPMG Funds Flow Project 21

22 Funds Flow Methodology GOALS Incentivize both healthcare and social determinant of health partners that have been and will be instrumental in the achievement of improved Medicaid Population health outcomes and will contribute to the sustainability of statewide and regional Health System transformation and Value Based Payment adoption For 2018 Funding o o o o o Focus on investing for planning Balance recognition of Provider/Partner commitment Offset realized and anticipated expenses for planning Encourage long-term partner participation and buy-in Provide flexibility to Partners to begin implementation 22

23 Funds Flow Methodology MODEL Base funding incorporates participation, commitment, assessment, and completion of implementation change plans Formulates a tiered methodology for distribution pools that includes fully committing to a partnership with the ACH, encourages cross-sector collaboration, acknowledges high volume Providers and rewards addressing health equity Establishes outcome criteria to earn funds (Commitments, Participation, Implementation Action Plans) GOVERNANCE PROCESS Model discussed and recommended by Waiver & Investment Committee Final approval by Board of Trustees 23

24 Initial Participant Allocations $4.0 Million available in

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26 Single Dimensional Norm Changes Silver $10k DEFINITION Describes organizational readiness to participate in developing strategies that promote health equity, stigma reduction, and equity-focused care through awareness, and required education, and training. GOALS: Equity-oriented improvement efforts imbedded into the organization s knowledge base. CHARACTERISTICS./ As an Organization identify ways in which you will seek to better understand the populations and communities we serve./ Agree to require all staff opportunities social and environmental effects on overall health and health care outcomes./ Provide opportunities and require staff to be trained on how to be more culturally competent and reduce behavioral health stigma./ Organizations and stakeholders may develop or modify some joint activities to better meet the common goals./ Share information and/or coordinate activities together so there are no conflicts Policy & System Changes Gold $25k DEFINITION Describes the organizational readiness to participate in implementing strategies that promote health equity, stigma reduction, and equity-focused care through awareness, and required education, training, improvement priority setting, and policy and system changes. GOALS: Equity-oriented improvement efforts imbedded into the organization s knowledge base, improvement priority setting, policies and systems, and daily work. CHARACTERISTICS./ Adopt a public zero tolerance policy on all forms of discrimination, including behavioral health stigma;./ Adopt the IHI Achieving Health Equity framework 1, specifically committing to reducing institutional racism./ Adopt hiring and workplace strategies that make our organization more accurately reflect the communities in which we work and those who experience the most health disparities./ Work towards the collection and use of REAL (Race, Ethnicity, and Language) data, plus data on the causes of health disparities./ Consider the multiple determinants of health when designing quality improvement work. In the design of transformation quality improvement efforts Multi-Dimensional Equity in All Policies & Partnerships Platinum $50k DEFINITION Describes the organizational readiness to participate in implementing strategies that promote health equity, stigma reduction, and equity-focused care through awareness, and required education, training, improvement priority setting, policy and system changes, and partnerships with community members and community-based organizations for health equity and social determinants. GOALS: Equity-oriented improvement efforts imbedded into the organization s knowledge base, improvement priority setting, policies and systems, daily work, and deep community partnerships. CHARACTERISTICS./ Create health system and community partnerships that keep health equity in the forefront as an overarching guiding principle;./ Partner with vulnerable communities to ensure they have a clear voice in the policy decision processes, including at town halls, community gatherings, and in community advisory panels./ Hire health ambassadors and/or community health workers who are community members trained to promote community care coordination and support healthy behaviors in the community./ Develop community-clinical linkage partnerships for neighborhood-based healthy activities and programs 1 IHI Framework for Improving Health Equity ( 26

27 Distributions for Planning Year Example 2: Community-Based Organization Community-based organization; completes Action Plan and binding Partnership agreement; enters into strong partnerships with other organizations on bi-directional integration Regional Inventory Letter of Intent Portfolio of Assessments Change Plan Binding Partnership Agreement Pool Partnership Integration Pool Settings/Services Base Total Total Community-Based Organization $ 2,500 $ 1,500 $ 5,000 $ 10,000 $ 19,000 $ 25,000 $ 50,000 $ 94,000 Additional Funding If you are a Pathways CCA: *CHW FTE support up to $150,000; HUB technology platform, training of CHWs Community Resiliency Fund grants *TBD based on projects identified in Action Plans that impact social determinants of health and sustainability of transformation work 27

28 Distributions for Planning Year Example 1: Behavioral Health Org with SUD Behavioral Health organization with SUD clinics; 10,000 Medicaid lives; achieves Equity requirements at a Gold level Regional Inventory Letter of Intent Portfolio of Assessments Change Plan Binding Partnership Agreement Pool Volume Equalizer Equity Accelerator Settings/Services Base Total Total Behavioral Health with SUD $ 2,500 $ 1,500 $ 25,000 $ 40,000 $ 69,000 $ 25,000 $ 50,000 $ 25,000 $ 169,000 Additional Funding If you are a Pathways CCA: CHW FTE support up to $150,000; HUB technology platform, training of CHWs Strategic Improvement: TBD based on needs identified in Action Plan HIE/HIT investments: TBD based on needs identified in Action Plan 28

29 Payment Milestones NOV February March April May June Phase 1: Regional Inventory and Initial Letter of Intent Phase 2A: Clinical Organizational Current State Assessment Phase 3: Community Current State & Transformation Assessment/Planning COMPLETED HIT/HIE Clinical Partners Community Based Organizations & Public Service Partners Phase 2B: Clinical Transformation Assessment/Planning Community Feedback Implementation Change Plans NOTE: Payment schedule contingent upon completion of each phase Assessment Partner Key Health Systems/Clinics Community Based Orgs / & Public Service Partners 29

30 Alisha Fehrenbacher CEO Pierce County ACH

31 Pathways Update

32 PREGNANT CLIENT Click to edit HUB Master text styles Second level Regional Organization and Tracking of Care Coordination Third level COMMUNITY Fourth level Fifth level Agency A Agency B Agency C Agency D CARE COORDINATION AGENCIES CARE COORDINATOR CLIENT Demographic Intake Initial Checklist -- assign Pathways Regular home visits Checklists and Pathways completed Discharge when Pathways completed (no issues) 32

33 Pathways Update Training for 8 Community Health Workers commenced Monday, 3/5 in partnership with DOH and Foundation for Healthy Generations Administrative work session with Care Coordination Agency partners last week, finalizing contract and administrative documents Dr. Sarah Redding on-site for training, working with PCACH staff on policy questions, finalizing target population risk factors beyond pregnancy Work underway to engage with community/stakeholders, assure alignment with other programs, engage providers 33

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35 Kyle Davidson Director of Health Transformation Pierce County ACH

36 Questions?

37 Public Comment

38 Thank you