The document summarizes recent health care reforms in Washington state. It discusses the expansion of Medicaid, challenges in accessing care, and the state's plan to transform the health care system by 2020. The goals are to pay providers based on the value and outcomes of care instead of volume, better integrate physical and behavioral health, and empower communities to improve health. Key steps taken include legislation supporting purchasing reform and integrated whole-person care, and establishing Accountable Communities of Health to drive regional health improvements.

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Latino Health Forum
October 9, 2014
Daniel Lessler, MD, MHA, FACP
Chief Medical Officer
Health Care Authority

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This is the first page to get started.
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LEGEND
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NEW 2018
TARGETS
Garfield
Thurston
Clallam
Grays
Harbor
Mason
Jefferson
Whatcom
San Juan
Island
Kitsap
Skagit
Snohomish
King
Pierce
Pacific Lewis
Wahkiakum Cowlitz
Clark
Skamania
Chelan
Kittitas
Yakima
Klickitat
Douglas
Oreille
Grant
Benton
Adams
Franklin
Walla
Walla
Whitman
Columbia
Asotin
Medicaid Expansion Enrollment Targets for January 1, 2018
Total New Adult Clients = 326,447*
Target for January 1, 2018 = 252,576
Percent of 2018 Target Met
Statewide = 129%
Between October 1, 2013 and June 5, 2014
Percent of goal met
ADULT
CLIENT COUNT
1,018
11,195
2,061
27,905
11,970
202
89,841
4,356
10,229
36,630
185
2,714
5,906
1,918
1,013
28,894
1,271
3,767
2,591
19,809
1,147
455
4,434
2,955
967
2,268
676
2,946
72
4,242
4,105
5,585
8,206
420
16,091
4,148
387
2,194
1,674
*109 additional clients do not map to Washington counties.
ON
TRACK
OFF
PACE
SOURCE: Washington State Health Care Authority, June 10, 2014 – based on 2012 estimates.
100% or higher 90 to 99% 80 to 89% 70 to 79% Under 70%

4. Apple Health (New Adults) Enrollment by Race/Ethnicity,
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29%
through Sep 11, 2014
* The Hispanic category includes all enrollees who indicated they are of Hispanic origin regardless of their race.
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5. HHeeaalltthh CCaarree RReeffoorrmm
• With implementation of the Affordable Care
Act, HCA will purchase care for approximately
2 million Washington residents.
• We must move ahead with coverage
improvements, but they will be unsustainable
if we do not change the cost of care.

6. Budget Challenges – the Washington View
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7. Challenges in Access to Care and Services
 Medicaid delivery system silos
 Fragmented service delivery - integrated care requires infrastructure &
EXISTING DESIGN NOT SUSTAINABLE
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capacity development
 Incentives & reimbursement structures not aligned to achieve outcomes or
value – for purchasers, payers, providers & communities
 Further home & community service balancing needed for supported seniors &
individuals with a disability
 Social determinants of health – attention to “prevention” needed in the
broadest sense

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• 8 month planning process
• 12 state agencies
• More than 100 meetings & public presentations
• Hundreds of thought leaders engaged through the
state
• Dozens of hospitals, clinics, community organizaitons
• 770+ Feedback Network members
• Funding from CMMI
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10. State Health Care Innovation Plan - Transformation by 2020
Goal - a healthier Washington
Pay for value and outcomes instead of
volume of services
Integrate physical and behavioral
health to address the needs of the whole person
Empower communities to improve health
and better link with health delivery
Critical Legislation Enacted in 2014
•E2SHB 2572 – Purchasing reform, greater
transparency, empowered communities
•2SSB 6312 – Integrated whole-person care;
purchasing and delivery system reform
Potential for Federal Financing
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http://www.hca.wa.gov/shcip/Documents/SHCIP_InnovationPlan.pdf

11. Transition to Increased Performance Risk
Future alternative payment methodology that supports innovation and rewards improved health
outcomes over volume of services delivered – see: http://www.hca.wa.gov/Pages/leg_reports.aspx.
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Current System
Based on volume not value
Performance measurement (and
data) difficult to obtain
Administratively onerous to clinics
and State
Payment system/financing not
predictable
Little accountability with no
shared savings
Inhibits innovative approaches to
care (e.g., group visits,
telemedicine, integrated/
coordinated care)
Multiple payment methodologies
implemented in response to
legislative direction
Future System
Based on value not volume (incentives
tied to health outcomes)
State-wide performance measures
based on data
Administrative simplification for clinics
and state
Prospective/predictable budgeting for
clinics and state
Accountability clear with opportunities
to share in savings
Rewards innovative approaches to care
(e.g., group visits, telemedicine,
integrated/ coordinated care)
Sustainable payment methodology
grounded in principles developed
through collaborative process with a
shared vision
The Bridge Challenge:
Transition Support/Capacity
Building
Systems for tracking services and
total cost of care
Data capacity improvements
Modernized service delivery, with
EHR ramp-up
Cooperative support and incentives
for practice transformation
Increased uniformity of payment
Workforce flexibility and training

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Behavioral Health Integration
• Integrated funding with shared resources
• Leadership support for integration as driving
model of operations
• Physical and behavioral health needs treated
collaboratively for all persons
• Consistent communication and collaboration
• Roles and cultures that blur or blend
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Accountable Communities of Health (ACH)
Collectively impact health through regionally driven priorities and
solutions
Medicaid purchasing alignment
Develop a region-wide health assessment and regional health
improvement plan
Driver of accountability
for results
Forum for harmonizing
payment models,
performance
measures and investments
Health coordination and
workforce development

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Why regional service areas?
•Leverages public purchasing to share accountability for
performance results across delivery systems
•Empowers “local” innovation - payment models,
performance measures, workforce development, health
care coordination with community services & support and
investments – and engages communities in local priorities
•Enhances opportunities for cross agency efforts around
common populations (especially those with high-cost,
multiple, health and social service system needs)
•Builds on lessons from current regional endeavors –
health homes, RSNs, community-based organizations,
service referral patterns, etc.

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 Federal Grant of $92.4 million requested end of July 2014
 Anticipated late-October announcement for 1/1/2015 start date
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17. QQUUEESSTTIIOONNSS??
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Daniel Lessler, MD, MHA
Chief Medical Officer
Health Care Authority
360-725-1893
Daniel.Lessler@hca.wa.gov