Welcome and Opening Remarks - Laura Zaichkin
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The current healthcare system separates physical, mental, and chemical dependency services, focuses on volume over quality, and costs are rising without improved outcomes. A better system would integrate services, emphasize coordinated and high-quality care over service volume, and reduce costs through effective services. The Healthier Washington initiative aims to build this better system through measures like accountable communities of health that bring together regional stakeholders, integrating physical and behavioral healthcare, and using data and payment reforms to incentivize value-based care focused on the whole person. The ultimate goals are better health, better care, and lower costs for Washington residents.
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Welcome and Opening Remarks - Laura Zaichkin
- 1. Working Together for a Healthier Washington Laura Kate Zaichkin Administrator, Office of Health Innovation and Reform Washington State Health Care Authority
- 2. Why do we need health systems transformation? • Separates the “head” from the “body” —no integration between services for physical health, mental health and chemical dependency. • Focuses on volume of services provided, not quality of outcomes. • Is expensive, and getting more so, without producing better results.
- 3. A better system… • Tom, 54, is covered by Medicaid and homeless. • He has used the ER more than 50 times in 15 months. • He needs help connecting to housing, health care, and other services. • ER doctors routinely repeat tests because they don’t have access to health histories. • Tom, 54, is covered by Medicaid and homeless. • He has used the ER more than 50 times in 15 months. • He needs help connecting to housing, health care, and other services. • ER doctors routinely repeat tests because they don’t have access to health histories. • Tom has an outreach worker who connects him with housing, health care, and other services. • Data systems give Tom’s providers immediate access to health histories, enabling coordinated care without duplicated services. • Effective services reduce costs. • Tom is healthier because he gets the services he needs. • Tom has an outreach worker who connects him with housing, health care, and other services. • Data systems give Tom’s providers immediate access to health histories, enabling coordinated care without duplicated services. • Effective services reduce costs. • Tom is healthier because he gets the services he needs. The current system… A better system…
- 4. Improve how we pay for services • Measure, improve and report common statewide performance measures. • As purchaser for Apple Health and state employees, drive market toward value- based models. Ensure health care focuses on the whole person • Integrate physical and behavioral health care in regions as early as 2016, with statewide integration by 2020. • Spread and sustain effective clinical models of integration. • Make clinical and claims data available to securely share patient health information. Build healthier communities through a collaborative regional approach • Fund and support Accountable Communities of Health. • Use data to drive community decisions and identify community health disparities. Implementation tools: State Innovation Models grant, state funding, potential federal waiver, philanthropic support Legislative support: HB 2572, SB 6312 Implementation tools: State Innovation Models grant, state funding, potential federal waiver, philanthropic support Legislative support: HB 2572, SB 6312 Healthier Washington builds the better system
- 6. Measurement Financing & Administration Information Technology Public Health Nutritious Food Transportation EmploymentEducation Crisis Intervention Family Support Criminal Justice Consumer Engagement Practice Transformation Workforce Development Substance Abuse Physical Health Long-Term Care Mental Health Oral Health Health & Recovery System Supports Housing Built Environment Whole Person Community Better health, better care, lower costs
- 7. Good health depends on high-quality health care and more… 3 Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper, State Quality Improvement Institute. Minnesota.
- 8. Healthier Washington is structured to leverage all sectors... 3
- 9. 4 …and recognizes the best way to improve people’s health is in the community where they live, work, and play
- 10. Equity is far reaching and key to achieving state goals 10
- 11. Learn more about Healthier Washington Web: www.hca.wa.gov/hw Email and to join our feedback network: healthierwa@hca.wa.gov 360-725-1980 11
Editor's Notes
- This is about bending the cost curve and focusing on outcomes, not just paying for “widgets.” Individuals with serious mental illness die 25 years earlier than the rest of the population, and often from preventable disease. Underlying all of this are disparities: Quality differentials can affect CAHPS scores, which has implication on hospital revenue under value-based purchasing and pay for performance models Disparities in care are costly and contribute to; extended length of stay, preventable readmissions, hospital acquired conditions Poor or inadequate informed consent Discounting pain and suffering through miscommunication Failure to recognize or take into consideration the patients cultural, religious, and ethnic beliefs Our health disparities initiative works in alignment with the mission and vision of the Health Care Authority. ACA Results Washington Healthier Washington
- Current state and future state we hope to achieve through Healthier Washington. Tom is an example of what some of our most vulnerable people in the state face currently, drawing upon real stories from real people. The better system demonstrates how we hope to transform the system through Healthier Washington.
- The big picture: Healthier Washington is about health system transformation, in order to achieve the triple aim, which is better health, better care, lower costs A Healthier WA will see engaged communities driving local health innovation and partnering with the state on health purchasing Accountable Communities of Health to link and align partners across the care and community continuum “Health in all policies” approach to ensure communities are at the table Using data to drive community decisions (health mapping) A Healthier WA will have integrated physical and behavioral health services in Medicaid that serve the whole person: Early Adopters Spread and sustain effective models of integration Clinical and claims data available to share patient health information. A Healthier WA will shift 80% of health care purchasing in Washington state from paying for volume to paying for value Measure and report common statewide performance measures Move toward accountable care organizations for Apple Health and state employees. Legislative support in 2014 session (Gov-requested bills) Resources include federal innovation grant, philanthropic support, plus potential Medicaid waiver
- By 2019: A Healthier WA will shift 80% of health care purchasing in Washington state from paying for volume to paying for value A Healthier WA will have integrated physical and behavioral health services in Medicaid that serve the whole person A Healthier WA will see engaged communities driving local health innovation and partnering with the state on health purchasing 2015 is the year when we begin the heavy lifting of moving away from a fragmented, bifurcated system to one that is person-focused and well-coordinated.
- The Healthier Washington initiative is predicated on the recognition that better health, better care and lower costs can only be achieved if state resources and communities are significantly more aligned. This requires overdue changes in health care delivery and financing methods, deeper recognition of social determinants of health, and innovative policies and structures. Healthier Washington proposes a new way of doing business that reaches across organizational silos. Synergistic health and recovery services, systems supports and community services will be achievable on a much broader scale through Healthier Washington. In order to achieve effective interplay between systems and supports and reach across silos to achieve health and well-being for the whole person, Washington will pursue solutions that address broad populations and drive, reward and measure a working health and health care system. Transition to Nathan…
- HW is grounded in an understanding that health is more than health care – that 80% of the factors that affect a person’s health occur outside of the health care system – and that improving people’s health outcomes (and lowering costs) will depend on addressing those factors and linking supports for them to the health care delivery system. The ACH represents all aspects of health within the community (not just the 80%), which means there is an opportunity to better align the entire system.
- Basis for the ACH investment: HW is grounded in an understanding that health is more than health care – that 80% of the factors that affect a person’s health occur outside of the health care system – and that improving people’s health outcomes (and lowering costs) will depend on addressing those factors and linking supports for them to the health care delivery system. The ACH represents all aspects of health within the community (not just the 80%), which means there is an opportunity to better align the entire system.
- Bringing together providers, social service organizations, health plans, hospitals, county governments, tribes, and others through nine regional Accountable Communities of Health (ACHs). ACHs will support communities in making informed decisions on health needs and priorities. The ACHs represent a solution to a complex systems problem – they are not another grant program. ACHs are based on the premise that no single initiative, sector or organization can independently create health systems transformation and accomplish the Triple AIM. ACHs are not new concepts in Washington state… ACHs will: Bring together public and private multi-sector partners to identify and work on shared regional health goals Identify opportunities for the ACH and community partners to understand and address aspects of health and quality of life that are traditionally outside the scope of clinical health care Coordinate systems and identify community supports so that services address all aspects of an individual’s health needs Two designated ACHs currently taking action…