Board of Trustees September 20, 2018
Board Business • Board Member Appointment • Minutes Approval • Finance Committee Report • Board Meeting Schedule • Election of Officers • Conflict of Interest • ACH Learning Session
Operations Dashboard Key Strategies Major Milestones TargetDate Success Metric Status Staffing Fill Vacancies Aug. 2018 Positions Filled Complete • Executive Director • Community Engagement Manager • Finance Director • Communications Director • Opioid Coordinator • Equity Manager • Review organizational roles and potential staffing models that support function Oct. 2018 Org. structure to In progress support 2019 Work Marketing & Communications • Hired a Communications Director to develop a communications plan Aug. 2018 Position filled/Plan Complete created • Communications Plan Launch and integration of Healthy Living Collaborative Winter 2018/9 In progress Budget/Funds Flow • Board approved operating budget Winter 2018/9 Approved budget In progress • New Opioid funding Sept. 2018 Grant approved Complete Internal Policies & Procedures • Review policies and procedures for gaps and fill gaps Fall 2018 Full policies and In progress procedures Healthy Living Collaborative • Integrate HLC programs, staffing, and services into SWACH regional plan Winter 2018/9 In Progress Integration • CHW Neighborhood Pilot Transition
Funds Flow Update
(REVIEW) Four High Level Funds Flow Categories Transformation Community Regional Capacity ACH Admin Plan Resiliency Fund Investments Implementation Investments impacting social Administrative operating Funds paid directly to Funds for Pathways • • • • determinants of health and expenses of SWACH partners to plan for and innovative solutions. Legal achieve DSRIP goals and Funds for ACH to make • • Financial overall transformation. regional investments that • Facilities Assessments support partners for specific • • Equipment Transformation plans purposes including workforce, • • Implementation health information, training, • support and other infrastructure funds. Funds will be used to promote • large scale transformation and sustainability across the region.
(REVIEW) How Many Dollars Are There? DSRIP Incentives $? $8.67M $7.2M $9.2M $7.8M $7.3M $5.9M Community BH Integration Year 1 Year 2 Year 3 Year 4 Year 5 Resiliency Fund ACH To support Regional Capacit y Invest ment s $721,217 – Year 1 bi-directional integration across Admin (10%) $1.8M $? $? $? $? Clark, Skamania, and Klickitat Year 1 = $? – Year 2 Counties (25%) $? – Year 3 $721,217 $? – Year 4 (10%) $? – Year 5 Part ners Transformat ion Plans/ Implement at ion $4M $? $? $? $? (55%) % t o t he Communit y Resiliency Fund
(REVIEW) Y1 Transformation Plan Implementation $1.7M Planning $2.3M Binding Agreements Health Information Assessment ($210,000) Binding 2019 agreements negotiated September through December Clinical Assessment ($260,000) These funds will combine with year 2 funds to support 2019 contracts Transformation Plan Submission ($900,000) Contracts will take into account Medicaid lives served and can support equity/anti-stigma work as well as partnerships needed to Non-Clinical Partner Engagement TBD achieve transformation outcomes ($330,000)
Y1 Transformation Plan Implementation: Budget vs Actual Budgeted Actual Health Information Assessment ($210,000) Spent: $172,500 Owed: $37,500 Clinical Assessment ($260,000) Spent: $220,000 Owed: $30,000 Transformation Plan Submission ($900,000) Spent: $0 (21 plans submitted so far) Non-Clinical Partner Engagement TBD Spent: $0 (RFI is currently open) ($330,000)
Current Thinking/Board of Trustees Decision in October DSRIP Incentives BH Integration Year 1 thru 5 10% ( ≈ $3.7M) ACH Admin ACH Admin $0 10% ( ≈ $3.7M) Community Resiliency Community Resiliency $868K (10%) Fund Fund Regional Capacity 25% ( ≈ $9.3M) Regional Capacity $2.2M (25.4%) Investment Investment 55% ( ≈ $20.5M) Transformation Transformation $5.6M (64.6%) Implementation Implementation
Current Thinking/ Board of Trustees Decision in October Total of DSRIP Incentives Year 1 thru 5 and BH Integration ACH Admin 8.11% (roughly $3.7M) Community Resiliency Fund 10.00% (roughly $4.6M) Regional Capacity Investment 25.07% (roughly $11.5M) Transformation Implementation 56.82% (roughly $26.1M)
Board Conversation • ACH-Pay For Performance • Strategic Plan
Pay for Performance (P4P) Measure Dashboard Aug 2018 Measurement Period: Oct 2016 – Sept 2017 SWACH Statewide Relative to Measure Date Performance Performance State Legend All-cause Emergency Department Utilization (per 1,000 member months) * Q3 2017 39.4 48.0 SWACH performance is Antidepressant Medication Management – Acute Q3 2017 51% 50% at or above statewide Antidepressant Medicaid Management – Continuation Q3 2017 36% 34% SWACH performance is below statewide Child and Adolescent Access to Primary Care (12-24 months) Q3 2017 89% 93% Child and Adolescent Access to Primary Care (2-6 years) SWACH is the lowest Q3 2017 81% 85% performing ACH region Child and Adolescent Access to Primary Care (7-11 years) Q3 2017 87% 90% Child and Adolescent Access to Primary Care (12-19 years) Q3 2017 86% 90% Improvement over Self Comprehensive Diabetes Care: Eye Exam Q3 2017 39% 33% Gap to Goal Comprehensive Diabetes Care: HbA1c Testing Q3 2017 83% 84% Comprehensive Diabetes Care: Medical Attention for Nephropathy Q3 2017 86% 86% Follow up after Discharge from ED for Alcohol or Other Drug Dependence (7 day) Q3 2017 34% 24% Data Sources Follow up after Discharge from ED for Alcohol or Other Drug Dependence (30 day) Q3 2017 43% 32% Follow up after Discharge from ED for Mental Health (7 day) Q3 2017 62% 61% Data sources used include: Healthier Washington Data Follow up after Discharge from ED for Mental Health (30 day) Q3 2017 75% 72% Dashboard + RDA Measure Follow up after Hospitalization for Mental Health (7 day) Decomposition Reports Q3 2017 86% 87% Follow up after Hospitalization for Mental Health (30 day) Q3 2017 91% 91% Inpatient Hospital Utilization (per 1,000 member months) * Q3 2017 65.3 67.1 *lower rate indicates better performance
Pay for Performance (P4P) Measure Dashboard Aug 2018 Measurement Period: Oct 2016 – Sept 2017 SWACH Statewide Relative to Legend Measure Date Performance Performance State SWACH performance is Medication Management for People with Asthma Q3 2017 32% 31% at or above statewide Mental Health Treatment Penetration Q3 2017 47% 46% SWACH performance is Percent Homeless (ages 18-64) * Q3 2017 4% 5% below statewide Plan All-Cause Readmission* Q3 2017 11% 14% SWACH is the lowest Substance Use Disorder Treatment Penetration (ages 18-64) performing ACH region Q3 2017 31% 29% Patients on High Dose Chronic Opioid Therapy Data for these measures not yet available Patients with Concurrent Opioid and Sedative Prescriptions Improvement over Self Statin Therapy for Patients with Cardiovascular Disease Q3 2017 80% 78% Gap to Goal Substance Use Disorder Treatment Penetration (Opioids) Q3 2017 36% 46% *lower rate indicates better performance About P4P Measures The first year ACHs will be held accountable for P4P measures is CY 2019. Performance in CY 2019 will be compared to baseline (CY 2017). Official ACH baseline performance will be calculated for CY 2017; the state intends to release baseline results in October 2018. Official improvement targets and benchmarks for measures will also be released in October 2018. SWACH performance reported here is preliminary. Benchmarks for gap to goal measures will likely be the national Medicaid 90 th percentile; ACHs must close the gap between baseline and benchmarks by 10%. Targets for improvement over self measures will be based on 1.9% improvement from baseline. Future updates of the P4P Measure Dashboard will include official baseline and benchmarks / improvement targets. The P4P Measure Dashboard will be updated quarterly where possible; however, some measures are only available annually or semi-annually.
Our Vision A healthy southwest Washington region where all people have equitable access to quality whole person care and live in connected and thriving communities without barriers to wellness
Our Framework Sustainable Large-Scale Impact Whole- Community- Person Clinical Integrated Linkages Clinical Care
Strategic Plan COLLECTIVE IMPACT SUPPORT -Cross Sector Shared Learning -Community Engagement System Sustainable -Equity Planning Large-Scale -Community Resiliency Funding Impact -Addressing policy and systems changes across care settings -Evaluation of Transformation Whole- Community- Person Clinical Integrated Linkages Clinical Care CLINICAL PARTNERS COMMUNITY SERVING -Clinical Improvement PARTNERS -Clinical Integration - Funding Social Determinant -Targeted Learning Collaboratives Partnerships (RFI) Community Based Care HUB -Targeted Learning Collaboratives - Pathways -Care Coordination
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