Healthier Washington & Paying for Value: Transforming Health in Washington State MaryAnne Lindeblad Medicaid Director Washington State Health Care Authority
HCA: purchaser, innovator, convener HCA purchases health care for over 2.2 million people, with a $10 Billion annual spend. • Medicaid (Apple Health) 2021 – 1.9 million clients 90% • Public Employees Benefits state-financed 50% 370,000 covered lives – commercial • School Employees Benefits (2020) 144,000 more covered lives coming – Tools to accelerate VBP and health transformation Tools to accelerate VBP and health transformation 2014 legislation directing HCA to implement VBP strategies 2014 legislation directing HCA to implement VBP strategies • • SIM Round 2 grant (Healthier Washington), 2015-2019 SIM Round 2 grant (Healthier Washington), 2015-2019 • • Healthier Washington Medicaid Transformation (Section 1115 waiver), 2017-2021 Healthier Washington Medicaid Transformation (Section 1115 waiver), 2017-2021 • • 2
What is Healthier Washington?
Healthier Washington’s overarching efforts Caring for the whole person Ensuring an Supporting effective health care providers workforce Empowering the patient Using data Leveraging to improve federal care funds Rewarding Focusing on high-quality communities care
Payment drives system transformation •Fragmented clinical and financial •Integrated systems that pay for and approaches to care delivery deliver whole person care •Uncoordinated care and transitions •Coordinated care and transitions •Unengaged people left out of their •Engaged and activated people who own health care decisions are connected to the care they need and encouraged to take a greater •Variation in delivery system role in their health performance, cost, and equity with no clinical or financial accountability •Standardized performance and transparency measurement with clinical and financial accountability and transparency for improved health outcomes Transformed Status quo (value-based) system 5
Examples of state VBP efforts State Employees and Retirees Apple Health - Medicaid Accountable Care Program, ACO 1% MCO premium withhold based on • • model with up and downside risk to quality and provider VBP incentivize clinical and quality arrangements accountability Behavioral and physical (financial) • health integration in Southwest WA, Total Joint Replacement Bundle and • statewide by 2020 Center of Excellence Exploring a value-based model for • Contracts with HCA require bidders • rural settings to offer substantially similar ACO Healthier Washington Medicaid • program (risk sharing and care Transformation: regional VBP goals transformation approaches) to tied to incentive payments spread VBP in the marketplace 6
Incentives drive collaboration Accountable Communities of Health Regional organizations that: Address health issues • through local collaboration on shared goals. Better align resources and • activities that improve whole person health and wellness. Support local and • statewide initiatives such as Medicaid Transformation, practice transformation, health equity, and value- based purchasing.
The 20/80 rule Health is more than health care. Adapted from: Magnun et al. (2010). Achieving Accountability for Health and Health Care: A White Paper , State Quality Improvement Institute. Minnesota.
Addressing the other 80% • Healthier Washington Medicaid Transformation – Diversion intervention (measuring: % homeless, % arrested) – Support of ACES (adverse childhood experience intervention) – Support of community health workers • New Medicaid eligibility categories – Long-term services and supports • Supporting unpaid family caregivers • Supporting people who need long-term services and are at risk of spending down to impoverishment – Foundational community supports • Helping those with complex health needs obtain and maintain housing and employment 9
Join the Healthier Washington Feedback Network: healthierwa@hca.wa.gov Learn more: www.hca.wa.gov/hw The Healthier Washington initiative is supported by Funding Opportunity Number CMS‐1G1‐14‐001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. 10
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