Part rtnerin ing g to o Im Improve e He Healt lth h Equ quit ity y and d Outcomes s An n In Information n Ses Sessio sion n for or Co Community ity-Based d Organizations Presen ented d by y Mar arya Ging Gingrey, , J.D. . Director Di r of of Equity quity and and Co Commun unit ity y Partne artnership hip Access the recording of this webinar here: http://bit.ly/HH-CBOinfo 2
What is HealthierHere? We are a new non-profit organization… dedicated to improving the healt lth and well ll-being of all ll people here in King County, through innovative, cross-sector collaborations. 3
Our Organization: A Cross-Sector Regional Partnership Medical Providers ▪ Governed by a 26-member cross-sector, Behavioral Health Providers multi-stakeholder board Hospitals ▪ Supported by professional staff Tribes Community Organizations ▪ Initial funding through contract with Payers / Managed Care Healthier Washington / Medicaid Waiver Organizations City & County Government Foundations Advocates Consumers 4
Our Values Equit ity Co Communit ity Part rtnership ip In Innovatio ion Resu sult lts 5
The Need: Health in in Our Region is is Not Equitable People in high-income areas of King County live ~5 years longer than people from high- poverty areas… and enjoy ~11 more years of healthy life . 6
A System of Silos: Too Many Hole les to Fall ll Through Transportation Acute Healthcare Housing Community Based Organizations Step Down Care Specialty Care Criminal Justice Primary Medical Care Addiction Treatment Behavioral Health Crisis Response 7
Our Vision: A Connected System of f Whole-Person Care No No matter where people enter th the system … th they ge get th the righ right car are, in in th the rig right pl plac ace, at at the the rig right tim time 8 8
Our Vision: A New Way of f Delivering Health Care Mea eanin ingful mec echanisms for com ommunity and con onsumer voic oice that help drive decision-making for healthcare Ca Care e tea eams th that t are rep epresentative, cu cultu lturall lly competent and res espectful l of individuals and community. Computer systems that talk to each other to improve Community/Clinical Co connections Payment mod odels ls that compensate providers for keeping people healthy (rather than #’s of procedures) and Community-Based Organizations for contributing to better outcomes 9
Our Model: Collaboration + In Innovation Con onnect or organiz izatio ions that don’t Medical & usually work together. Behavioral Health Hel elp the them part partner r with each other to o de develo lop and and tes est Community Government new sol ne solutio ions to health and Based Agencies & social problems. Organizations Services Engage com En ommunity ty and and con onsumers to o inform an and guid uide the process and decision-making. Innovative Invest in In n system-wide ass assets to support connection, Solutions collaboration and improved consumer experience. 10
Our First Effort: Im Improve Health for People on Medicaid HealthierHere is contracted to be the Accountable le Co Communit ity of f Heal alth for the Kin King Co County Regio ion through the Healthier Washington Medicaid Waiver Program. ▪ Multi-Year Effort ▪ Allows Medicaid funds to be used to test innovative approaches that otherwise would not be funded ▪ Focused on improving specific target health measures 11
The Aim: A System that Works Better for Everyone People here get better, more equitable care Improved Outcomes at Lower Costs CBOs receive support to Providers get support to address Soc ocial De Determinants improve quali im lity ty of of care 12
How It Works: Two Path thways to a Healthier Community HealthierHere earns start-up Plan and catalyze support for system-wide innovations funds for planning and reporting Engage partners to develop target innovation initiatives 13
How It Works: Measure Year-over-Year Im Improvement Earn start-up funds for Plan and catalyze support for system-wide innovations planning and reporting Measure outcomes against target metrics Engage partners to develop target innovations 14
How It Works: Earn Funding by Performing as a Region Earn start-up funds for Plan and catalyze support for system-wide innovations planning and reporting Measure outcomes Earn funding against target by meeting metrics metric goals Engage partners to develop target innovations 15
How It Works: Reinvest in in System-wide Im Improvement Earn start-up funds for Implement, expand and sustain system-wide innovations planning and reporting Measure outcomes Earn funding against target by meeting Invest in n on ongoi oing g metrics metric goals Engage partners inno nnovatio ion to develop through thr target Equity & innovations Wellness Fund Investment incentives partially offset costs of practice change 16
System-wide Investment: Building a Le Learning Community HealthierHere invites organizations interesting in improving population health to join us as Innovation Partners: Innovation Partners Clinical Community ▪ Connect with other community and clinical partners ▪ Attend educational events as part of our learning community ▪ Share your efforts and learn what others are doing ▪ Provide input to help define priorities and processes 17
Focus on Target Metrics: Practice (C (Change) Partners Innovation Partners Clinical Community A small ll subset of f Inn Innovation Partn rtners rs will ill Practice Partners be e in invit vited to parti rticipate Develop / Implement Innovation Target in in Inn Innovation Targ rget Initiatives In Initi itiativ ives based on abilit ility to aid id in in moving th the e metr trics 18
Focus on Practice Change: In Innovation Targets Increased safe and Expanded access; successful improved prescribing practices for TRANSITIONS OPIOID USE for those leaving jail INTEGRATED and hospitals DISORDER CARE Physical and behavioral The Go Goal: l: health integration Improve year-over-year county-wide health measures for Medicaid enrollees across Expanded supports for four innovation targets. those with CHRONIC CONDITIONS 19
Focus on Practice Change: Social Equity Framework Community Based Care Shift the focus from what works Coordination for organizations to what works for people and populations OPIOID USE TRANSITIONS DISORDER INTEGRATED “Did you get the CARE care/service you need?” Address the “Did it help you? ” Improve Equity Social and Reduce Determinants Disparities CHRONIC of Health CONDITIONS 20
Innovation Target: Physical and Behavioral Health Integration Outcome Metrics Primary Reduced Overuse (ED visits, Re-admissions) Medical Care Improved Behavioral Health Behavioral Improved Physical Health Health Levers Shared Care Plans Enhanced Screening Evidence-based Best Practices Interoperable Data System s 21
Innovation Target: Safe and Successfu ful Transitions Outcome Metrics Reduced ED visits Reduced Inpatient Utilization Acute/ Specialty Care Reduced Readmissions Fewer Released to Homelessness Step-Down Jail Levers Community Based Care Coordinators Primary Care Peer Support Specialists Behavioral Linkages to Community Organizations Health Interoperable Data Systems 22
Innovation Target: Prevent and Manage Chronic Conditions Outcome Metrics Reduced ED visits Reduced Inpatient Utilization Improvement on Clinical Measures Cardiovascular Diabetes Levers Asthma Self-Management Support COPD (Lung Disease) Population Health Management (Registries) Team-Based Care Community Health Workers (CHWs) 23
Innovation Target: Reduced Opioid Use Outcome Metrics Reduced Mortality / Overdoses Prevention Reduced Morbidity Treatment Penetration Levers Treatment and Recovery Improved Prescribing Practices Support for People with Opioid Use Disorder Increased Access to Evidence-Based Treatment (e.g., Medication Assisted Treatment) Overdose Prevention Recovery Coaches for Long-term Stabilization 24
Steps to Selecting Community Practice Partners Listen & Learn Identify Strategic Priorities Assess Capability & Capacity 25
Step 1: Engage Consumers and Community We have launched a Sm Small l Gr Grants Program to help us Listen & Learn engage with community and better understand: ▪ What are the greatest needs? Eng ngage tho those who ho ▪ Where are the biggest gaps? are clos are losest to the the problem: pro ▪ What are the biggest barriers? Con onsumers rs an and d ▪ What strengths already exist within community? Com ommunit ity ▪ What might be most effective in achieving the target metrics? 26
Step 2: Pri rioritize Based on Potential Im Impact Which typ types of of par artners mig ight be most effective in in Identify Strategic improvin im ing th the tar arget metrics cou ountywid ide? Priorities Medicaid Population Medicaid Enrollees Consumer Input Meets needs that Serves substantial consumers have population who identified as critical may be on Medicaid Services intersect with innovation targets 27
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