Cascade Pacific Action AllianceProject Workplans Part of project application is a “high-level”...
Transcript of Cascade Pacific Action AllianceProject Workplans Part of project application is a “high-level”...
Cascade Pacific Action Alliance
Domain 2 + Chronic Disease Workgroup
October 17, 2017
Agenda for Today
Review Work from Last Meeting/Overall Plan
Project Workplans
Domain 1 Investments
Logic models
Project Alignment & Telling our story
Next Steps
Section I (ACH) Project Update
Finance Committee has been meeting and made recommendations to the Council and Board about funding allocations
Last week Council and Board met- decided to move forward on 6 projects and approved funding flows.
Section II (Project Specific Workgroup Activities)
August/September
• Identified target populations
• Discussed engaged providers via RFQ and high-volume Medicaid providers
• Identified Domain 1 assets and challenges (for Section I)
• Developing proposals- HMA and CPAA
October:
• Workplans
• CPAA role for Domain 1
• Alignment
• Refining proposals
November: Review project proposals
Project Workplans
Project Workplans
Part of project application is a “high-level” workplan specific to each project, but similar milestones
CPAA earns dollars for completed milestones
• E.g. completed landscape analysis, contracts signed, # of providers trained
Three phases of work
• Planning (DY 2: 2018)
• Implementation (DY 3: 2019)
• Scale & Sustain (DY 4 &5: 2020-2021)
Workplan Example: Care Coordination
Project Stage Milestones
Deadli
ne
(DY,
Qtr) ACH Approach for Accomplishing Milestones
Stage 1: PlanningAssess current state capacity to effectively focus on
the need for regional community-based care
coordination
DY 2,
Q2
CPAA will implement a rigorous project planning and monitoring
approach to implementation of each project. The ACH will employ
project planning software and tools to lay out required deadlines,
key tasks, subordinate tasks, and milestones. Each project plan
will define critical paths and key dependencies. Failure to meet a
critical milestone will prompt a timely management response at
regular meetings that CPAA will convene with the staff and
providers responsible for implementation of each project.
CPAA Role
Domain 1 Challenges from last time
Workplans
What do you need from CPAA for the projects to move forward?
Domain 1 - Value-Based Purchasing
Assets: MCOs and providers are already moving toward VBP, with incentives and withholds
Challenges:
VBP approaches will require clean, accurate data that the ACH, payers and providers can timely access.
Patient Attribution: how to correctly attribute patients to providers?
Small providers and rural areas have too few patients to bear risk.
May need bridge funding to help providers transition to VBP
Assure VBP doesn’t penalize providers serving challenging clients
Potential CPAA Roles:
Convene and educate key stakeholders (health plans, providers, etc.)
Bring payers together to “harmonize” systems; identify where efforts cross and attempt to standardize processes across payers. Outcome: health plans work in concert with each other
Domain 1 - WorkforceChallenges:
Provider shortages (especially rural areas): create conditional scholarships or loan forgiveness for more professions. Recruiting rural providers requires recruiting the spouse
Patient engagement: effectively engaging complex patients is a major priority. Training, home visits and consistent engagement are key.
CHWs: training CHWs and Medical Asst’s to work with complex patients also a priority. Can we create local training programs (e.g. community colleges)?
Silos: Train BH and medical staff to work across silos
Time: costly for providers to go to training.
Potential Mitigation Strategies:
Telehealth to expand short resources
Tuition support (loan forgiveness & conditional scholarship)
Partner with colleges for internships
Expand use of family members as care givers
Engaging clients for MTD success
Survey what workforce trainings are needed; conduct onsite group instead of individual trainings
Use Qualis Health as training resource
Establish a learning collaborative of partnering providers
Domain 1 – Health Info Technology
Assets:
EDIE and Premanage are widely used and helpful
Avatar is widely used in BH agencies.
EPIC is used in ~40% of hospital systems
PRISM provides comprehensive picture of careChallenges:
Timely access to data: Need comprehensive, timely integrated picture of claims for patient registries, risk stratification and monitoring/reporting
EHRs: there are multiple platforms and versions making it impossible to aggregate data. EHRs don’t handle non-medical data (e.g., BH, dental, LTC)
Bi-directional: Sharing information between primary care and behavioral health
Cross-system data-sharing: Need ability for first responders, EDs, law enforcement, corrections, BH and PC to access data for shared clientsPotential CPAA Roles:
Develop inventory of EHRs partnering providers are using
Support multi-directional communication between parties: HCA providers, MCOs
Visually Displaying the Work
Application must include logic model that depicts the work and tells our story
Medicaid Demonstration is only Part of the CPAA Work
Medicaid Demo Project
All Other CPAAProjects
Maternal and Child Health & Reproductive Health 10 Recommendations to Improve
Women’s HealthHome Visiting Program
Bright Futures
Bi-Directional Integration of Care & Primary Care Transformation
Collaborative Care Model
Medicaid Projects & Strategies
Chronic Disease Prevention and Control Chronic Care Model
Addressing the Opioid Use Public Health Crisis
Prevention, Treatment, Overdose Prevention, Recovery
Transitional CareINTERACT 4.0
Transitional Care ModelThe Care Transitions Intervention
Community Based Care CoordinationPathways Community HUB
Target Pop (Medicaid Clts) Project Outcomes
↓ util. (ED, I/P, readmits)
↑ opioid care (hi-dosetherapy, MAT)
↑ BH care & follow-up (post ED, post I/P)
↓ homelessness
↑ access – pediatric care/screenings
↑ chronic disease screenings
(diabetes, depression, asthma)
↑ maternal & reproductive screenings and care
↑ diabetic care (eyes, HbA1C, nephropathy)
CPAA Medicaid Demo Project Logic Model - Option 1
Having or at-risk for behavioral health conditions
In transition from intensive settings of care or institutional settings
Having or at risk for, arthritis, cancer, chronic respiratory disease, diabetes, heart disease, obesity and stroke
Women of reproductive age, pregnant women, mothers
Youth and adults who use, misuse, or abuse, prescription opioids and/or heroin
One or more chronic disease or condition and at least one risk factor
↑ MH or SUD screenings
↑ Rx management (anti-depressant, asthma, statin)
Medicaid Demonstration ProjectLogic Model – Option 2
Maternal and Child Health & Reproductive Health 10 Recommendations to Improve
Women’s HealthHome Visiting Program
Bright Futures
Bi-Directional Integration of Care & Primary Care Transformation
Collaborative Care Model
Medicaid Projects & Strategies
Chronic Disease Prevention and Control Chronic Care Model
Addressing the Opioid Use Public Health Crisis
Prevention, Treatment, Overdose Prevention, Recovery
Transitional CareINTERACT 4.0
Transitional Care ModelThe Care Transitions Intervention
Community Based Care CoordinationPathways Community HUB
Hospitals
PCPs
BHOs Social Services
Target Pop 1 Target Pop 2
Target Pop 3Target Pop 4
Long-Term Outcomes
↓ util. (ED, I/P, readmits)
↑ opioid care (hi-dosetherapy, MAT)
↑ BH care & follow-up (post ED, post I/P)
↓ homelessness
↑ access – pediatric care/screenings
↑ chronic disease screenings (diabetes, depression, asthma)
↑ maternal & reproductive screenings and care
↑ diabetic care (eyes, HbA1C, nephropathy)
↓ concurrent sedatives
↑ MH or SUD screenings
↓ arrests
↑ Rx management (anti-depressant, asthma, statin)
Long Term Outcomes
(2021+)
Intermediate Outcomes(2019-2021)
Short Term Outcomes
(2018)
Resources/Strategy
Shared vision for the community
Multi-Sector engagement
Greater Columbia ACH
Medicaid Transformation Project Funding
Collective understanding of community needs
EXAMPLE OF ANOTHER ACH LOGIC MODEL (Greater Columbia)A vibrant, healthy community in which all individuals, regardless of their
circumstances, have the ability to achieve their highest potential.
Project Portfolio Implemented to:
Achieve project implementation milestones (e.g. # of providers trained, implementing models)
Achieve project process and system metrics (e.g. # of screenings, reduced ED).
Generate resources for community investments
Project Portfolio Planned to:
Improve overall health outcomes
Reduce disparities
Make strategic health system capacity investments that support projects and sustain change
Project Portfolio Scaled to:
Achieve project scale and sustain milestones (e.g. # of providers using models)
Achieve systemwide outcome metrics (e.g. reduced ED, inpatient hospitalizations)
Invest in the community to sustain the vision
Decreased health disparities
Improved and efficient health care delivery system
Empowered, engaged individuals and communities collaborating and innovating to address community problems
Other Examples
Prepared by the Center for Community Health and Evaluation www.cche.org
Accountable Communities of Health | Conceptual Model
Regional multi‐sector community organizations:
- Develop vision & role
- Build functional capacity
- Collaboratively implement health improvement projects & activities
- Contribute to system‐level capacity building
Health improvement is
measurable, scaled & spread
System, practice & policy changes
support & sustain
transformation
Collaboration model is effective, integral &
sustainable
Healthier communities & transformed health system:
- Improved health care cost, quality & access
- Improved wellbeing & health equity
Approved ACH Logic ModelAccountable Communities of Health | Logic Model
Short-term (2017-18) Intermediate (2019-20) Long-term (2021+)
Achieve MTD scale & sustain project outcomes
Upstream/broader community improvement efforts implemented
Demonstrated synergy between MTD & broader community efforts to amplify health systems change (leveraging MTD investments, etc.)
Well-functioning community organizations
Shared understanding of regional priorities/needs
MTD projects planned, implemented effectively & achieving initial process / implementation outcomes
Upstream/broad community improvement efforts planned
Articulated synergy: MTD & broader community efforts
ACH multi-sector members & partners
Existing community collaboration
Community resources & programs
SIM funding & resources
Healthier WA initiative
MTD funding, structure, & resources
Healthier WA’s ability to influence Medicaid / health system
Outcomes Activities Inputs
Implement collaborative health improvement projects & policy/practice changes to transform the health system (Whole community & MTD)
Meet VBP targets
Increased workforce capacity & effective HIE to better meet needs
Fully integrated managed care implemented
Meet VBP targets
Incorporate workforce & pop health (data) management in projects
Fully integrated managed care plan developed
Contribute to HWA coordinated statewide health system capacity building efforts
Demonstrated ACH value- add to regional health system & communities
Evolving ACH role
Development of policy/ business model to support it
ACH is an effective, integral sustainable part of a transformed system
Enacted policy/business model to support role
Demonstrated value-add beyond MTD projects
Develop & implement shared vision for a regional collaborative model, including the ACHs long term role in region
2014-2016: ACH foundational development through SIM
Well- functioning, high capacity, transformed health care system
Healthier communities
Improved health care cost, quality, access & workforce
Improved health & well-being
Improved SDOH & health equity
Build strong, functional community organizations with capacity to coordinate regional health improvement activities (Whole community & MTD)
Discussion
What do you like about this?
What is missing?
What don’t you like?
How do we convey the alignment between multiple projects targeted to multiple target populations and multiple outccomes?
Next Steps
HMA and CPAA Staff working on Project Drafts
Posted in November for Review/Comment
Final Project Application to Council & Board for approval