WA State Role in Developing WA State Role in Developing Accountable Care OrganizationsAccountable Care Organizations

NASHP Annual State Health Policy ConferenceNASHP Annual State Health Policy ConferenceOctober 5, 2011October 5, 2011

Jenny Hamilton, MSGProject Manager, Washington State Health Care Authority

The “Why” and “What” for WA StateThe “Why” and “What” for WA State

• State budgets – driven by health purchasing costs & revenue shortfalls

• Health system status quo unsustainable• Leveraging state roles as purchaser, regulator, &

licensor• Facilitator/convener for payment reforms with

multiple payers• Governor’s 4% challenge & request for federal

flexibility – Health Innovation for Washington

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Key State Roles in ACO Development*Key State Roles in ACO Development*

• Developing new data capability• Designing & promoting new payment models• Fostering use of accountability measures• Identifying & promoting systems of care• Supporting a continuum of care & role of

medical/health home models

* from NASHP report “On the Road to Better Value: State Roles in promoting ACOs”, February 2011

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Developing New Data CapabilityDeveloping New Data Capability

• Governor’s five point plan (2005) includes data transparency

• Medicaid Predictive Risk Intelligence System (PRISM)

• Puget Sound Health Alliance (PSHA) Community Checkup

• HITECH coordination, HIE development• All payer claims database?

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New Payment ModelsNew Payment Models

• Multiple payer, payment reform pilot– Public private collaboration (7 health plans, 8 practices,

25,000 patients)– Performance outcomes (reductions in avoidable ER use

& avoidable hospitalization)– Key challenges

• Consolidation of public purchasing (HCA)• ACA opportunities• Health Innovation for Washington requests for

federal flexibility

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Fostering Accountability MeasuresFostering Accountability Measures

• Puget Sound Health Alliance – resource use measures – Dartmouth Atlas frame

• Multi-payer pilot outcomes• Consolidated state health purchasing & self

funded plan third party administrator (e.g., eValue8)

• Beacon community coordination• Discussions with Oregon – focus on metrics

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Systems of Care & Health Home ModelsSystems of Care & Health Home Models

• Primary care health homes & new legislation • ACA funding – planning for dual eligibles

integration/shared savings & health homes• Expansion of Boeing Intensive Outpatient Care

Program (IOCP) model with public employees and other purchasers

• Legislation for ACO pilot design • Organic interest in regional health authorities

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Opportunities & LessonsOpportunities & Lessons

• Build on/acknowledge previous experience• Be realistic about time-lines & expectations• Payment reform much harder than envisioned• Challenge to health system status quo (technical,

political, etc.) – data are key• Stakeholdering time-consuming but critical• Coordination of ACA opportunities essential• Private sector opportunities & collaboration

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Additional ResourcesAdditional Resources

• PSHA community checkup: http://www.wacommunitycheckup.org/

• ACO legislation (ESSB 6522) & pilot: http://apps.leg.wa.gov/documents/billdocs/2009-10/Pdf/Bills/Session%20Law%202010/6522-S.SL.pdf http://www.hca.wa.gov/accountable_care.html

• Multi-payer medical home pilot: http://www.hca.wa.gov/medical_homes.htm

• Governor Gregoire’s health reform site: http://www.governor.wa.gov/news/news-view.asp?pressRelease=1469&newsType=1

• Health Innovation for Washington: http://www.governor.wa.gov/priorities/healthcare/default.asp

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Questions?Questions?

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" When you come to a fork in the road ....Take it “

Yogi Berra