1. King County Integration Workgroup August 22, 2011 Dale Jarvis, CPA dale@djconsult.net

2. Discussion Topics 1.Dale’s abridged presentation to the Healthcare Cabinet 2.Lessons from Other States and Regions – Central Oregon – where it all began on the West Coast – Vermont and Camden NJ – where it all began on the East Coast – Eastern WA and SW WA Planning Ideas – California’s Planning Ideas 3.Health Foundations Partnership

3. The Role of Regional Health Alliances in Washington State Healthcare Reform Dale Jarvis, Managing Consultant dale@djconsult.net 206-613-3339

4. It started with a Discussion in Southwest Washington Last Summer We already know how to fix the healthcare system: Medical Homes and Accountable Care Organizations Supported by Payment Reforms 4

5. But what about folks in the Safety Net? For many children, families, and adults in the safety net, good healthcare is not enough Consider a mom with depression and diabetes Add to this scenario the facts that she is the head of household of a family of three, has lost her job, is experiencing domestic violence and she and her children are on the brink of homelessness 5

6. A Key Part of the Equation: Addressing the Social Determinants of Health There is a distinct relationship between an individual’s health status and the social and environmental conditions in which he or she lives The US healthcare system is not currently structured to address these problems, separating health from human services 6

7. A New Vision: The “Healthcare Neighborhood” The Next Generation Safety Net Healthcare System The Fulton County Georgia (Atlanta area) Neighborhood Union Primary Care Partnership’s One Stop Shopping: – Well patient care – Sick-patient care – OB/GYN services – Travel immunization services – Communicable disease intervention – WIC/nutrition education – Oral health services – Behavioral health services – A day center for parents receiving services – Employment assistance – Disability and vocation rehabilitation services – Foreclosure prevention services – Housing assistance – A reading room/information center that offers ESL classes – A farmer’s market – A community garden – A walking trail 7

8. Which requires the Customization of the Patient-Centered Medical Home as well as the Accountable Care Organization 8

9. The Current “Wiring Diagram” just doesn’t work… 9

10. But, what about the unfolding HCA design? 10 All Medicaid enrollees move into managed care RSNs intact for now (may change by 2014) Payment reform pilots ACO pilots HCA Design Expansion of managed care ?

11. Stealing the Best Ideas: Regional Improvement Efforts 11

12. Two-Part Idea: – A Regional Health Alliance to organize the payors/funders to create a supportive payment and regulatory system – In order to support organizing the delivery system into accountable systems of care 12

13. Key RHA Tasks 1.Community-wide needs assessment and improvement plan 2.Multi-Payer “virtual” budget development 3.Community health improvement projects/hot spotting 4.Multi-Payer payment, contracting, and performance measure models 5.Person-Centered Healthcare Home development support 6.Local ACO development support 7.Support Patient Registry, EHR, Health Information Exchange development 8.Community-wide performance measurement 13

14. Organizing the New Healthcare Ecosystem in Washington State 14

15. Lessons: Central Oregon – where it all began on the West Coast 15

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20. Lessons: Vermont and Camden NJ – where it all began on the East Coast 20

21. Vermont Blueprint for Health The Healthcare System of the Future? Key Ingredients: – Medical Homes – Community Health Teams – Mental Health Providers – Public Health Prevention – Accountable Care Organizations 21

22. Camden, NJ: Hot Spotting 22

23. We have the tragedy of a murder to thank for the development of a practice we now know as case spotting. Brenner became involved. Searched for better ways to deploy police resources. COMPSTAT- mapping crime hot spots and concentrating police resources there. Hot Spotting or COMSTAT Comes to Healthcare 23

24. Turned the idea towards the analysis of patient flow and healthcare expenditure patterns. Studied where ambulances picked up patients with fall injuries. Found one facility that sent far more elderly to the ER with serious falls than any other. (57 in 2 years= $3 million in costs) Hot Spotting 24

25. COMPSTAT >> HEALTHSTAT Two most expensive city blocks, 900 people, accounted for 4000 hospital visits, 200 hundred million in healthcare costs over a 5 year period. 1% of 100,000 people used 30% of costs Hot Spotting/Case Spotting 25

26. Lessons: Eastern and SW WA Planning 26

27. Washington RHA Activity 27

28. RHA Structure & Key Tasks 28

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31. Draft Timeline 31

32. Next Steps 32

33. Lessons: California’s Home Runs 33

34. How to get paid for integrated care 34

35. Modeling Demand, Revenue, Costs, and Cost Offsets 35

36. Health Foundations Partnership 36

37. Partial List of Foundations Bill & Melinda Gates Foundation Building Changes Community Foundation of Southwest Washington Empire Health Foundation Group Health Foundation Kaiser Foundation Legacy Health Foundation Murdock Foundation Northwest Health Foundation Pacific Hospital and Preservation and Development Authority PeaceHealth Southwest Foundation Providence Foundation Regence Foundation St. Luke’s Foundation Washington Dental Service Foundation Washington Health Foundation Yakima Valley Community Foundation 37

38. Partnership Plan Ideas Organize the Foundations into a Health Funders Partnership Develop a strategy to help Washington State succeed at healthcare reform and become the healthiest state in the nation; ideas discussed: – Matching dollars for federal funds for state projects – Regional Health Alliance seed money – Accountable Care Organization seed money 38

39. Google and then Read this Paper 39

40. Questions and Comments? 40