1. WA State Role in Developing Accountable Care Organizations NASHP Annual State Health Policy Conference October 5, 2011 Jenny Hamilton, MSG Project Manager, Washington State Health Care Authority

2. The “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 2 Hamilton

3. 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 3 Hamilton

4. Developing 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? 4 Hamilton

5. New 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 5 Hamilton

6. Fostering 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 6 Hamilton

7. Systems 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 7 Hamilton

8. 8 Opportunities & 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 8 Hamilton

9. Additional Resources PSHA community checkup: http://www.wacommunitycheckup.org/ 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 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 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 http://www.governor.wa.gov/priorities/healthcare/default.asp 9 Hamilton

10. Questions? 10 Hamilton " When you come to a fork in the road....Take it “ Yogi Berra