1. A Five-Year Plan for Washington State Inland Northwest State of Reform Health Policy Conference September 12, 2013 Nathan Johnson, HCA Division Director, Health Care Policy State Health Care Innovation Planning

2. Agenda State Health Care Innovation Planning  How did we get here?  What have we learned?  Where are we going?  Q&A / Discussion 2

3. State Health Care Innovation Planning * 30% of expenditures attributed to wasteful spending, poor care delivery, excessive administrative costs, unnecessarily high prices and fraud  In Washington State, personal health care expenditures have grown from $3.8 billion in 1980 (7.3% GDP) to $45.4 billion in 2009 (13.6% GDP)  Nationally *, personal health care expenditures have grown from $217.1 billion (8.0%) to $2.1 trillion in 2009 (15.1% GDP) H OW DID WE GET HERE ?

4. 4 The Affordable Care Act Washington State Implementation Timeline State Health Care Innovation Planning

5. Why Washington Needs an Innovation Plan  With full implementation of ACA, 85% of Washington’s uninsured adults will have access to affordable coverage (N = approx. 727,000)  Assuring quality care that is affordable requires fundamental change in how health care is delivered  Extending access without such changes will not be financially sustainable 5

6. The State Innovation Models initiative is a national effort and grant program of the Center for Medicare and Medicaid Innovation (CMMI) to identify and spread health practices that result in better health and better care at lower costs. What are “SIM” and “SHCIP”? SIM SHCIP State Health Care Innovation Planning Washington State was one of three states awarded a nearly $1 million model pre- testing grant to fund collaborative development of a five-year plan for health innovation. Other states have received “model design” grants, and are engaged in similar work. The effort is called: State Health Care Innovation Planning 6

7. What SHCIP is… An opportunity, with federal support, to refresh, and align key Washington strategies to improve health and healthcare delivery for our people and communities. Positions us to apply for a Testing Grant, and potentially, $20-$60 million to support implementation of our multi-payer delivery system and payment reform model 7

8. Test innovative payment and service delivery model s with the potential to lower costs for Medicare, Medicaid and CHIP, while: Maintaining or improving quality of care Raising community health status Reducing long term health risks for federal beneficiaries All of the above, for the rest of Washington State’s population. Refresh our approaches for health and health care improvement through evidence-driven approaches, innovation, collaboration and full use of the “levers” at our disposal. SHCIP Objectives CMMI Federal Washington State 8 Center for Medicare & Medicaid Innovation

9. Project Oversight State Health Care Innovation Planning Cabinet Level Representatives of: Dept. of Commerce Dept. of Health Dept. of Social & Health Services Governor’s Office of Health Policy Health Care Authority Health Information Exchange Labor & Industries Office of Financial Management Office of the Insurance Commissioner State Board of Community & Technical Colleges Multiple state agencies involved in project oversight Executive Oversight Project Director Consultant Team State Core Team In-Kind Experts & Staff

10. State Health Care Innovation Planning Karen Merrikin SHCIP Project Director  Hired from the private sector to lead the state planning process  Long-time veteran of health policy around payment and care delivery Consultant Team Coordinating the Work  Bree Collaborative  Manatt Health Solutions  Mercer Consulting Consulting Partners  Cedar River Group  Puget Sound Health Alliance  Strategies 360  University of Washington  Washington Park Consulting  CMMI  MacColl Institute

11. State Health Care Innovation 5-Year Plan Five Phases Major Deliverable to CMMI State Health Care Innovation Planning 11  Discovery Intensive & broad work on “As-Is” and “To Be”  Analysis Review of findings & identification of key components  Assessment & Feedback Assess identified components & gather feedback  Draft Draft plan complete by September 30  Plan Refinement & Finalization Refinement complete October – Mid-November

12. W HAT H AVE W E L EARNED ? “As-Is” environment  In general, information gathered from various “streams” of inquiry indicates there is support for improving Washington’s health system—thoughts vary on how “To be” environment – the potential future  The process has and continues to help identify:  Key focus areas and strategies for transformation  The “levers” to move transformation forward (activities, tools, policies, legislative adjustments)  Performance measures needed to assess the value of the reforms State Health Care Innovation Planning 12

13. State Health Care Innovation Planning All people in Washington achieve and maintain better health* W HERE A RE W E G OING ? Draft Vision Draft Broad Aim By 2019, the people of Washington state will be healthier because our state has collectively shifted from a costly, disconnected non-system for health care to aligned health approaches focused on achievable targets for better care, lower costs, prevention and reduction of disparities.* * Under review; not finalized

14. State Health Care Innovation Planning State Health Care Innovation Plan Draft Preliminary Outline  11-page document, but direction is changing by the day, as feedback is provided. Available at: http://www.hca.wa.gov/shcip/Documents/ outline.pdf http://www.hca.wa.gov/shcip/Documents/ outline.pdf  Outlines specific components, following guidelines of the CMMI grant  Rough draft of the plan due to CMMI September 30  Available for review. Email your thoughts on the outline to: simquestions@hca.wa.gov simquestions@hca.wa.gov

15.  Transformational, focused strategies and tactics  Sharp financial analysis and evaluation plan  Clearly defined infrastructure needs  Commitment sought among key influencers  Strategic multi-year legislative and regulatory strategies Project Priorities State Health Care Innovation Planning 15

16. 1. Promote well-being and eliminate systemic barriers to health and recovery for individuals at risk for or experiencing mental health and substance abuse challenges State Health Care Innovation Planning 16 2.Multipayer, purchaser and provider transformation  Payment approaches supporting coordinated care  Evidence-based care reducing unwarranted variation  Consumer engagement  Infrastructure  Strengthen purchaser alignment and influence Focus narrowed to drive the work Two Streams of Focus for Transformation

17. 1. Physical & Behavioral Health Aims 17  Bi-directional seamlessness/integration of physical and behavioral health care and social supports for individuals with co-morbidities  Enhanced early disease prevention and mitigation throughout the lifespan – toward accountable communities of health. The material on this page is considered DRAFT and is available for review and comment by key stakeholders.

18. 2. Multipayer Aims  Three draft key objectives for health care delivery system transformation in Washington State:  Effective prevention and screening to improve health and avoid chronic disease and major acute conditions;  Effective chronic disease management, particularly for complex patients; and  Preferred use of lowest cost, highest quality care for acute conditions.  One common measure set needed for each objective to align efforts and evaluate progress on a statewide basis. 18 The material on this page is considered DRAFT and is available for review and comment by key stakeholders.

19. 19 The material on this page is considered DRAFT and is available for review and comment by key stakeholders. 2. Multipayer Aims  Four-part strategy is recommended to help achieve each of the three objectives. 1. Redesign healthcare delivery to reduce cost, improve quality and improve patient experience 2. Restructure healthcare payment systems to support and reward providers who deliver high-value care 3. Restructure healthcare benefit design to enable and encourage patients to improve their health and use high-value healthcare services 4. Educate and encourage state residents to improve their health and use high-value healthcare services Important “headlines” include:  Phase out fee-for-service payment;  Give consumers clear financial incentives (through benefit design)

20. State Health Care Innovation Planning ROW TOGETHER for a healthier Washington A State Plan will help us… Working together, providers, consumers, health plans, employers, state agencies, and other partners can transform health care to a system that better serves everyone. Toward a Healthier Washington

21. State Health Care Innovation Planning  Focused strategies & tactics are in analysis phase—nothing finalized  Outline of the draft plan is complete and being circulated for comment. Located at : http://www.hca.wa.gov/shcip/P ages/resources_and_document s.aspx http://www.hca.wa.gov/shcip/P ages/resources_and_document s.aspx  Sign up for the Feedback Network to receive updates: simquestions@hca.wa.gov simquestions@hca.wa.gov  Register for October 15 webinar, 11 am – 12:30 pm  https://www2.gotomeeting. com/register/680518578 https://www2.gotomeeting. com/register/680518578 Next Steps 21

22. Q & A / Discussion State Health Care Innovation Planning 22