Washington State has embarked on an ambitious plan, called Healthier Washington, to redesign the health care system in our state so that people are healthier and the cost of health care is more under control.
The plan was designed by the state with significant input from a broad variety of stakeholders, including WSHA. Last year, the state was awarded $65 million to make the plan a reality. In addition to the grant, the state is applying for a Medicaid global waiver to transform care delivery, including improving long term care, mental health integration, and the focus on population health. The state has submitted its application to CMS and is asking for about $3 billion over five years in federal funds to build on the work started under Healthier Washington. CMS and HCA will now enter into a formal negotiation period over the details of the global waiver program.
WSHA is an active partner in this work, and is devoting considerable resources and energy to working with the state during the next year’s planning phase and the three-five years of implementation that will follow. Our role is to analyze the proposed changes, share our expertise with state planners, and keep members and communities informed.
One of our special interests in this work is around access to rural health care as the state redefines payment for small critical access hospitals.
To learn more about WSHA’s work in this area, keep reading!
WSHA submitted four global waiver proposals to the state Health Care Authority (HCA) in January 2016 on ways to transform Medicaid and improve care for patients. HCA released a broad call for proposals to assist in identifying areas the state will pursue in a global waiver to draw down $3 billion from the Centers for Medicare & Medicaid Services (CMS). WSHA’s proposals include:
- Deploying of community care coordinators
- Expanding end of life care improvements
- Building on the work of the Safe Deliveries road map
- Exploring a pre- and post-surgical value-based payment
This is a large and ambitious plan with four areas that will have major impact hospitals and health systems:
Community empowerment through Accountable Communities of Health (ACH): The idea is that local communities are in the best position to identify the health needs of the community and meet them. ACHs will help coordinate those efforts. See the map of Washington’s ACHs here with hospitals listed by district.
Practice transformation: The practice of medicine has changed dramatically in the last generation, but more change is coming.
Payment redesign: The state will promote four different payment models.
• Model 1 involves integrating the payment for mental and all other health care services. More integrated payment will help pave the way to providing more integrated services.
• Model 2 will develop new payment models for a small segment of critical access hospitals, along with rural health clinics and federally qualified health centers.
• Model 3 and 4 will develop accountable care organizations and high value networks. This will mean some health systems will take more of the risk and possibly the reward that is possible by providing more integrated health care. These models will be spread in the private sector.
Analytics, interoperability and measurement: In order to know if we are improving the health care system, we have to measure it. A significant part of the federal grant is for data collection and analysis. This data could be a goldmine of information that will help hospitals and health systems continue to be forces for their own improvement.
WSHA is committed to working with the Health Care Authority, Department of Health and other stakeholders to make the most of this opportunity. We intend to keep our members informed and engaged throughout the process.
There are four key staff who are devoted to this effort, all bringing different expertise. Please feel free to contact any of us with questions:
Claudia Sanders, Senior Vice President, Policy Development
Ben Lindekugel, Executive Director, Association of Washington Public Hospital Districts
Jacqueline Barton True, MSW, MPH, Director, Rural Health Programs
Chelene Whiteaker, Policy Director, Member Advocacy
In order to keep our members informed and engaged, we will be using some new and traditional modes of communication:
• Newsletters (Weekly Report and Fiscal Watch)
• Webcasts as needed
• Video (designed to be used with hospital boards and public audiences, this animated video about the innovation plan will be debuted at the Chelan Rural Conference in June)
Engagement with formal and informal groups, including:
• Rural Committee
• Public Policy Committee/ Public Policy Advisory Group
• Chief Financial Officer group
• Patient Safety Committee
• WSHA Board of Trustees
• Work groups on ACHs, practice transformation, mental health
Letters to HCA and CMS on Medicaid Waiver Transformation (August and October 2015)
WSHA has commented directly to the Health Care Authority on the global waiver. Additionally, WSHA submitted a letter of support to the Centers for Medicare & Medicaid Services on the state’s application.
WSHA Bulletin (March 26)
This bulletin provides initial information on “Healthier Washington” and discusses WSHA’s actions to shape the decisions and how hospitals should engage in this multi-year process.
WSHA Bulletin (July 23)
This bulletin provides background information on the Medicaid global waiver. See the state’s global waiver application to CMS for the latest detailed information.
The Health Care Authority is the lead agency on Healthier Washington, and they have made many resources available to the public, including:
• Washington State’s Medicaid Global Waiver Application to CMS
• 5-minute: Healthier Washington Video
• 90-seconds: Healthier Washington Video
• The Grant Application Materials
• Healthier Washington Grant Budget