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Medicaid Implementation Plan Submission Marks Major Milestone

By Elevate Health

Our goal is to provide whole-person, integrated, quality health care in Pierce County. We were established — along with eight other Accountable Communities of Health organizations in Washington — in support of the 1115 Medicaid Waiver, which allows the state to earn more than $1.5B in federal funds over a five-year period to transform the Medicaid delivery system in our state. To secure continued funding, we must meet specific requirements set by the Washington State Health Care Authority (HCA) to continue to earn the 1115 waiver funds for our region. The incentives we wearn are allocated by the Board to partner agencies that can demonstrate the most immediate, far-reaching and long-term impact in order to maximize funding for our region.

“Submission of the Plan to HCA is an exciting milestone that opens doors and helps us break new ground as we work to fulfill our promise of transforming health care in Pierce County,” said Chief Executive Office, Alisha Fehrenbacher. “Our commitment to a community-inspired vision of health for our region will drive change for years to come.”

What is the Implementation Plan?

As of October 1, 2018, our organization has successfully submitted the Medicaid Transformation Accountable Communities of Health Implementation Plan to the HCA.

The Implementation Plan (the Plan) identifies the milestones, steps, programs, key deliverables and outcomes for each task along the road to healthcare transformation. Because building better health for Pierce County relies on partners to transform the system, the Plan establishes a timeline, prioritizes local action and identifies roles and responsibilities for our staff, partners and provider organizations.

Transforming health care is an ambitious goal that requires long-term investment and strategic planning. The Plan holds our organization accountable to HCA for its funding and serves as a checklist to ensure the right steps are taken today to build a solid foundation for long-term health transformation. Our strategy is built on the Quadruple Aim framework: (1) increase access and equity in health care, (2) provide higher quality care, (3) lower costs and (4) improve support for providers and caregivers.

Finally, the Plan is an agreement and shared roadmap between HCA and Elevate Health and enables federal 1115 Wavier funds to flow through HCA to Elevate Health.

How is the Plan important to the work we are doing as an ACH?

Successful completion of the Plan is a key pay-for-reporting (P4R) deliverable. For our organization, demonstrating measurable results (reporting) is necessary to receive funding now and into the future.

As work expands, we will determine how to best engage other partners. Each partner must be able to adhere to strict reporting and data requirements. We are committed to assisting agencies in reaching the reporting requirements so that funding can benefit all who are working to elevate social determinants of health and contribute to health care transformation in our region. As we receive funding for successful completion of Plan tasks, partner agency timelines must parallel Pierce County ACH's to ensure continuation of work.

What was our approach to developing the Implementation Plan?

The Plan is a community-inspired vision for the future and commitment to innovation in pursuit of a healthier Pierce County. At the outset, we determined that the best strategy was to maximize federal funding flowing into the region by partnering with agencies that were ready and able to impact state-wide measurements right out of the gate. Through the Catalyst RFP process, we determined which organizations met our criteria for funding and further identified those which can help Pierce County maximize the funding it receives by demonstrating measurable impacts on key population health metrics. The Plan reflects that strategy and provides both a timeline and roadmap for its implementation.

What will be the result of the Implementation Plan?

The Plan serves as the overall vision and purpose for Pierce County ACH to realize a transformed health care system. Our goals are to elevate care equity and use data, community linkages and partnerships to streamline delivery of better, more accessible and lower-cost health care in Pierce County. Strategic partnerships improve care coordination, which leads to individuals and systems experiencing positive change.

Who benefits from the Plan in both the short-term and long-term?

In developing partnerships, we are building a solid foundation for funding and increasing support in the region. Because funding is reliant on showing results, the more Pierce County ACH can prove advancement — with data and measured delivery improvements — the more funds Pierce County can expect. That key funding factor focused our strategy on funding partners that can maximize efforts and most quickly move the needle.

The number of people in our area who can benefit from this work is significant. This investment impacts providers who serve over 187,000 Medicaid recipients in Pierce County. Systems such as MultiCare and CHI Franciscan cover 88 percent of all emergency department visits in the county. By investing in organizations like these that have the greatest immediate impact on population health, we can reach our goals more quickly.

In addition to the Plan, we are developing the OnePierce Community Resiliency Fund (OnePierce), which will provide additional funding and flexibility in the future to support the strategies in and beyond the Plan. OnePierce will provide additional targeted funding to non-clinical services that impact the overall health of the community. OnePierce establishes a strong foundation to ensure that social determinants of health remain at the forefront of transformation efforts.

What should be expected after the Implementation Plan is in place?

Once we establish the baseline metrics for all partnerships and can move through to maintenance and implementation, plenty of work remains. We have prioritized initial work and also remains aligned with state and federal priorities. Financial and clinical integration are key components to continuing transformational work. The longer-term strategies OnePierce are at the forefront and act as a drumbeat and establishes a momentum we can maintain. The Plan serves as a guide through prioritizing our tactical, daily work to accomplish. Beyond the Plan, we are working with our communities to define our longer-term plan and vision for the future of healthcare in Pierce County.

What projects has Pierce County ACH outlined in the Plan?

Projects that are specifically based on Washington State’s priorities are outlined within the Plan. Our organization is focused on four main projects:

  • Bi-Directional Integration of Physical and Behavioral Health through Care Transformation
  • Community-Based Care Coordination
  • Addressing the Opioid Use Public Health Crisis
  • Chronic Disease Prevention and Control

Additional work outlined in the Plan is incorporated into our current projects.

Who are our current partners?

Last month, we announced the Catalyst funding recipients. The funds are designed to accelerate our community's strategic goals. Selected partners are organizations that can accelerate the implementation of integrated care and reinforce ongoing and future efforts. The organizations have also been selected as year-one partners in the Plan:

  • MultiCare Health Systems
  • Sea Mar Community Health Centers
  • CHI-Franciscan
  • Pediatrics Northwest
  • HopeSparks

In addition to the Catalyst partners, the Tacoma-Pierce County Health Department has also been selected as a partner in support of its many on-going projects in coordination with our organization.

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