The Healthier Washington Initiative Promotes Accountable Communities of Health Statewide

At a recent NASHP preconference, Improving Health, Lowering Costs: Translating Population Health into Effective State Policy, we heard from Washington State about the innovative work currently underway as part of its Healthier Washington initiative. This panel featured MaryAnne Lindeblad from the Washington Health Care Authority (HCA) and two local perspectives: Patty Hayes, Director of Public Health in Seattle & King County, and Barry Kling from the Chelan-Douglas Health District. They discussedAccountable Communities of Health (ACH), regions that bring together public and private entities to improve health and health systems, improve population health, and drive physical and behavioral health integration.

Nine regional ACHs will bring together health care providers, social service organizations, health plans, hospitals, county governments, tribes, and others. They are being phased in throughout the state based on community readiness determined by aligned policies, designated regional borders, and Medicaid procurement. Performance measures, metrics, and expectations are intended to be developed in partnership with the state. ACHs will be governed through public-private partnerships, tailored to fit the community in question, and will receive funds through the state that can then be distributed to the various partners carrying out transformation projects within each region. Potential responsibilities of ACHs include partner procurement; the development of a regional health assessment or health improvement plan; the assumption of accountability for results; acting as a forum to decide on payment models, performance measures, and investments; workforce development; and using data to address community health needs.

Even before the start of the Healthier Washington initiative, King County’s Transformation Plan was already well underway. This five-year, equity-driven Transformation Plan aims to shift the focus from a costly, crisis-oriented health response to prevention, embrace recovery, and eliminate disparities to significantly increase the health and well-being of the community by 2020. It incorporates several initiatives within King County, including Communities of Opportunity, Behavioral Health Integration, and the Familiar Faces Initiative. When the Healthier Washington initiative selected King County to be one of the many ACHs, those in King County viewed this as an opportunity to carry forward the momentum that was already underway in that area.

Chelan-Douglas Health District, a rural, politically conservative community, faces similar struggles of other rural areas—among them a stressed health care system and workforce shortages. As of early 2014, Chelan-Douglas became part of the North Central ACH. Several skeptical partners challenged this involvement in the Healthier Washington initiative, but ultimately agreed to participate in order “to be at the table [rather] than on the menu.” For this district, participation as an ACH means new organizational structures and new financial arrangements, along with some skepticism about participating in a new state program.

As the Healthier Washington initiative continues to move forward, the State will need to balance the various needs of the many ACHs and think about how such structures either support or inhibit local change. Specific questions to consider as this initiative moves forward are whether the HCA will take into account the special circumstances of rural health care and how savings will be invested into population health improvement strategies. Ultimately, it plans to leverage resources and opportunities to transform healthcare in Washington.

How is your state supporting local innovation through state level initiatives to improve population health and address social determinants? Let us know by starting a discussion on State Refor(u)m.