Medicaid Transformation Basics
What are the projects?
Last fall, the BHT Board selected four project areas from the state Toolkit:
- Bi-directional Integration of Care
- Chronic Disease Management
- Addressing Opioid Public Health Crisis
- Community-Based Care Coordination
In addition to the four project areas, the BHT Board approved four local priority areas:
- Reduce unintended pregnancies
- Improve oral health
- Increase behavioral health access
- Reduce jail recidivism
Why did BHT also select priority areas?
The Board selected these priority areas to honor the topics that came out of the early BHT focus groups, to highlight activities that came from the projects that were not select from the toolkit, and because there is a lot of opportunity in these areas for community alignment. Approving these priorities gave BHT the authority to continue to drive transformation in those areas.
What is BHT doing with the data now?
We are using the information to make recommendations for future region-wide technical support and tools. Each Collaborative will receive a summary to inform the Partnering Provider and Collaborative Transformation Plans. BHT will use the data to aid in completing the semi-annual, state-level reporting to the Health Care Authority (HCA).
How can I get a copy of my organization’s assessment results?
Key contacts from each organization received a copy of any assessment completed. If you don’t know who the key contact is at your organization, please email Justin Botejue at firstname.lastname@example.org and you will be connected with the appropriate person.
How much is our organization getting paid for doing the assessment(s)?
BHO contracted Mental Health and Substance Use Medicaid providers who completed the FIMC Readiness assessment qualified for a payment of $15,000 for tribal organization and $20,000 for all others. The payment MTP assessment was $15,000 for primary care providers and $5,000 for behavioral health providers.
Can I request additional information from the assessments?
Yes, there were more questions about several other topics than we were able to include in the webinar. If you have a specific request, please contact Hadley Morrow at email@example.com to see if we have data available.
Partnering Provider Transformation Plans
Who is supposed to be submitting plans?
In this phase of the planning, BHT is asking for Plans from behavioral health and primary care Partnering Providers.
How are these plans different than the Collaborative Transformation Plan?
The Collaborative Transformation Plans were developed by all Partnering Providers within each Collaborative. The idea is for these plans to help provide a framework of regional goals and activities. These Plans also contain the regional plan for activities related to community-based care coordination.
The Partnering Provider Transformation Plans will be specific to how that each provider will make changes to their practice; describing their strategies/activities, goals, timeline, and budget for activities within the project areas of bi-directional integration, chronic disease, and opioids. It is intended that the Provider Plans will be driven by the framework established in their Collaborative’s Plan.
If only behavioral health and primary care Partnering Providers are completing individual Plans, how are the other Partners meant to participate?
BHT would encourage pharmacy, oral health, social determinants of health, and other key Partnering Providers to develop their value proposition of how they could assist behavioral health and primary care Partnering Providers in meeting their setting requirements and value-based payment (VBP) goals.
It is also expected behavioral health and primary care Partnering Providers would be developing their plans with eye towards establishing the linkages necessary to meet the setting requirements.
BHT will continue to convene Collaborative members with an aim towards each Collaborative developing a deeper understanding of the individual organizations involved and how Partners can work together.
If we don’t know how much is available to earn, then how can we make a budget?
Transformation Plan Budgets are for informational purposes only and it is not expected Project funds will fully cover projected costs. Providers should build their financial plans with a view towards weaving together funding to meet setting requirements, not “pitching” specific project ideas. For each budget category in the template, BHT is requesting Partnering Providers to identify estimated costs associated with Transformation Plan activities along with costs associated with project management and convening. BHT will be reviewing Transformation Plans with an eye for whether or not each Providers is able to meet all of the of pay-for-reporting and pay-for-performance measures. If yes, they would earn the full amount allocated to those activities.
Can items on the budget be retroactive?
(Example, reimbursing organizations for time already spent organizing.)
No. Plans are for Implementation year activities only.
Can BHT include some examples of line-items for each of the 4 categories of spending on the budget?
Yes! We are working on some examples.
Are providers required to do activities within every project area?
Yes. BHT does not see Transformation separate projects but as a set of aligned activities. We hope that all providers can answer for all three project areas. However, if you are not able to take on one of these projects, we ask you to explain why in your plan.
One notable exception is that the Opioid project area has four strategies, and while each Collaborative needs to address all four strategies, not every Partnering Provider will need to do all four.
If a partner does not select a project/activity, how will that impact how much money they can earn?
We have not made any decisions on how incentive and performance payments will flow past the policies in place. However, it is unlikely that there will be a set dollar amount, or score tied to specific projects and activities.
How do the BHT technical councils fit into this work?
Each technical council is a specialized group, meant to help inform and guide the transformation process. The councils developed the recommendations that led to the framework of the Transformation Plan. Also, members from each council will participate in the review of the plans.
What kind of support is BHT providing to the Partnering Providers while they create their Transformation Plans?
BHT has planned an extensive support plan including the following:
- Webinars covering every aspect of the Partnering Provider Transformation Plan Template
- Regularly updated FAQ (email your questions to Kim Brinkmann at firstname.lastname@example.org)
- Links to documents and resources on Collaborative Workspace web page, such as:
- HCA Toolkit
- Performance measures and baseline data
- Assessment summaries
- Office hours: call (509) 960 8593 to be directed to staff who can answer questions or to set up a one-on-one appointment
- Subject matter experts: available for T.A. calls/questions about the models
What additional suggestions for support do you have?
When are Transformation Plans due?
Partnering Provider Transformations Plans are due to BHT on or before August 1, 2018. This deadline allows BHT time to review plans, communicate with the Partnering Provider if there are any questions, and then formulate our report to the HCA. BHT will notify Partnering Providers by September 5 if we have any outstanding questions regarding their plans.
How do I submit my Transformation Plan?
You can submit your Transformation Plan either via the secure webform on the Collaborative Workspace or you can email your plan to Hadley Morrow at email@example.com.
How much money is there?
Approximately, $61.7 million is available to the BHT region to earn over the next five years. The Waiver Finance Workgroup has approved the following allocation breakdown:
- 55% to Collaboratives
- 30% to Regional Infrastructure
- 10% to a Community Resiliency Fund
- 5% to BHT for Administrative costs
How will money be earned after this planning year?
The region (via BHT) earns money differently than how providers earn dollars.
BHT earns the regional funding by submitting two reports to the Health Care Authority (HCA) each year. As long as we can demonstrate that we have met the anticipated milestones, we will earn 100% of the dollars.
BHT and the Waiver Finance Workgroup have not yet made any additional decisions on how Project dollars will be earned by Partnering Providers other than the allocations established for this planning year (MOU, volume and equity accelerators, assessments, and Implementation Plans for behavioral health and primary care Partnering Providers).
BHT does expect that Project Fund allocations for Year 2-5 will be comprised of a combination of pay-for-reporting and pay-for-performance measures and will be informed by the Collaborative and Partnering Provider Implementation Plans. The Waiver Finance Workgroup will allocate dollars to specific improvement activities in late 2018 or early 2019. If Partnering Providers are able to meet all those activities, they will be able to earn 100% of the dollars.
What is the Community Resiliency Fund?
The Community Resilience Fund (CRF) will grow from the 10% allocation of project funds over 5 years, for a total of approximately $7.1 million, to be expended by 2022. It is meant to ignite and support regional, community-led initiatives aimed at strengthening resilience in our community through social determinant investments and key system investment to promote improved population health. We expect the Community Resilience Fund will deepen and strengthen existing investments as well as provide a model for future investments that is attentive to the ever-changing landscape.
How will the Community Resiliency Fund be spent?
No decision has been made yet on how these funds will be distributed. We will be conducting a community process to generate ideas from the region via brainstorming sessions with our council. We plan to have a model for distribution ready for board review this fall, with funds being distributed in early 2019.
Core Principles of the Fund:
- Utilize data to drive community decision making
- Extensive and expansive community feedback to inform where change is needed
- Balanced community-based governance on fund distribution
- Aligned priorities and leveraged investment across regional health and community
- Utilize shared savings model to drive additional investment
What are the rural accelerator funds?
The rural accelerator funds were earned by each of the five rural Collaboratives ($50,000 each), to be used for supporting integration of primary care and behavioral health. It is anticipated funds will be used to support planning activities such as; staff to coordinate identified collaborative activities, technology to manage relationships and interactions among member organizations, cost to convene meetings and trainings, including materials. The funds may not be used for programs and/or services covered by Medicaid and other funders.
What are the equity accelerator funds?
The equity accelerator dollars were earned by primary care and behavioral health organizations that serve a client pool with greater than 10% racial diversity. This is meant to support organizations who take on serving a higher percentage of the underserved populations, who often correlate with a higher probability of negative health outcomes. This is a onetime payment to demonstrate the BHT’s commitment to closing the gap on health inequities.
What are the volume equalizer funds?
The volume equalizer dollars were earned by primary care and behavioral health organizations serving a higher percentage (>10%) of the Medicaid population, recognizing that the more people your practice serves the more your organization will need to do to meet Transformation goals.
I’m a public hospital district and I received IGT funds. Who should I talk to about that?
Please email Ben Lindekugel, executive director of the Association of Washington Public Hospital Districts at firstname.lastname@example.org. This article explains the IGT funding process in more detail.
Who is receiving FIMC funds?
The first round of FIMC funding goes to BHO contracted Medicaid Providers and Tribal BH Providers in order to help them prepare for financial integration in 2019.
How much did they receive?
BHO Contracted Medicaid Partnering Providers, regardless of volume or geography, earned $70,000 each. Tribal behavioral health Partnering Providers, regardless of volume or geography, earned $45,000 each.