Why paying providers differently improves health (and how we’re doing it)

At a fundamental level, everyone agrees that the purpose of our healthcare system is to improve people’s health. But, the financial systems and incentives in place are often at odds with that goal. The King County Accountable Community of Health is one of nine regional entities across our state established to improve our health care delivery system, starting with Medicaid. The goal is to reboot the system so that people can access the care they need, when they need it, in a more seamless and holistic way.

It’s a complicated task, so we sat down with Public Health’s Policy Director Ingrid McDonald to learn more about the nuts and bolts of this strategy.

Q: Let’s start off with the fundamentals of the Accountable Community of Health (ACH). Why did the ACH come about? What does it do?
Simply put, the ACH is about making the health care system work better for people, starting with the more than 400,000 people in King County who now have coverage through Medicaid.

In an ideal world, it would be easy to access the care you need when you need it. Your health care team would communicate with one another and connect you with whatever type of support that is important to keep you well – whether that be diabetes self-management or mental health counseling.

We all know that’s not typically how the system works now. Instead of a coordinated, integrated approach, health care is delivered in silos, the root causes of ill health go unaddressed and people fall through the cracks.

The purpose of the ACH is to fix this by bringing together organizations from across sectors to test new ways of doing business.

Q: What was Public Health and King County’s initial role in launching the King County ACH?
Over the past two years, Public Health played a key role in incubating the King County Accountable of Health, convening stakeholders and setting the stage for this work.

The ACH is now its own legal entity, with an Executive Director and staff and a newly established cross-sector, 25-member Governing Board. With our support, the King County ACH recently passed a state certification process and is now eligible to receive $6 million in Medicaid funding to design local demonstration projects.

Q: So, as you mentioned above, the ACH is taking a hard look at the financial incentives that influence the way healthcare is provided. What would that change look like?
In today’s world, most health care providers are paid based on volume. The more patients they see, the more tests they order, the more they get paid.

In tomorrow’s world, health care providers will be based on value. Providers will be incentivized not only to treat you when you are sick but also to keep you well.

The King County ACH will plan and implement local demonstration projects to support this shift. The key areas of focus will be the integration of physical and behavioral health; addressing the opioid crisis; chronic disease prevention and management; and transitional care to support people as they are released from jail and hospitals.

Q: That seems a big ship to turn. From a practical perspective, how is the ACH taking that on?
Two key ingredients will fuel the work of the ACH – a new level of cross-sector collaboration and robust funding.

In the past, managed care organizations, hospital systems, community clinics didn’t necessarily know or talk with housing advocates, youth and family service providers and substance use disorder specialists. Today they meet regularly around a common table with a shared goal of improving health outcomes in King County.

Under the umbrella of the ACH, these partners have the opportunity to earn more than $100 million in incentive funding based on successful implementation of demonstration projects.

Here’s an example:  The Transitional Care Project” focuses on providing people more support when they leave hospitals or jail because we know that without that support, people bounce back into the system.  Project partners will apply evidence based approaches such as better connecting people with housing or mental health services.

For more information, visit King County ACH.

Originally posted October 26, 2017

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