Healthier Washington

  • Medicaid Payments for AIANs 2008 and 2009 (from CMS MAX Extract Database) exceeds $4 billion, but less than $1.5 billion is paid to Indian health programs (IHS, Tribal, Urban Indian).

  • Innovation CMMI grants.

  • Port Gamble S'Klallam Tribe Innovation 
  • Expanded Chronic Disease Management with Community Health Nursing and CHRs
  • Join regional inter-tribal planning effort (with Olympic Peninsula Tribes) and 3 counties
  • IT Infrastructure:  Integrate Medical, Dental and Behavioral Health Services all deployed 2014/2015 with Personal Health Portal planned for 2015.
  • Meetings; first Tribal,then agencies, then Govt to Govt.
  • No need to wait while state and federal government delay funding for case management and full integration of services.
State Health ReForum  Innovation Plan Population Health Matrix
Where do Community Health Representatives and other front line workers fit in?
Arizona includes over $4 million for AIAN  in SIM proposal.
  • HealthPath Washington is a multi-stage process of improving coordination of care and cost containment for Medicaid and Medicare dual eligibles. 
Sept 2014 letter announcing delay and the New July 2015 start date.
December 13, 2012 Congressional Dual Eligible Hearing, Testimony, Mary Ann Lindeblad and CMS(Bella).

Demographics of Duals  April 2013 start of phase 1.
Dual Eligibles
Data to Information:  Where will it come from?

How will Indian health programs get useable information from their electronic health care systems without additional funding from the CMS-funded Healthier Washington Initiative?

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Can we turn medical visit/claims data into health planning information?  How will tribes with largely global budgets (IHS funds) combine EHR data with claims data?  Will an underfunded IT budget be able to keep up with others in ACHs?

Electronic Health Records (EHRs), even if they are linked to Health Information Exchanges (HIEs), do not have enough information to fill this need. The only truly comprehensive information about all of the healthcare costs associated with an episode of care or with a group of patients, particularly the prices being paid for the services delivered, comes from claims data maintained by payers. Consequently, providers would be more willing and better able to participate in new payment models if they could get access to claims data from health plans, Medicare, and other payers.

---source:  Center for Healthcare Quality and Payment Reform---

  • Phase Two of Health Care Reform 
  • Payment Reform driving Health Service Delivery Reform
  • 1.  $65 Million for 4-year Healthier WA (Innovation Plan).
  • 2.  Duals, Healthpath WA
  • 3.  Integration of 2 webportals?: 
  • 4. WA Healthplanfinder and WA Connections
  • 5.  Medicaid and WA Health Benefit Exchange Contracting
Oregon Transformation Center (Operations of CCOs)
Tribal Health Home Materials

Promising new payment mechanism for case management.
  • Medicaid Transformation
  • ​Transformation Projects
  • ​Long Term Care and Support Services
  • Housing and Employment Support.
New Mexico's Centennial Managed Care has not worked well for tribes despite 3 years of consultation with Tribes.
  • ​Tribal Engagement in Global Waiver and Healthier Washington
  • Forum, August 5, 2015 in Spokane (at Native Project)
  • Monthly Medicaid Meetings (M3 meetings)
  • Joint American Indian Health Commission and NPAIHB Workgroup
  • AIHC August 13, 2015 agenda/discussion.
  • August 14 Consultation at HCA Olympia.
CMS-approved plans have little evidence of 'success' to include Indian Health Programs with SIM funded 'innovation' or 1115a Waivers in Minnesota, Arizona, Oregon, New Mexico.
  • Minnesota tribes recently engaged (2015) in 3rd year of MN initiative.
  • Regional Planning and engagement
  • Regional inter-tribal planning effort has limited success (but some) in the past with Regional Support Networks (RSNs)
  • There are some examples of:
  • Tribes working regionally with other tribes
  • Tribes working regionally with tribes AND governments.
  • Strengths and Weak Links in the Healthier Washington Tribal Connection
  • States with Indians Tribes have yet to succcessfully include tribes in their Innovation Grants-funded efforts.
  • Global Waiver Slide Deck (Tribal workgroup meeting
  • 20 best comments from letters and emails to CMS.
Suggested Citation: Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2016 Website.
Free and unlimited use granted with citation (suggested citation above).
edfox_phd@yahoo.com