governing board meeting – april 4, 2019, 1:00 pm - 4:00 pm · capacities” or “co-design...

Equity | Community | Partnership | Innovation | Results

Governing Board Meeting – April 4, 2019, 1:00 pm - 4:00 pm PacTower - 1st Floor Training/Event Space: 1200 12th Ave S. Seattle, WA 98144

MEETING GOALS The primary objectives of today’s meeting are to: (1) approve Governing Board appointments for the April 2019 wave of new terms, (2) learn about the latest developments in HealthierHere’s community engagement work, and (3) discuss the current landscape and risks for behavioral health providers in our region.

AGENDA

1:00 pm 1) Welcome & Introductions • Meeting goals and agenda review

Betsy Lieberman & Esther Lucero, Board Co-Chairs

1:10

2) Community Voice / Public Comment • Opportunity for community members to share

reflections and provide feedback

1:15

3) Board Business • Approval of March 7th meeting minutes • Executive Director report

Betsy Lieberman & Esther Lucero, Board Co-Chairs Susan McLaughlin, HealthierHere

1:25 4) Governance – Board Appointments • Decision memo: Member reappointments • Decision memos: New member appointments

Betsy Lieberman & Esther Lucero, Board Co-Chairs Susan McLaughlin, HealthierHere

1:50 BREAK

2:00 5) Community Engagement • Community partner selection update • Connecting community and clinical partners • Developing equity measures

Marya Gingrey, HealthierHere Marguerite Ro, Seattle-King County Public Health

3:15 6) Context and Risks to the Behavioral Health Sector • Role of HealthierHere

Behavioral Health Provider Representatives Molly Carney, David Johnson, Daniel Malone and Victor Loo

4:00 pm ADJOURN

Next Meeting: Thursday, May 2, 2019, 1:00-4:00pm (Seattle Foundation, 1601 5th Ave, Suite 1900, Seattle, WA)

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Governing Board Meeting Summary March 7, 2018, 1:00 p.m. – 4:00 p.m. King County Elections – 919 SW Grady Way, Renton, WA 98057

Members Present: Elizabeth “Tizzy” Bennett (Seattle Children’s Hospital), Roi-Martin Brown (Washington Community Action Network), Molly Carney (Evergreen Treatment Services), Elise Chayet (Harborview Medical Center), Kristin Conn (Kaiser Permanente of Washington), Shelley Cooper-Ashford (Center for Multicultural Health), Steve Daschle (Southwest Youth and Family Services), Ceil Erickson (Seattle Foundation), Patty Hayes (Public Health), Marissa Ingalls (Coordinated Care), David Johnson (Navos), Cathy Knight (Seattle Aging and Disability Services), Betsy Lieberman (Betsy Lieberman Consulting), Daniel Malone (Downtown Emergency Service Center), Jeff Sakuma (City of Seattle), Erin Sitterley (Sound Cities Association), Elizabeth Tail (delegate for Steve Kutz, Cowlitz Indian Tribe), Sherry Williams (Swedish Medical Center)

Members Not Present: Teresita Batayola (International Community Health Services), Sybill Hyppolite (SEIU1199NW), Esther Lucero (Seattle Indian Health Board), Jihan Rashid (Somali Health Board), Giselle Zapata-Garcia (Latinos Promoting Good Health)

Staff: Marya Gingrey, Thuy Hua-Ly, Abriel Johnny, Susan McLaughlin, Gena Morgan, Kelsey Robinson, Lisa Watanabe (HealthierHere), Christina Hulet (Hulet Consulting) Guests: Tracy Adair (King County DCHS), Samantha Anderson (United Healthcare), Angelique Cardon (United Healthcare), Laura Johnson (United Healthcare), Hani Mohamed (Community Health Plan of Washington), Semra Riddle (Sound Cities Association)

Welcome & Introductions Betsy Lieberman (Betsy Lieberman Consulting) welcomed everyone and brief introductions were made by the board and public. She reviewed the meeting goals/agenda and opened the floor for public comment. No public comment was made. The board reviewed and approved the 2/7 meeting minutes with no revisions. Abstentions: Patty Hayes (Public Health), Cathy Knight (Seattle Aging and Disability Services), Betsy Lieberman, Elizabeth Tail (Cowlitz Tribal Health), Sherry Williams (Swedish Medical Center) Ingrid Ulrey (Public Health) updated the board on a recent proviso from King County that is looking for opportunities to provide better health coverage for underinsured citizens. There are five viable options to move this work forward. Discussions about cost and scope are underway. A report will be brought to the Council in June. It was requested that an update on the proviso be provided at the July board meeting.

Board Business Executive Director Report Report to City of Seattle: Susan Mclaughlin (HealthierHere) and Jeff Sakuma (City of Seattle) provided

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an overview of HealthierHere’s (HH) work with the City of Seattle’s Housing, Health, Energy and Worker’s Rights Committee. Hiring: We are pleased to announce that Abriel Johnny has joined the HH team as our new Community and Tribal Engagement Manager (Tribal focus). Community Webinar: Our first 2019 Community Webinar had over 90 participants. HH will continue to host quarterly informational webinars to keep partners informed of HH’s work. ACH’s Joint Request: On February 19, the ACHs released a joint Request for Proposals (RFP) to solicit expertise to assist all nine ACHs in identifying and implementing statewide solutions in technology and sustainability. The ACHs received 4 proposals in response. Proposal review is underway.

Approval of 2019 Investment Strategy Thuy Hua-Ly (HealthierHere) reviewed the “2019 Investment Strategy Recommendation” slide deck. She reminded the board that the funds under discussion are the 2019 funds for Medicaid providers only. There will be a separate discussion about the Community Based Organization (CBO) investment strategy. Twenty-three investment options were tested and prioritized based on HH’s values and pay for performance (P4P) metrics. This resulted in a list of 12 investments that scored above the 50th percentile and promote systems and tools for providers to enhance patient care, support data sharing, and address provider training and technical assistance (TA) needs. Through this process the following investment principles were identified:

• Clinical and community partners co-design and implement • Informed by consumer voice and experience • Benefits Medicaid beneficiaries and improves outcomes • Investments are used to seed and catalyze innovation • Engage with payors early to identify value-based payment opportunities • Providers are paid for progress and performance

The board was reminded that to accomplish everything we would like to do in 2019 we need to strategically stage and phase our investments. Susan reviewed the “marathon/sprint” approach. Some of our investment strategies to “Strengthen Foundational System, Infrastructure and Capacities” or “Co-design Integrated Models to Enable Whole Person Care” will take time (marathon); while others will support quick tests of innovation (sprints). Thuy reviewed the budget information for the 2019 Investments. A general work plan was established for each investment strategy. Key activities and deliverables were identified and costs were scoped. About $5.7M is available to support clinical partners in developing foundational systems, tools and skills to integrate population health approaches into practices and successfully transition to value-based care. $1M will be available to convene clinical and community partners to co-develop blueprints for system-wide integrated care. Another $2.7M will be available to support partners to test innovative care models that improve community-clinical linkages and achieve outcome metrics.

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Next steps include: developing and finalizing investment workplans; defining criteria and processes to support provider pay-for-progress and performance; creating and sending contracts to partners; and monitoring and reporting progress of investment workplans. Thuy and the Finance Committee (FC) are prepared to regularly review the 2019 budget and adjust for any under/over-spending. The board expressed some concern around investments that are provider-driven and how smaller organizations will be able to continue to participate or support transformation efforts. HH is working to create dashboards and effective mechanisms to track and provide reports/updates on the work. The committees will have the opportunity to “dig-deeper” and course correct as needed. There was a request to continue to lean into the Community & Consumer Voice Committee (CCV) to identify those missing from the process. Thuy briefly reviewed the decision memo. The FC, in partnership with the CCV, Transformation Committee (TC), and Performance, Measurement & Data Committee (PMD), requested that the board approve HH’s 2019 investment strategies. They believe that these investments will set our region on a path toward transformation and lay the foundation to achieve our overall goals.

The 2019 Investment Strategy decision memo was approved with no revisions or abstentions.

Governance Christina Hulet (Hulet Consulting) took a moment to ask the board if they felt adequately prepared to take a vote on the Updated Bylaws decision memo. The board received the decision memo 3 business days before the meeting (instead of 5) but felt that they had adequate time to review. The operating agreement was approved by the Executive Committee (EC) in February. Originally, we had an LLC agreement with Seattle Foundation (SF) that was approved by the Interim Leadership Council. In consultation with legal counsel, we decided to separate the organizational bylaws from the SF operating agreement to allow more flexibility to amend our bylaws without requiring the approval of SF. New language was added to several sections to better reflect and clarify the board’s current operations. The bylaws can be amended, or new bylaws can be adopted by a two-thirds majority vote of the board. The EC recommended that the board approve these changes. The motion was approved with no revisions.

ACH Participant Survey Results Gena Morgan (HealthierHere) reviewed the “HealthierHere ACH Participant Survey: 2018 Results” slide deck. For the past 4 years, the Center for Community Health & Evaluation (CCHE) has conducted an annual survey of regional stakeholders engaged with their ACH on behalf of the Health Care Authority. The purpose is to support our learning and self-improvement, and not intended to be a “report card.” Overall, HH received positive feedback and scored higher on average. HH will be highlighted in the state-wide CCHE report for our Community Engagement work. Some opportunities for improvement include more effective communication to the broader community about ACH mission and activities, clearly defined roles and responsibilities for ACH members, and agreement on how to sustain the regional collaborations beyond the period of Medicaid Transformation. Responses from the Board:

• We may have scored higher if more board members had participated. Board members may not have participated as strongly as in past surveys because we feel things are going well.

• How can we be more transparent in our communications?

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• There was a request for an “elevator pitch” with tangible items. • There was a request for simple ways to help board members be aware of the work of the CCV

and other committees (e.g. “spotlight” on meeting agendas). • There was a request for a dashboard to assist the board in tracking/understanding progress in

the work. Shelley Cooper-Ashford (Center for Multicultural Health) invited the board to “A Report Back on our Consumer Voice Listening Project” the evening of April 16. Community leaders will share their experience related to gathering information from community members through the HH Community Small Grants Program. This is an opportunity to hear lessons learned about community engagement and key community take-aways.

CBO Partner Selection Update Marya Gingrey (HealthierHere) updated the board on the process of selecting community-based organization (CBO) partners. In November 2018 “Community Partner Information Sessions” were launched. These sessions served to share about HH’s work, connect to, and learn from partners. HH made numerous connections and saw collaborations amongst partners begin. HH invited each organization that attended an information session to fill out an interest form. HH received 97 interest forms and about 50 organizations indicated an ability to impact MTP performance metrics. HH will launch a “Community Partner Assessment” and invite partners that have the greatest likelihood of impacting the performance metrics to participate. The assessment will help determine potential community partner capacity and readiness for partnership with HH. Community partners will have the opportunity to identify strategies to improve health outcomes via the Community Partner Summits. HH will also host a combined Community and Clinical Partner convening to promote collaboration and shared learning. After receiving assessments, HH will invite community partners best positioned to impact the portfolio to complete an “innovation plan.” From there, HH will select community partners and begin contract negotiations. The meeting was adjourned.

Next Meeting: Thursday April 4, 2019 from 1pm-4pm at PacTower – 1st floor Training/Event Space: 1200 12th Ave S. Seattle, WA 98144


DECISION MEMO: Governing Board Member Reappointments Memo prepared by: Christina Hulet, on behalf of the Executive Committee Date prepared: March 22, 2019 Date of proposed action: April 4, 2019

Issue In April 2019, term limits for eight of HealthierHere’s Governing Board seats, or approximately one-third of the Board, will expire (our first “wave” of terms). The following decision memo pertains to the reappointment of five members currently serving on the Board.

Background HealthierHere’s 26-member Governing Board was established with designated seats representing specific sectors and perspectives (see table 1 below). In allocating seats, the team sought to balance representation between public, private, and non-profit organizations, as well as between institutional health care partners and community-based organizations/members.

To facilitate a smooth process, the Executive Committee established three “waves” of Governing Board member terms and developed a process for the first wave of appointments scheduled for April 2019 (see table 2 below). The process for filling these seats varied depending on: (a) whether the seat was “reserved” (i.e., assigned to a lead entity to recommend a candidate) or “open” to the public for anyone to apply, and (b) whether an applicant was an existing Board member seeking reappointment or a new candidate not currently on the Board. HealthierHere’s bylaws allow existing members to be reappointed to a second, three-year term. For “open seats” existing members have a “first right of refusal” option; for “reserved seats” lead entities are responsible for nominating their representative. Term limits for a total of eight board seats expire in April 2019. Of these, we have five existing board members who are seeking reappointment:

1. Roi-Martin Brown (consumer seat; lead entity Community/Consumer Voice Committee) 2. Elise Chayet (hospital/health system seat; lead entity Washington State Hospital

Association) 3. Kristin Conn (primary care provider seat; open seat) 4. Patty Hayes (public health seat; lead entity Public Health - Seattle King County) 5. Jeff Sakuma (City of Seattle seat; lead entity City of Seattle Mayor’s office)


If approved, members would serve a three-year term effective April 2019. Letters of support from lead entities are included in the supplemental board packet, pages 1 through 5.

Recommendation The Executive Committee recommends that the Governing Board approve the reappointment of the following board members via a consent agenda: Roi-Martin Brown, Elise Chayet, Kristin Conn, Patty Hayes, and Jeff Sakuma. Each representative brings invaluable expertise to our board, contributes actively to the organization, and helps HealthierHere have consistency in leadership during this first wave of terms.

Values How does this recommendation align with HealthierHere’s core values of equity, community, partnership, innovation, and results?

In making this recommendation, the Executive Committee relies on and appreciates the expertise of community partners such as the Washington State Hospital Association, the Community and Consumer Voice Committee, the City of Seattle, and King County government to identify preferred candidates for board seats. We also value a board that reflects a diversity of background, expertise and personal experience to shape HealthierHere’s work.


Table 1: Governing Board Composition

SECTOR / PARTNER # OF SEATS TYPE RESERVED SEATS: LEAD ENTITY

Providers / Payers Primary care provider 1 Open

Federally qualified health centers 1 Reserved Community Health Center Council

Hospital, health systems 3 Reserved Washington State Hospital Association

Behavioral health providers, inc. at least 1 substance use provider

3 Reserved King County Provider Association

Managed care organizations (MCO) 1 Reserved Coordination between MCOs

Local public health 1 Reserved Public Health - Seattle King County

SUB-TOTAL 10 (38%)

Government King County 1 Reserved King County Government

City of Seattle 1 Reserved Seattle Mayor's Office

Suburban area 1 Reserved Sound Cities Association

SUB-TOTAL 3 (12%)

Community / Consumer Community-based equity networks, coalitions and/or consumer advocate organizations

3 Reserved ACH Consumer/Community Voice Committee

SUB-TOTAL 3 (12%)

Tribes Federally recognized tribes in King County 3 Reserved Tribal Governments: Cowlitz,

Muckleshoot, Snoqualmie Indian Tribes Urban Indian Health Board 1 Reserved Seattle Indian Health Board

SUB-TOTAL 4 (15%)

Community Based Organizations / Social Determinants of Health

Housing 1 Open

Long-term care services/supports 1 Open

Non-profit social service organizations 2 Open

Philanthropy 1 Reserved The Seattle Foundation

At-large 1 Open

SUB-TOTAL 6 (23%)

TOTAL SEATS 26


Table 2: Term Limits


DECISION MEMO: Governing Board Appointment – King County Seat Memo prepared by: Christina Hulet, on behalf of the Executive Committee Date prepared: March 22, 2019 Date of proposed action: April 4, 2019

Issue In October 2018, Governing Board member Adrienne Quinn resigned from the board as part of her transition from King County employment. This created a vacancy for the King County government seat. Below is the Executive Committee’s recommendation for filling this seat.

Background As mentioned in the prior decision memo, HealthierHere’s 26-member Governing Board was established with designated seats representing specific sectors/perspectives. In allocating seats, the team sought to balance representation between public, private, and non-profit organizations, as well as between institutional health care partners and community-based organizations and members. In addition, some seats were designated as ‘open’ (i.e., open to applicants from the general public), while others were ‘reserved’ for a lead entity to nominate a candidate for the board’s approval.

Per our bylaws, the King County government seat is ‘reserved’ to King County to nominate its preferred candidate. As such, the Executive Committee received and reviewed the County’s request to appoint Leonardo (Leo) Flor to the Governing Board.

Leo Flor serves as Director of King County’s Department of Community and Human Services. Prior to this, he led the King County Executive Office’s plan to renew and expand the Veterans, Seniors and Human Services levy and served on the King County Public Defense Advisory Board.

Leo’s full application and letters of support from King County Executive Dow Constantine and Kent Youth and Family Services’ Executive Director Michael Heinisch are included in the supplemental board packet, pages 6 through 13.

Recommendation The Executive Committee recommends that the Governing Board approve King County’s nomination to appoint Leo Flor to the King County government seat. If approved, Leo would serve a three-year term effective April 2019.



In making this recommendation, the Executive Committee values and relies on the expertise of its community partners to identify the best candidate for this seat. Having the senior executive from the County’s Department of Community and Human Services on the board will also improve our ability to align efforts and achieve necessary results.


DECISION MEMO: Governing Board Appointment – Behavioral Health Provider Seat Memo prepared by: Christina Hulet, on behalf of the Executive Committee Date prepared: March 22, 2019 Date of proposed action: April 4, 2019

Issue Governing Board member Molly Carney was appointed to a two-year board term effective April 2017, representing one of three behavioral health provider seats on HealthierHere’s board. Her term expires this April. She is not seeking a second term. This creates a vacancy for a behavioral health provider seat. Below is the Executive Committee’s recommendation for filling this seat.

Background As referenced in the previous decision memo, HealthierHere’s 26-member Governing Board was established with designated seats representing specific sectors/perspectives. In allocating seats, the team sought to balance representation between public, private, and non-profit organizations, as well as between institutional health care partners and community-based organizations and members. In addition, some seats were designated as ‘open’ (i.e., open to applicants from the general public), while others were ‘reserved’ for a lead entity to nominate a candidate for the board’s approval.

Per our bylaws, the three behavioral health seats are ‘reserved’ to the King County Behavioral Health Providers Association (KCBHPA). At least one of these seats must include a substance use provider. As such, the Executive Committee received and reviewed KCBHPA’s request to appoint Victor Loo to the Governing Board.

Victor Loo serves as Director of Recovery Services at Asian Counseling and Referral Service (ACRS). He is a Washington State Certified Chemical Dependency Professional and a National Certified Addiction Counselor. Victor is actively involved with the King County Behavioral Health Providers Association, the King County Integrated Care Network, the Heath Care Authority, and the National Council for Behavioral Health.

Victor’s full application and letters of support from KCBHPA, ACRS, the Health Care Authority and Public Health – Seattle & King County are included in the supplemental board packet, pages 14-21.


Recommendation The Executive Committee recommends that the Governing Board approve KCBHPA’s nomination to appoint Victor Loo to the vacant Behavioral Health Provider seat. If approved, Victor would serve a three-year term effective April 2019.


In making this recommendation, the Executive Committee appreciates and relies on the expertise of community partners such as the King County Behavioral Health Providers Association to identify the best candidate for this seat. We value a board that includes the expertise of organizations serving diverse community members and believe this is critical to HealthierHere’s ability to achieve results. Victor also brings significant, meaningful experience in health equity.


DECISION MEMO: Governing Board Appointment – Federally Qualified Health Center Seat Memo prepared by: Christina Hulet, on behalf of the Executive Committee Date prepared: March 22, 2019 Date of proposed action: April 4, 2019

Issue Governing Board member Teresita Batayola was appointed to a two-year board term effective April 2017, filling the Federally Qualified Health Center (FQHC) seat on HealthierHere’s board. Her term expires this April. She is not seeking a second term. This creates a vacancy for the FQHC seat. Below is the Executive Committee’s recommendation for filling this seat.

Background As referenced in the previous decision memo, HealthierHere’s 26-member Governing Board was established with designated seats representing specific sectors/perspectives. In allocating seats, the team sought to balance representation between public, private, and non-profit organizations, as well as between institutional health care partners and community-based organizations and members. In addition, some seats were designated as ‘open’ (i.e., open to applicants from the general public), while others were ‘reserved’ for a lead entity to nominate a candidate for the board’s approval.

Per our bylaws, the federally qualified health center (FQHC) seat is ‘reserved’ to the Community Health Council (CHC) of Seattle & King County. As such, the Executive Committee received and reviewed the CHC’s request to appoint Raleigh Watts to the Governing Board.

Raleigh Watts serves as Executive Director of Country Doctor Community Health Centers. Prior to this, he worked with the Washington State Department of Health and public health nonprofits in King County. He also serves on the Washington Health Benefits Exchange Advisory Committee and the Seattle Human Services Coalition Steering Committee.

Raleigh’s full application and letter of support from the Community Health Council are included in the supplemental board packet, pages 22-24.


Recommendation The Executive Committee recommends that the Governing Board approve the Community Health Council’s nomination to appoint Raleigh Watts to the Federally Qualified Health Center seat. If approved, Raleigh would serve a three-year term effective April 2019.


In making this recommendation, the Executive Committee appreciates and relies on the expertise of community partners such as the Community Health Council to identify the best candidate for this seat. We also value a board that includes the expertise of organizations serving diverse community members and believe this is critical to HealthierHere’s ability to achieve results. Raleigh brings significant, meaningful experience in health equity.


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Glossary of Terms

ACH Accountable Community of Health AI/AN American Indian/Alaska Native AIM Analytics, Interoperability, and Measurement, part of the Health Care Authority AIMS Advancing Integrated Mental Health Solutions, part of University of Washington AMDG Agency Medical Directors’ Group BHO Behavioral Health Organization BMI Body Mass Index BRFSS Behavioral Risk Factor Surveillance System CMS Centers for Medicare & Medicaid Services CBO Community-Based Organizations CCM Chronic Care Model CCV Community/Consumer Voice Committee CDP Chronic Disease Prevention and Control Project CDR Clinical Data Repository CEO chief executive officer CHARS Comprehensive Hospital Abstract Reporting System CHW Community Health Worker(s) CLS Community Learning Sessions CMCH Center for Multi-Cultural Health CMS Centers for Medicare & Medicaid Services DCHS Department of Community and Human Services DPC Demonstration Project Committee DPP Diabetes Prevention Program DSHS Department of Social and Health Services DSRIP Delivery System Reform Incentive Payment DT Design Team DY1 DSRIP Year 1 ED Emergency Department EHR Electronic Health Record FIMC Fully Integrated Managed Care FFS Fee-For-Service FPL Federal Poverty Level FQHC Federally Qualified Health Centers G2P Guidelines to Practice HCA Health Care Authority HCP LAN Health Care Payment Learning & Action Network HHSTP Health and Human Services Transformation Plan HIE Health Information Exchange HIT Health Information Technology HKCC Healthy King County Coalition HUD U.S. Department of Housing and Urban Development IDC Integration Design Committee IHCP Indian Health Care Provider


ILC Interim Leadership Council IOM Institute of Medicine IT Information Technology ITU Indian Health Service, tribally operated, or urban Indian health program JAMA Journal of the American Medical Association KCACH King County Accountable Community of Health LEAD Law Enforcement Assisted Diversion LGBT Lesbian, Gay, Bisexual, and/or Transgender LOI Letter of Intent MAT Medication Assisted Treatment MCO Managed Care Organization MeHAF Maine Health Access Foundation MHIP Mental Health Integration Program MIDD Mental Illness and Drug Dependency MOU Memorandum of Understanding MTP Medicaid Transformation Project(s) MVP Medicaid Value-Based Purchasing OUD Opioid Use Disorder P4P Pay-for-Performance P4R Pay-for-Reporting PAL Partnership Access Line PCORI Patient-Centered Outcomes Research Institute PCP Primary Care Provider PHSKC Public Health – Seattle & King County PIMH Partnership for Innovation in Mental Health PMD Performance Measurement and Data PMP Prescription Monitoring Program PRISM Predictive Risk Intelligence System PSH Permanent Supportive Housing QBS Quality Benchmarking System RHIP Regional Health Improvement Plan RHNI Regional Health Needs Inventory SAMHSA Substance Abuse and Mental Health Services Administration SBIRT Screening, Brief Intervention, and Referral to Treatment SCORE South Correctional Entity SIHB Seattle Indian Health Board SIM State Innovation Model(s) SUD Substance Use Disorder TA Technical Assistance TSP Transition Support Program UIHI Urban Indian Health Institute US United States VBP Value-Based Payment VOCAL-WA Voices of Community Activists and Leaders, Washington State Chapter WSHA Washington State Hospital Association WSMA Washington State Medical Association

governing board meeting – april 4, 2019, 1:00 pm - 4:00 pm · capacities” or “co-design...

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