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Marie Maes-Voreis, Director of the Health Care Home initiative: Marie presented overview of next steps for Accountable Communities for Health ($7 million SIM grant); adapted from Maine Quality Counts.
Health IT, new payment models, sharing data will support the care coordination.
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RFP will be posted in July and responses will be due within a couple months.
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Implementation is 3 months behind due to delay on CMS approval.
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Community preparation phase will be through June.
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MDH is still doing interviews with partnership models to help inform the RFP so please let her know of additional partnership collaboratives they should talk with (attendees suggested others such as Allina’s Backyard initiative).
PowerPoint presentation posted on MPHA web site.
Questions/Feedback for MDH:
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Provide more concrete dates. This is very important when trying to connect and plan with community partners – please get more concrete as soon as possible, such as providing 10 core criteria of what RFP will require.
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Strengthen public health involvement throughout the ACH/SIM process. What is the value/vision for public health in ACH and goals/objectives?
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Provide stable, adequate funding. Support development of sustainability plans.
Comments from Marie to address the current level of specificity about ACH and RFP:
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People should already be meeting with their clinics, hospitals, and community to discuss what their community issues are, how do you define a population, etc.
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Are there guidelines to help us do that? No, this is procurement process so there will be highlevel guidelines, but the newly established ACH advisory committee is who will build the details of the RFP. Lots of flexibility, lots of innovation, and they anticipate all programs will be at different place.
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Evaluation: There is a very rigorous evaluation plan with State Health Access Data Assistance
Center (SHADAC). CMS has also hired their own evaluator as well.
ACH can transform how we all work together.
Local Public Health Perspective
Gretchen Musicant, Commissioner of Health, Minneapolis Health Department, provided a local public health perspective for the group. She encouraged the group and the state to be innovative, learn new things and seek to reach far beyond the status quo. It is hoped that MDH will be open to seriously considering a broader definition of who can be an ACH. She invited attendees to reflect especially on the first discussion question: What do we hope to discover or learn from these new experimental opportunities?
Accountable Communities for Health Part 2
March 7, 2014

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Themes based upon the questions presented around ACH and the role of public health and MPHA
H OPES FOR LEARNING FROM NEW EXPERIMENTAL OPPORTUNITIES :
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Demonstrate models that truly embed addressing social determinants of health in health care settings (don’t just “tweak” medical model but truly move upstream – primary prevention). How do we produce health, instead of just “fixing” their health conditions (don’t just focus on care coordination)? How do you change community systems and not just be content with referring people to community resources?
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Learn how a community driven process fundamentally changes health care delivery and providers.
This is not just about services.
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Develop or use existing electronic tools to connect people with needed resources. For example website the public can access to find resources.
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Governance structure: Discuss health without being overwhelmed by ‘healthcare’; incorporate the community. o How to get communities to think PSE v. programmatic; will this be about PSE?
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Hope that the pilots will help prove the assumption that ACH (ACOs) work. For instance, do incentives really add value?
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Sustainability: o ACH, 2-fold approach: Focus on needs of immediate population, while also focusing on the long-term picture o Reduce silo-ed approach (i.e. community paramedics)
 Create “sidewalks between silos” o Joint ownership of health, through planning, financial buy-in, etc. o More resources must be provided on the front end to be ahead of the problems o Incorporate policy that allows payment to non-traditional providers.
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Funding: o True payment reform: incentivize good health instead of treatment. o When will financing follow the holistic model? Is there enough money if there is considerable restructuring? o Will this opportunity be enough to get community buy-in even without funding; what are the underlying factors that are motivating? o Meaningful information about payment reform to support upstream support of good health
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Look at incarcerated populations as a defined community to use ACH model: o Mental health, attempting to treat all problems clinically/diagnostically, limited supportive housing (released into homelessness).
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Data collection/sharing: o Hope that the data will be shared to help improve quality of care through broader engagement of stakeholders. Need more proactive use of information (both individual and collective) use of data/information. o Develop measurement metrics for upstream efforts with input from others. Strive for data consistency among core measures. Share data for learning.
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Evaluation beyond what makes a good partnership. Evaluation can be iterative process. Risk is something the state needs to embrace, if we only fund ‘safe’ programs we won’t learn as much potentially. We must accept risk, and see it as an opportunity. Hope that the pilots will help prove the assumption that ACH (ACOs) work. For instance, do incentives really add value?
Accountable Communities for Health Part 2
March 7, 2014

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C OMMUNITY DRIVEN MODEL :
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Get all the right voices at the table (especially in decision making process); this could be an issue in the metro as there are so many voices.
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Develop an appreciation for all the difference voices and expertise that are brought together.
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Bring together worksites, communities, schools, and partners.
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Regulate participation – do not allow one sector to dominate.
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Focus on community need, rather than organization need.
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Silos get broken down, interoperability, sharing of services.
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Marry best practices around social determinants of health; embedding social determinants of health
– not just superficial referral of client to provider
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Ability to break through the glass ceiling for communities to create their own health. Need authentic community involvement. This takes time.
N ETWORKING WITH NEIGHBORING COMMUNITIES TO SHARE INFORMATION :
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Accountable communities could be jail population or mental health crisis patients.
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Collective ‘we’ rather than ‘me’.
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Identify barriers along Health in All Policies (HiAP) (Housing, transportation) so that the community can define community health; HiAP are new concepts to public health, so increase education
(potential use of fact sheets).
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Difficulty in identifying evaluation measures, although Health Impact Assessments could be considered.
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Sell the ideas – highlight local initiatives that have worked.
Develop partnerships to disseminate information or bring attention to the issues (TPT).
H OW CAN MPHA SOLVE SOME OF THE PROBLEMS ?:
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Grassroots problem solving.
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Help promote strong community participation.
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Set collective goals (how?).
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A shared language is needed to help facilitate the process.
O VERALL ROLE OF ( LOCAL ) PUBLIC HEALTH :
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Public health must be brought to the forefront.
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Educate and interact with the communities to determine what they would want (especially when considering the incorporation of technology).
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Act as the convener, help understand what creates health, share best practices.
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Two way communication, with regard to data shared between LPH and healthcare.
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End up with agreements across jurisdictions to share “private data” so that providers could be connected around a family
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Assure more access: Public health is a useful resource to help communities become healthy or maintain health.
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Address social determinants of health occurring outside of healthcare.
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Using CHWs effectively.
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Data sharing, data consistency, sharing of core measures.
Accountable Communities for Health Part 2
March 7, 2014