PORT ANGELES — Forks Community Hospital, Jefferson Healthcare and Olympic Medical Center will join in an Accountable Community of Health system as part of Gov. Jay Inslee’s proposed Healthier Washington initiative.
The Olympic Community of Health, as it is known, received official state designation Dec. 22 and includes hospitals in Clallam, Jefferson and Kitsap counties.
The Olympic Community of Health is one of nine accountable communities throughout the state.
While the hospitals in the community of health remain independent, they work together under one umbrella to achieve jointly defined goals.
“The Olympic Community of Health will explore priorities for a Regional Health Improvement plan, and we will work collaboratively to reach the established goals,” Bobby L. Beeman, OMC’s communications manager, said Thursday. Beeman said the initiative is in the planning stages.
Major changes
In the coming three to four years, “we expect major changes to Medicaid, completely changing the way we are paid,” Eric Lewis, OMC chief executive officer, said during Wednesday’s regular hospital board of commissioners meeting.
“This is really big stuff. I think all reimbursements are at risk.”
In 2015, about 17 percent of patients who visited the hospital were Medicaid recipients, Lewis said.
The state intends “to go away from cost reimbursement to a new payment methodology which could be more like fixed budgets,” he said.
That could mean OMC and other hospitals would get a fixed fee for service instead of being paid for each patient visit,
Lewis said.
“They might just mail us $1 million a month,” he said.
There would be “no more fees for service” but a fixed “budget to take care of all the medical needs of all the Medicaid enrollees in our service area,” he said.
“That is a lot of risk. They want to transfer risk to providers.”
After implementation, “there will just be one bucket of Medicaid dollars going out to enrollees,” Lewis said.
“That is a big change from right now.”
Regional basis
According to the state Health Care Authority, the goal of the accountable communities is to establish collaborative decision-making on a regional basis to improve health and health systems, bring together all sectors that contribute to health to develop shared priorities and strategies for population health, and to drive physical and behavioral health care integration by making financing and delivery system adjustments, starting with Medicaid.
The state Health Care Authority and Department of Social and Health Services have submitted an application to the Centers for Medicare and Medicaid Services for a five-year Medicaid Transformation Demonstration Waiver to help fund the initiative, according to the state Health Care Authority.
This plan, part of Healthier Washington, is intended to give the state the flexibility and expenditure authority necessary to transform the delivery system for the 25 percent of Washington’s population served by Medicaid, state officials say.
The application covers three initiatives: transformation projects, long-term services and support, and supportive housing and supported employment, according to the state Health Care Authority.
Focus on prevention
The state intends to focus on “population health and reducing state costs for the health care delivery system,” Lewis said.
“They want hospitals like us to become part of accountable care organizations, and they want to pay us for keeping people out of the hospital rather than paying us for people being in the hospital,” he said.
The plan is to “pay less for inpatient acute care and invest that money in public health and wellness and chronic disease management to prevent admissions,” Lewis said.
The $3 billion Medicaid waiver sought by the state, which would be doled out over a five-year period, would be used “for community health and wellness and chronic disease management” and will be funneled “through these accountable communities of health,” Lewis said.
Lewis said it is important to have a seat at the planning table as the new initiative is launched, especially because 80 percent of the population in the Olympic Community of Health resides in Kitsap County.
“I think we are going to have to be active in the new payment methodologies,” he said.
“We are going to spend a lot of time in this area.”
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Reporter Chris McDaniel can be reached at 360-452-2345, ext. 5074, or cmcdaniel@peninsuladailynews.com.
