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The ‘C’ of Acronyms: CCOs, CACs, CHAs, CHIPs and CHWs

Explore the coordinated care model, community advisory council structure, community health assessments, community health improvement plans, and the role of community health workers in Oregon's health system transformation.

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The ‘C’ of Acronyms: CCOs, CACs, CHAs, CHIPs and CHWs

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  1. The ‘C’ of Acronyms: CCOs, CACs, CHAs, CHIPs and CHWs Bill Bouska, MPA Innovator Agent Belle Shepherd, MPH Innovator Agent Health Systems Division, Oregon Health Authority

  2. Today’s Topics • Coordinated Care Organizations and Model • Community Advisory Council structure • Community Health Assessments • Community Health Improvement plans • Community Health workers

  3. Coordinated care MODEL

  4. Wrong focus = wrong results

  5. Oregon’s Health System Transformation • Began implementing the coordinated care model within coordinated care organizations (CCOs) in 2012 • CCOs are networks of all types of health care providers (physical health, addictions and mental health, and dental care) who work together to serve Oregon Health Plan (Medicaid) members • Now spreading the coordinated care model to other payers

  6. Community Advisory councils (cac)

  7. Community Advisory Councils (CACs) Oregon Statute: CCOs must have a CAC to ensure that the health care needs of the consumers and the community are being addressed. CACs must: • Include representatives of the community and of the government of each county served by the CCO. Consumer representatives must constitute a majority of the membership.

  8. Community Advisory Councils (cont.) • Identify and advocate for preventive care practices to be utilized by the CCO • Oversee a community health assessment and adopt a community health improvement plan to serve as strategic guidance for the CCO to address health disparities and meet health needs for the communities in their service area(s) • Annually publish a report on the progress of the community health improvement plan

  9. Total number of CACs around the state = 37 over 400 members • AllCare Health Plan:  3 • Cascade Health Alliance:  1 • Columbia Pacific CCO:  5 • Eastern Oregon CCO:  13 • FamilyCare, Inc:  1 • Health Share of Oregon:  1 • Intercommunity Health Network:  4 • Jackson Care Connect:  1 • PacificSource Central Oregon:  1 • PacificSource Columbia Gorge:  1 • PrimaryHealth of Josephine County:  1 • Trillium Community Health Plan:  2 • Umpqua Health Alliance:  1 • Western Oregon Advanced Health:  1 • Willamette Valley Community Health:  1 • Yamhill Community Care Organization:  1

  10. Community health assessments (cha)

  11. Community Health Assessments:Overview A CHA: • is a process of collecting, analyzing, and interpreting information about a community’s health assets and needs. • helps to identify and prioritize areas needing improvement. • informs policy formulation, implementation, and evaluation. • must be overseen by each CAC every five years.

  12. The Community Health Assessment OAR 410-141-3145 (5) “The CCO’s Community Advisory Councilshall oversee the community health assessment and adopt a plan to serve as a strategic population health and health care system service plan for the community served by the CCO. The Council shall annually publish a report on the progress of the plan.”

  13. CHA alignment

  14. Community health improvement plans (chip)

  15. Community Health Improvement Plans: Overview A CHIP is based on data from the CHA. It is a detailed working outline used to: • identify priority issues. • develop strategies for action. • ensure accountability for creation of measurable health outcome improvement. • guide our work as CAC members.

  16. Community Health Improvement Plan (CHIP) The activities, services and responsibilities defined in the plan may include, but are not limited to: • Analysis and development of public and private resources, capacities and metrics based on ongoing community health assessment activities and population health priorities; • Health policy; • System design; • Outcome and quality improvement; • Integration of service delivery; and • Workforce development.

  17. Community Health Improvement Plans: summary of priorities • Public health/social determinants/health equity: 60% of CHIP priorities • Public health: maternal and child health/early childhood; chronic disease; tobacco use; obesity prevention • Social determinants: housing, transportation, jobs • Health equity: addressing disparities; cultural competency; health literacy • Clinical: 40% of CHIP priorities • Mental health/substance abuse; oral health; access

  18. Community Health Improvement Plans:priority areas • Mental health integration (13 CHIPs) • Maternal health, early childhood &youth (11 CHIPs) • Access to care (8 CHIPs) • Health equity and socioeconomic disparities (7 CHIPs) • Oral health (7 CHIPs) • Healthy housing and the built environment (7 CHIPs) • Public health, chronic disease and chronic illness prevention (6 CHIPs)

  19. Jackson and Josephine Counties: 2 counties, 3 CCOs, 4 CACs overlapping CHIPs

  20. One page strategic maps of all three CCO CHIP’s Similar Design Elements & Collective Goal Areas

  21. Community Advisory Council

  22. Community Representation • Regional CAC Structure • 12 IHN-CCO members (63%) • 3 county staff • 3 community members • 1 Chair • Three Local Advisory Committees • 6 CAC Representatives plus county & community partners • Provide broader, deeper level of community involvement

  23. CHIP: Community Health Improvement Plan • CHIP Focus Areas • Access to healthcare • Behavioral health • Chronic disease • Maternal & Child health • Strategic Planning • The CHIP focus areas are used to prioritize transformation pilot projects

  24. Community health workers (chw)

  25. How is coordinated care changing the workforce needs? • Team based care • Working at the top of degree • Traditional Healthcare Workers/Community Health Workers • Healthcare Navigators • Outreach Workers • Peer to Peer specialists • Doulas • Dental care specialists • Behavioral Health Specialists • Emergency Department guides

  26. THWs help individuals in their communities by providing physical and behavioral health services. There are 5 THW types: • Community Health Workers (CHW): Assist community members in receiving the health care they need. • Peer Support Specialists (PSS): Provide support, encouragement, and assistance to addictions and mental heath consumers. • Peer Wellness Specialists (PWS): Provide support, encouragement, and assistance to address physical and mental health needs. • Personal health navigators (NAV): Provide care coordination for members from within the health system. • Birth Doulas: Provide companionship and personal, nonmedical support to women and families throughout the childbirth and post-partum experience. 

  27. Local success stories • Mid-Willamette Valley • Southern Oregon

  28. Health System Transformation Health.Oregon.gov More information at: TransformationCenter.org Contacts: Bill.bouska@state.or.us Belle.shepherd@state.or.us

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