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Managing Hospitals & health systems through reform

Managing Hospitals & health systems through reform. The Health Council Model. Structure: PacificSource Community Solutions CCO One Contract, two regions. CAP Co-chairs. Columbia Gorge Health Council The Board Activities: Directs CCO activities

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Managing Hospitals & health systems through reform

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  1. Managing Hospitals & health systems through reform The Health Council Model

  2. Structure: PacificSourceCommunity Solutions CCOOne Contract, two regions CAP Co-chairs Columbia Gorge Health Council The Board Activities: Directs CCO activities for the region, reviews financials, provides strategic direction to the CCO Clinical Advisory Panel Activities: Provides clinical direction to the CCO by structuring review of high spend clinical areas, originates some initiatives, provides guidance for QI review and transformation fund spending. . Community Advisory Council Activities: Informs the CCO about member-relevant issues, directs coordination of the Community Health Assessment. CAC Chair CAC liaison

  3. Aim I: lowering Cost Tactic: Communicate Health Council Target Areas to the Medical Staff of both hospitals, and individually via the CAP members. Example: Focus Areas Super-users • 161 people (2.2%) use 40% of the funding ($7M) • 273 people (3.7%) use the next 20% chunk of funding • Proposed Solutions: The “hot-spotter strategy”: Community Health Worker Hub and Primary Care PCPCH Case Management Education • Emergency Department Usage • Wasco County ER use rate is 2x Hood River County, even though the population is divided 55% Wasco and 45% Hood River • Proposed Solution: ED Diversion Program (like the Central Oregon Model)

  4. Aim I: Lower Cost CGHC Focus Areas (cont.) • Behavioral Health Integration • Poorly managed mental health conditions magnify costs of treating chronic physical conditions • Proposed Solution: Integrate care, (like the MCOC model) • Specialty Drug Use • Our CCO is 30% lower in occurrences of chronic disease but we are 4.3X higher in specialty drug use cost • Pharmacy costs are a large piece of the spend • Proposed Solution: Investigate 340B cost savings and review prescribing practices at a peer to peer level

  5. Aim II: Improve Quality through Incentive Measures

  6. Aim III: Improving the Experience of care with Transformation Projects • Transformation funding- Model for distribution

  7. Aim III: Improving the Experience of care with Transformation Projects • Transformation funding- Model for distribution • Clinical Advisory Panel: Does the project have ethical merit? • Community Advisory Council: Is it right for our community? • Board: is it financially viable and is there sufficient ROI?

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