Health Care Transformation & Coordinated Care Organizations

1. Health Care Transformation & Coordinated Care Organizations Presented by Senator Dr. Alan Bates & Paul Phillips, Pac/West Tuesday, July 26, 2011 Hosted by

2. 2011 Session Overview • 3rd Term for Governor John Kitzhaber • Senate Democrats hold a small advantage 16-14 • First time: Oregon House was evenly divided 30-30 • Co-Speakers • Co-Chairs (One Democrat/One Republican) for every Committee

3. Health Care Legislation Passed • Major health care legislation still manages to pass: • Oregon Health Insurance Exchange • Parity of in-patient/out-patient methodologies payments • Elimination of payments for adverse and/or never events • Recruitment and retention of physicians • Health Care Transformation

4. Why the Need for Health Transformation? • The cost of health care rises every year • Oregon has a 3 billion dollar budget hole • Bad economy = more Medicaid clients IN SHORT: Oregon must help more people with less money

5. Health Transformation: Process • Goal: Integration and reduce costs in order to build a sustainable system • The Governor established a work group process • Input was gathered from throughout the State • Turf protection became the focus • A smaller work group established a baseline • The legislature worked on a bill • Eventually leadership took over (Bates, Freeman, Kotek, Roblan, Hanna, Thompson)

6. House Bill 3650: Health Transformation • Goal: Provide better care and reduce costs and focus on unique community needs • Break down the delivery silos • Operate inside a global budget • Find cost savings (reduce redundant care, stop payment for never events, med/mal reform) • Integrate services with Coordinated Care Organizations (CCOs) • Build on the successes of MCOs like WVP

7. Old Way of Delivering Care • Each silo has their own pot of money • Services often don’t work together • Patients and systems can get lost in the shuffle (See pg. 2 of handout)

8. New Model • Work from one global budget for all a patient’s needs • CCO is one point of contact for the patient to get care they need • Funding more clear • Flexibility to fund the programs and care that get results (See pg. 2 of handout)

9. What is a CCO? • Similar to a locally based Managed Care Organization, except will integrate: • Physical health (including prevention) • Mental health • Dental health • Behavioral health • Provides all health services for Medicaid clients and acute care for dual eligibles • Organization can be set up through contracts or partnerships

10. CCO Structure (See pg. 3 of handout)

11. How a CCO Works • CCO will be made up of primary care providers, clinics, mental health providers, hospitals, specialists & preventative care programs, etc… • Services for client will be coordinated by the CCO • Governance: Locally controlled board made up of those taking financial risk in the CCO • Public Input: Community Advisory Council made up of community leaders will give feedback to the CCO • No entity has a “veto” power over another (Plan, County, Hospital, major provider)

12. What’s Next? • OHA is forming the Transformation process: • Workgroups: CCO Criteria, Global Budgets, Quality Metrics and Dual Eligibles • Analysis of defensive medicine • MCOs need to lead the transition to CCOs: • Legislative approval still needed specific to: • Global budgets • CCO organizationally • Defensive medicine analysis

13. Timeline (See pg. 4 of handout)

14. Timeline • The transition time is very short (July 2012) • In less than a year, CCOs will have to be up and running with a community focus • Work withOHA during the interim will be vital • Oregon will be looking for a leader • WVP and other plans are positioned to be leaders right along with their community partners and healthcare delivery systems

15. WVP Well Positioned • WVP has delivered GREAT results • Executive staff and organizational excellence • WVP offers a unique set of credentials: • We have the physician community thus the professional expertise and the primary care provider networks to serve our community • We offer population based management with a proven record of innovation and cost containment • We are the bridge between facility based management and a healthier community

16. Summary • Transformation has worked in Oregon • SB 27: 1989 The Oregon Health Plan • SB 44: 1991 Expansion of OHP Coverage • Transformation will work again • HB 3650: 2011 OHP Phase Three • Transformational success will be based off: • Cooperation • Vision • Removing impediments within regulatory existing system

17. Summary • Transformation will result in Medicaid clients getting the right care at the right time • Professionals providing care will have more tools to help their patients get healthy • CCOs will save the system money though better coordination and care • Community-based care will continue to be the cornerstone of OHP as MCOs lead transition

18. Summary • Don’t wait: Become a CCO now • Start building partnerships with local providers • Share your vision of a CCO with everyone • Identify new cost savings in a coordinated care model • Be a leader: this isn’t a competition it is a coordination

19. Questions Thank you!