CCO Priorities for Health Systems Transformation

1. CCO Priorities for Health Systems Transformation September 18, 2013

2. Agenda • CCOs – What, Why and How? • Structure of the CCO in Central Oregon and what entities are involved? • How is the community be involved? • CCO priorities for health systems transformation • Technical mumbo-jumbo • Questions?

3. Oregon Health Plan Source: OHA/Gov’s Office

4. Why Transform? • Unsustainable • Health care costs are increasingly unaffordable to individuals, businesses, the state and local governments • Inefficient healthcare systems bring unnecessary costs to taxpayers • When budgets are cut, services are slashed • Dollars from education, children’s services, public safety squeezed • 2014: as many as 240,000 Oregonians will be added to OHP (Approximately 15,500 in Central Oregon)

5. The Old Way… • Doesn’t Work • Costs too high • Health outcomes too low • Too much $$ spent on fragmented care

6. 5 Drivers for Change Source: OHA/Gov’s Office

7. Goal: Triple Aim • A New Vision for a Healthy Oregon

8. How are CCOs Unique? • Local governance and oversight • New levels of collaboration and transparency • Treating healthcare as a community asset • Creating community standards of care • Changing how we reimburse for health care • Includes paying for roles and services not currently paid for • Advancing patient centered care models • Patient centered primary care home • Integration of physical, behavioral, oral health • Focused attention on vulnerable populations with medical complexity • Using a community health improvement plan to drive CCO transformation plan and key local initiatives • New partnerships between health care delivery system, public health, community mental health programs, social services agencies • Focus on health inequities

9. CCO Governance • Major components of health care delivery system • Entities or organizations that share in financial risk • At least two health care providers in active practice • Primary care physician or nurse practitioner • Mental health or chemical dependency treatment provider • At least two community members • At least one member of Community Advisory Council Source: OHA/Gov’s Office

10. Governance & Committees

11. Community Advisory Council • 15-17 members • Chair COHC member • Majority consumers • Bend • Redmond • LaPine • Sisters • Prineville • Madras • Warm Springs Other representatives ? e.g. • Area non-profits, safety net • Community action agency • Housing authority • Children & Families Cmsn. • Educational Service District • Council on Aging • Community health worker

12. CCO Joint Management Agreement

13. Community Advisory Council • 15-17 members • Chair COHC member • Majority consumers • Bend • Redmond • LaPine • Sisters • Prineville • Madras • Warm Springs Other representatives ? e.g. • Area non-profits, safety net • Community action agency • Housing authority • Children & Families Cmsn. • Educational Service District • Council on Aging • Community health worker

14. Oregon’s Accountabilities Savings: 2% reduction in per capita Medicaid trend Baseline is calendar year 2011 Oregon spend Trend 5.4% as calculated by OMB for President’s Budget State to achieve 4.4% by end of year 2 and 3.4% there after. No reductions to benefits and eligibility in order to meet targets Financial penalties for not meeting targets Quality Incentive Pool Transparency and workforce investments Source: OHA/Gov’s Office 14

15. CCO Priorities • Transformation Plan • Local initiatives • Quality Metrics

16. Transformation Plan • Integrated Primary Care Model • Advancing Patient-Centered Primary Care Home • Consistent Alternative Payment Methodologies • Community Health Assessment & Annual Health Improvement Plan • Electronic Health Records & Health Information Exchange • Tailoring Communications & Services to Cultural, Health Literacy & Linguistic Needs • Diversity and Cultural Competence • Quality Improvement Plan to Reduce Health Disparities • Primary Care & Public Health Partnership

17. Quality Metrics • Quality: • Strong criteria • Financial incentives (sticks and carrots) at CCO level • 17 measures • System indicators - ED utilization • Getting better – mental health diagnosis/follow-up; alcohol/drug treatment screening/brief intervention • Living with illness - BP/diabetes control measures; • Staying healthy - colorectal cancer screenings; well-child check up; developmental screening, prenatal care

18. Local Strategic Initiatives • Maternal Child Health • School Based Health Centers • Behavioral Health/Primary Care • Primary Care in Behavioral Health • Chronic Pain • Transitions of Care • Complex Care Coordination • Pediatric RN Care Coordination • Integrating Care for Children with Special Healthcare Needs

19. CCO Priorities • If we are successful with: • And Transformation Plan Local Initiatives Triple Aim: Better Health, Better Care, Lower Costs Perform well on Quality Reduce Health Care Trend to 2%

20. Technical Mumbo Jumbo • Medicaid Expansion • The Affordable Health Care Act of 2010 creates a new national Medicaid minimum eligibility that covers most Americans with household income up to 133 percent of the federal poverty level. This new eligibility requirement is effective January 1, 2014 • An estimated 240,000 Oregonians would become newly eligible for Medicaid when the state expands the program – this figure is expected to include 10,800 veterans and encourage approximately 20,000 previously eligible Oregonians to enroll in coverage.

21. Service Integration • Services that will flow through the CCO global budget include: Dental (2014), Targeted Case Management (2014), Non-emergent medical transportation (2014)

22. Health Insurance Exchange • An Exchange in itself is a mechanism for organizing the health insurance marketplace to help consumers and small businesses shop for coverage in a way that permits easy comparison of available plan options based on price, benefits and services, and quality. By pooling people together, reducing transaction costs, and increasing transparency, Exchanges create more efficient and competitive markets for individuals and small employers. • Beginning with an open enrollment period in 2013, Exchanges will help individuals and small employers shop for, select, and enroll in high-quality, affordable private health plans that fit their needs at competitive prices. Exchanges will assist eligible individuals to receive premium tax credits or coverage through other Federal or State health care programs. By providing one-stop shopping, Exchanges will make purchasing health insurance easier and more understandable.

23. Global budget • A global budget would be provided to each CCO to provide high-quality coordinated health care to the population it serves. • Providers would have more fl exibility in how they use this budget, so they can work to keep members healthier in the ways • that best meet their members’ and community’s needs. • Global budgets also provide opportunities for shared savings when providers and CCOs meet their goals.

24. Now your turn to quiz me ;)