Coordinated Care Organizations

1. Coordinated Care Organizations How do CCOs work? Where are we in the transformation process? How it will affect you and your clients? How can you play a role?

2. LEGACY HEALTH

3. Why Transform? Why Now? • Fragmented, siloed systems • Unsustainable health care costs • Not great health outcomes • State budget woes

4. System Challenges: Influence Factors on Health Status Environmental 5% Social 15% Human Biology 30% Lifestyle & Behavior 40% Medical Care 10% Source: McGinnis J.M., Williams-Russo, P., Knickman, J.R. (2002). Health Affairs, 21(2), 83

5. Eight year old, Malik, lives with asthma. Thanks to a Coordinated Care pilot project and his Community Health Worker, Malik learned how to manage his asthma daily. Now he spends more time playing with his friends and less time in the hospital.

6. Vision of CCO Implementation [The Triple Aim] [A CCO]

7. “I think you should be more explicit here in Step two.”

8. … And dentists

9. [Insane] CCO Development Timeline July ‘11 January ‘12 March ‘12 April ‘12 May/Jun ‘12 July ‘12 August ‘12 Nov ‘12 Jan ‘13 Feb ’13 January ’14 • HB 3650 signed into law • OHPB’s Implementation Plan published, • SB 1580 signed into law • CCO Letters of Intent submitted, RFA published • Application for CCO Certification due • Readiness Review • Execute CCO Contract with OHA- Go Live! • FFS enrolled into CCOs • Transformation Plan draft due • Transformation Plan implementation begins • Medicaid population expansion

10. Key Components of CCO Development • Geographic/Demographic Scope • Business & Operations • Information Systems • Utilization Management • Administration • Claims Processing • Customer Relations • Workforce Development • Local Governance • Board of Directors • Community Advisory Council • Clinical Advisory Panel • Model of Care • Physical, mental, oral health integration • Social service networking/integration • Delivery system transformation • Keeping people healthy • Financing • Global Budget • Capitalization • Risk • Revenue • Alternative Payment Methodologies

11. Why would Oregon’s health systems agree to do all this (just for Medicaid)? • ~18% of Oregonians are enrolled in Medicaid today • Will jump to 25% after ACA Medicaid expansion in 2014 • The Governor is working to fold all publicly funded health coverage into the CCO model • PEBB & OEBB • If that happened, ~40% of Oregonians would have care paid for and coordinated through CCOs • $1.9 Billion in federal investment  accounts for 19% of the state’s Medicaid budget this biennium

12. Community Advisory Council • Majority consumers • CAC member sits on Governing Board • Duties include: • Community Needs Assesment • Community Health Improvement Plan • We are looking for community members NOW! • Contact your local CCO to join or attend meetings.

13. What does Transformation look like? • The fundamental questions for stakeholders: • Can we do more with less? • Can we do more of what works? • Can we let go of what doesn’t? • How do we together foster communities that support the best possible lives for everyone in Oregon?

14. Thank you! Rose Englert Sr. Manager, Regulatory Affairs CareOregon

15. List of CCO Maps and Governing Boards: http://www.oregon.gov/oha/OHPB/Pages/health-reform/certification/index.aspx

16. CareOregon Affiliated CCOs Health Share of Oregon Columbia Pacific CCO Jackson Care Connect Yamhill County Care Organization PrimaryHealth of Josephine County

17. What Does It Take To Be A CCO? • Corporate Structure/Governance • Community Advisory Council • Coordinate physical, behavioral, & oral health • Experience managing financial risk • Minimum financial reserves • Primary care medical homes • HIT strategy • Written agreements with counties, public health & Area Agency on Aging

18. CCO Possibilities • Ability to reduce preventable conditions • Widespread use of primary care health homes • Improved outcomes due to enhanced care coordination and care delivered in most appropriate setting • Reducing errors and waste • Innovative payment strategies • Use of best practices and centers of excellence • Single point of accountability for achieving results 18

19. Minimum Standards to Evaluate CCO TransformationIntegration, Primary Care, Payments • Implement a health care delivery model that integrates mental health and physical health care and addictions. • Implement Patient-Centered Primary Care Homes. • Implement consistent alternative payment methodologies that align payment with health outcomes.

20. Minimum Standards to Evaluate CCO TransformationAssessments, Improvement, & IT • Prepare a strategy for developing a Community Health Assessment and adopt an annual Community Heath Improvement Plan. • Develop a plan for encouraging electronic health records; health information exchange; and meaningful use.

21. Minimum Standards to Evaluate CCO TransformationReflecting Diversity, Addressing Disparities • Assure communications, outreach, Member engagement, and services are tailored to cultural, health literacy and linguistic needs. • Assure that the culturally diverse needs of Members are met; provider and new health care workers reflect member diversity. • Develop a quality improvement plan focused on eliminating disparities in access, quality of care, experience of care, and outcomes.