1 / 13

Oregon’s CDSMP Insurance Reimbursement Strategy

Oregon’s CDSMP Insurance Reimbursement Strategy. Laura Saddler Health Systems & Self-Management Lead Oregon Public Health Division Arthritis Council Call October 28, 2010. CDSMP Infrastructure & Support. Cross-program partnership to support program delivery by diverse partners:

samv
Download Presentation

Oregon’s CDSMP Insurance Reimbursement Strategy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Oregon’s CDSMP Insurance Reimbursement Strategy Laura Saddler Health Systems & Self-Management Lead Oregon Public Health Division Arthritis Council Call October 28, 2010

  2. CDSMP Infrastructure & Support Cross-program partnership to support program delivery by diverse partners: • Public Health Division: Arthritis, Diabetes, HDSP, Asthma, Comprehensive Cancer Control, WISEWOMAN • State Unit on Aging: NCOA Sustainable Systems, Agency on Aging, ARRA/CDSMP Living Well (CDSMP) infrastructure in Oregon: • 400+ trained leaders, 60+ Master Trainers, 1 T-Trainer, 46 licensed organizations • Two training & TA contractors • Eastern Oregon, Tomando Control

  3. Total Living Well/Tomando Control Workshops by County, 2005-2009

  4. Total Living Well/Tomando Control Participants in Oregon, 2005-2009

  5. Financial Sustainability Opportunities • Coverage/reimbursement through Oregon Health Authority • Medicaid (Oregon Health Plan) physical health, mental health, Home & Community Based Services waiver • Pubic Employees Benefit Board/Oregon Educators Benefit Board • Oregon & Federal Medical Insurance Pools (high-risk) • Medicare • Older Americans Act IIID (prevention/wellness funding) • DHS Children, Adults & Families Self-Sufficiency (TANF) • Private insurers • Hospital community benefits • Private pay/sliding scale fees • Senior Community Service Employment (CSEP) • Local funders & service organizations

  6. Oregon’s Strategy to Date • Identify per-participant costs (investment) • Used National Council on Aging cost calculator • Averaged responses from seven local/regional coordinators • Identified $375 average program delivery cost per participant • Quantify potential impact of program to date • Health care utilization and costs • Health status and quality of life • Project future impacts if 5% of Oregon’s population living with chronic conditions completed the program • (Same measures)

  7. Results: QALYs and utilization Estimates made based on most appropriate results to date—there is substantial variation around utilization effect sizes in previous studies, common to such research Living Well is estimated to have saved $1,446 per participant.

  8. Hypothetical Living Well impact What if 5% of Oregonians with chronic disease (78,300) were enrolled in Living Well? Substantial program and logistic challenges of “ramping up”

  9. Oregon’s Current & Future Strategy • Become a part of local health reform: • Health Improvement Plan – self-management access and Medicaid reimbursement are part of draft plan to be presented at legislature 2011 • Patient Centered Medical Care Home Standards • Public Employees Purchasing Committee • Propose Medicaid pilot • Use ARRA grant to bring together partners, develop systems and test feasibility of reaching targeted group • Prepare the pitch • Develop talking points and sales materials to support local partners’ conversations with insurers & other potential funders • Cultivate allies • Bring together a high-level advisory group – insurers, funders, policymakers – to support development of system for reimbursement

  10. Challenges & Opportunities • Opportunities: • Strong program delivery infrastructure & partnerships (Living Well Network) • Federal & local health reform • ARRA funding through 4/2012 • Challenges: • Ever-shifting landscape due to political process • Many competing priorities within health reform • Disease-specific self-management programs

  11. Next steps: work out the details • Who gets reimbursed? • How much do they get paid per participant? • What billing code(s) should be used? • Who provides the programs (medical staff, health navigators/community health workers, peers)? • How do we keep reimbursement funds from “medicalizing” this community-based, peer led program?

  12. The Vision Self-management programs are fully integrated into statewide communities and connected to the health care delivery system  through partnerships and referral systems. This provides opportunities for all Oregonians with chronic health conditions to improve their health outcomes and quality of life, and reduce healthcare costs. Self-management programs are supported through many funding streams and covered as a core benefit by public and private insurers.

  13. Thank you! Laura Saddler Health Systems & Self-Management Lead Health Promotion & Chronic Disease Prevention Oregon Public Health Division Laura.c.saddler@state.or.us 971-673-0984

More Related