Creating a healthier Central Oregon.

Transcription

1 Creating a healthier Central Oregon. COHC Community Advisory Council Deschutes County Building (DeArmond Room) 1300 NW Wall St. Bend, OR Agenda Conference Line: Participant Code: # Time Topic Action 11:00-11:10 Welcome/Public Comment Linda McCoy CAC Summit Reminder 11:10-12:00 Dental Care Community Outreach Project Nikki Zogg Discussion 12:00-12:30 CAC Charter Review Rebeckah Berry Current CAC member survey Discussion 12:30-12:45 CCO Update Leslie Neugebauer Discussion 12:45-1:00 Flexible Services Update Therese Madrigal Discussion 1

2 2015 CCM Summit: Travel Assistance for CAC Members Overview Greetings CAC Members, You are invited to the Oregon Health Authority s 2015 Coordinated Care Model (CCM) Summit: Highlighting Outcomes and Promoting Excellence in Oregon s Coordinated Care Model The Oregon Health Authority invites you to join providers and clinicians, public and private health care purchasers, coordinated care organizations (CCOs), community stakeholders, CCO community advisory council members, health leaders, lawmakers, policymakers and funders for a one- day meeting to: share outcomes and lessons learned; support excellence in coordinated care model implementation across sectors; and inspire future innovation in Oregon and beyond When: 8 a.m. 6 p.m., Tuesday, November 17, 2015 Where: Oregon Convention Center, 777 NE Martin Luther King, Jr. Blvd., Portland, OR Cost: $35 registration fee Fee waived for Community Advisory Council members (non- CCO staff) and Oregon Health Authority (OHA) staff. Agenda: The draft agenda is available on the Coordinated Care Model Summit website ( Center/Pages/Coordinated- Care- Model- Summit.aspx) and the registration website below. Registration: Please visit to register for the summit. 2

3 2015 CCM Summit: Travel Assistance for CAC Members Travel Please use the Travel Assistance Form to request either a travel advance or travel reimbursement. Once complete, send the form to CCMSummit@beattygroup.com A travel advance is a pre-issued amount of money to you or your personal care attendant to pay for travel expenses, and is to be requested prior to the summit. Please send your request by October 9, 2015, in order to be processed in time for the summit. A travel reimbursement is to be requested after the summit to cover costs associated with attending the summit. Please submit your form and receipts no later than December 14, Staff will be present at the registration desk at the summit to help you complete this form. Key Deadlines: October 9: Deadline to request travel advances October 14: Deadline to register for the CCM Summit if a hotel room is required. Note: Rooms may still be available after this date, but are no longer guaranteed. December 14: Deadline to request travel reimbursement after the CCM Summit. 3

4 OREGON S COORDINATED CARE MODEL SUMMIT: HIGHLIGHTING OUTCOMES AND PROMOTING EXCELLENCE IN THE COORDINATED CARE MODEL November 17, 2015 Oregon Convention Center 777 NE Martin Luther King, Jr. Blvd., Portland, OR :00-8:00 a.m. Breakfast & Summit Registration 8:00-9:00 a.m. Opening Plenary Achieving Results: Voices from the Frontline Lynne Saxton, Director, Oregon Health Authority, Focusing on outcomes for a healthier Oregon Maggie Polson, Chief Operations Officer, Cascade Health Alliance, Mobile Crisis Team: Reducing emergency department utilization Jennifer Johnstun, Director of Clinical Operations, PrimaryHealth of Josephine County, Maternal Medical Home: Improving prenatal and postpartum care Tracy Muday, M.D., Medical Director, Western Oregon Advanced Health, FEARsome Clinic: A one-stop shop for health assessments serving children in the foster care system 9:00-9:20 a.m. Break 9:20-10:35 a.m. Breakout Sessions 1A-1D 1A: Behavioral Health Integration (Facilitated by Pam Martin, Behavioral Health Director, Oregon Health Authority) Lynnea Lindsey-Pengelly, Trillium Community Health Plan, The tipping point of physical and behavioral health integration in medical homes Tina Busby, M.D., PacificSource Central Oregon, Improving severe and persistent mental illness outcomes in behavioral health homes James Phelps, M.D., Samaritan Health Service, Psychiatric services in integrated care settings Shelly Uhrig, Options for Southern Oregon (AllCare CCO, Inc., Primary Health of Josephine County), Integration inside and outside primary care to reduce emergency room visits and improve health outcomes 1B: Improving Health through Community Engagement (Facilitated by Cara Biddlecom, Health Systems Transformation Lead, Oregon Health Authority Public Health Division) Meg Pitman, FamilyCare, Inc., A population-health approach to meeting the needs of transition age youth Sandra Clark, Health Share of Oregon, Using a community-inclusive framework to identify and address health disparities Kim Whitley, Intercommunity Health Network CCO, Building a collective impact to address social determinants of health Kelly Rowe, Umpqua Health Alliance, Kickstart Douglas County 4 1

5 1C: Improving the Patient Experience of Care (Facilitated by Lisa Bui, Quality Improvement Director, Oregon Health Authority) Jim Connolly, Trillium Community Health Plan, Rapid-cycle improvement for teambased care to increase access to care and improve patient and team satisfaction Colleen Reuland, Oregon Pediatric Improvement Partnership, OHSU, Multiple uses of patient experience of care data 1D: Using Technology to Improve Health (Facilitated by Susan Otter, Director, Oregon Health Authority Office of Health Information Technology) Mark Lovgren, Oregon Health and Science University (Health Share of Oregon), Project ECHO Susan Kirchoff, Oregon Health Leadership Council, Emergency Department Information Exchange (EDIE)/PreManage Coco Yackley, PacificSource Columbia George and Gina Bianco, Jefferson Health Information Exchange, Jefferson Health Information Exchange: The making of an electronic community health record 10:35-10:55 a.m. Break 10:55 a.m.-12:10 p.m. Breakout Sessions 2A-2D 2A: Empowering Patients to Take Charge of Their Health (Facilitated by Oliver Droppers, Policy Analyst and Director, Oregon Health Authority Medicaid Advisory Committee) Jeanine Stice, Willamette Valley Community Health, Interventions to encourage effective weight management and increase participation in the Living Well selfmanagement programs Heidi Hill, Jackson Care Connect, Environment, social connectedness and traumainformed coaching to improve engagement and outcomes for wellness programs Laura Fisk, Yamhill Community Care Organization, Using software to track outcomes of a pain management member wellness program 2B: A Culturally Competent Workforce (Facilitated by Carol Cheney, Equity, Policy and Community Engagement Manager, Oregon Health Authority Office of Equity and Inclusion) Lynska Villiarimo, FamilyCare, Inc., Providing culturally and linguistically appropriate services to reduce health inequity and improve access to care Celia Higueras, Oregon Community Health Worker Association, The Warriors of Wellness community health worker project collaboration Ally Linfoot, Clackamas County Behavioral Health Division, Outcomes of creating a peer-delivered services system of care in the community Diane Barr, Cascade Health Alliance, Using non-emergent medical transportation and community health workers to improve access to care for vulnerable populations in rural areas 2C: Complex Care (Facilitated by Ron Stock, M.D., Director of Clinical Innovation, Oregon Health Authority Transformation Center) 5 2

6 Tami Tigner, West Valley Fire District (Yamhill CCO), Community emergency medical service program to improve health outcomes for medically vulnerable populations Tracey Smith, Moda Health, Using health plan incentives to engage high utilizers Michael Harris, Oregon Health & Science University, Novel interventions in children's health care to bend the curve in pediatrics 2D: Oral Health Integration (Facilitated by Bruce Austin, D.D.S., Dental Director, Oregon Health Authority) Max Williams, President and CEO, Oregon Community Foundation, Children s Dental Health Initiative Sharity Ludwig, Advantage Dental, Evaluating the effectiveness of new delivery and payment systems for improving dental care and oral health Linda Mann, Capitol Dental Care, The Virtual Dental Home: An innovative and costeffective system for providing dental care 12:10-1:30 p.m. Lunch and Plenary Moving Upstream: Connecting with the Community to Improve Health (Facilitated by Zeke Smith, Chief Impact Officer, United Way of the Columbia-Willamette; Chair, Oregon Health Policy Board) Soma Stout, M.D., Lead Transformation Advisor, Cambridge Health Alliance; Executive Internal Lead for Health Improvement, Institute for Healthcare Improvement, Social determinants of health and patient-centered care Dr. David Labby, M.D., Health Strategy Officer, Health Share of Oregon, Health Commons Grant: A community-wide partnership to improve health Megan Lee Gomeza, Lifeways, Inc., Malheur Community Advisory Council, Eastern Oregon CCO, Eastern Oregon CCO s Upstream Initiatives to Improve Health in Eastern Oregon Wendy Wilson, Principal, John Wetten Elementary School (FamilyCare, Inc.), Healthy Kids video presentation Soma Stout and Zeke Smith, Reflections and the future 1:30-1:50 p.m. Break 1:50-3:05 p.m. Breakout Sessions 3A-3D 3A: Reflections from Policymakers on Oregon s Health System Transformation (Facilitated by Courtney Westling, Legislative Director, Oregon Health Authority) Speakers to be determined 3B: Trauma-Informed Care (Facilitated by Emilee Coulter-Thompson, Learning Collaboratives Manager, Oregon Health Authority Transformation Center) Teri Petterson, M.D., Trauma-Informed Oregon, Providing clinician adverse childhood experiences and trauma-informed care training to increase integration in clinical practice R.J. Gillespie, M.D., The Children s Clinic, Screening for parental adverse childhood experiences in primary care pediatrics to prevent toxic stress transmission to children Stacy Brubaker, Jackson County Mental Health, Innovative application of a traumainformed approach in a corrections population to reduce the rate of re-traumatization 3C: Opioids 6 3

7 (Facilitated by Cat Livingston, M.D., Associate Medical Director, Oregon Health Authority Health Evidence Review Commission) Jim Shames, M.D., Jackson County Health and Human Services (AllCare CCO, Inc., Jackson Care Connect), A collaborative approach to improve outcomes for complex chronic non-cancer pain Lydia Anne Bartholow, Central City Concern, A primary care approach to reduce opiate overdose deaths Claire Ranit, Columbia Pacific CCO, An alternative pain clinic model 3D: Social Determinants of Health (Facilitated by Chris DeMars, Director of Systems Innovation, Oregon Health Authority Transformation Center) Alicia Atalla-Mei, Oregon Primary Care Association, Impacting the social determinants of health at Oregon's community health centers Lynn Knox, Oregon Food Bank, Improving health with food insecurity screening and intervention Kevin Campbell, Eastern Oregon CCO, Improving health through supportive housing 3:05-3:25 p.m. Break 3:25-4:45 p.m. Closing Plenary Ensuring Success: Learning from the Past, Looking Toward the Future (Facilitated by Lynne Saxton, Director, Oregon Health Authority) Ian Galloway, Senior Research Associate, Federal Reserve Bank of San Francisco, Ensuring financial sustainability Gil Munoz, Chief Executive Officer, Virginia Garcia Memorial Health Center, Payment models to improve health outcomes Ignatius Bau, Health Care Policy Consultant, Using data to address health disparities Purchaser initiatives: Innovation and sustainability, speaker to be determined 4:45-6:00 p.m. Poster Reception 7 4

8 "PREDICT" INFORMATION FOR COMMUNITY PARTNERS What is PREDICT? PREDICT is a quality improvement project designed to dramatically improve dental access while reducing dental disease and dental care costs. PREDICT stands for Population Centered, Risk-Based, EvidenceBased, Dental Inter-Professional Care Team. The target population for PREDICT is low-income children under age 21 and pregnant women (up to 2 months post-delivery). The goal is to manage dental care for this population in community settings and also change payment systems for dental care providers. The PREDICT model is being implemented in 7 "test" counties where there is potential to impact more than 40,000 lives. These counties were selected at random and include: Coos, Deschutes, Douglas, JacksonJosephine, Klamath, Morrow and Wasco. Results will be compared with 7 "control" counties: Crook, Curry, Grant, Jefferson, Lake, Lincoln and Umatilla. Advantage Dental Services, LLC (Advantage) will provide the dental care and referral for treatment for PREDICT. Managing Care in Community Settings PREDICT patients will be seen by an Expanded Practice Dental Hygienist (EPDH) and receive an oral health risk assessment in community settings such as WICs, Head Starts, schools, and other community sites. The risk assessment will place patients in one of three risk categories: low, moderate and high. Based on risk classification, patients will then receive preventive treatment, disease management and/or cavities stabilization services that align with the assigned risk category. Dental services will include silver fluoride, betadine/fluoride varnish, sealants and glass ionomer temporary restorations. Disease management services will be provided up to four times per year in the same community settings. The goal is to manage the dental care needs of the target population in community settings by providing risk-based prevention, intensive case management and dental home referral for treatment. Patients that are low and moderate risk will be referred for treatment based on the outcome of their screening and will be referred to their Primary Care Dentist (PCD) once per year. Patients that are high risk will be referred to their PCD for treatment based on the outcome of their assessment and will see an EPDH up to four times per year in the community setting. Data Collection and Continuity of Care Advantage case management will work with the PCD s office to schedule treatment for patients enrolled with Advantage insurance. Medicaid patients who are not enrolled with Advantage will be referred to their dental plan via the assigned CCO. Uninsured patients will be referred to a local collaborating entity BETTER CARE BETTER ACCESS BETTER VALUE 442 SW Umatilla Ave., Suite 200 Redmond, OR p f

9 (i.e. Neighborhood Dentist Program or a Federally Qualified Health Center (FQHC)). Patients with private insurance will be referred back to their PCD. All records of dental services performed in community settings will be entered into Advantage s cloudbased Electronic Health Record System, ADIN (Advanced Dental Information Network). By recording claims services in ADIN, Advantage is able to bill Medicaid and make appropriate referrals for treatment. If the patient is enrolled with Advantage, the system will send an notification to the patient s PCD letting the practice know that the member has been seen and the services the patient received. Claims for non-advantage Medicaid patients will be submitted to capture the encounter data. There will be no claims submitted for non-medicaid members seen. The expectation is that most patients will be seen in community settings by Advantage EPDHs. EPDHs will use clinical algorithms built into ADIN to determine which treatments patients receive based on risk level. It is anticipated that most of the target population will be low risk and receive no preventive treatments, but will receive toothbrush kits and preventative messaging. In addition to toothbrush kits and preventive messaging, moderate or high-risk patients will also receive silver fluoride, betadine/fluoride varnish, sealants and glass ionomer temporary restorations based on need*. Recall intervals in the community settings will vary by risk level. Alternative Payment Model Quarterly performance benchmarks will be established and tied to incentive payments for those providers in test counties. Quarterly benchmarks are cumulative over a 2-year period, and will be raised quarterly to incentivize ongoing participation by the PCDs and EPDHs (table below). Starting in Spring 2016, PCDs will receive incentive payments if at least 20%of all the assigned members in the target population receive at least one dental service annually and 20% those referred from community settings to the PCDs by the EPDHs are seen within 60 days. Data will be reported monthly and payments made quarterly. Metrics The table below lists the required levels by quarter for the first 2 years. All of the measures count both members seen in community settings and by Advantage PCDs, although the expectation is that most will be seen in community settings. PCDs and Advantage staff will receive performance reports monthly. The incentives are additive each quarter. That is, the counts in Q1 are also included in Q2, etcetera. BETTER CARE BETTER ACCESS BETTER VALUE 442 SW Umatilla Ave., Suite 200 Redmond, OR p f

10 Metric 1. Provide at least one dental service annually 2. Provide topical fluoride treatment twice yearly to all continuously enrolled and screened moderate risk children (ASTDD code 0, CDT D0602). 3. Provide dentist care to continuously enrolled screened high risk children with early (ASTDD 1B) or urgent dental care needs (ASTDD 2) within 60 days. Q1 20% 0% Q2 30% 0% Q3 40% 0% Q4 50% 0% Q5 60% 50% Q6 70% 60% Q7 75% 70% Q8 80% 80% 20% 30% 40% 50% 60% 70% 75% 80% Key References for Clinical Approach (available on request, contact Sharity Ludwig): Substitution of silver diamine fluoride topical treatment of permanent molars instead of routine use of fissure sealants: Llodra JC et al. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars. J Dent Res 2005; 84: Efficacy of twice yearly silver diamine fluoride to stabilize (arrest) decay and prevent new lesions: Horst JA et al. UCSF protocol for caries arrest using silver diamine fluoride: Rationale, indications, and consent. J Calif Dent Assoc. (in press to appear in Fall, 2015). Efficacy of povidone iodine with sodium fluoride varnish: Milgrom PM et al. Topical iodine and fluoride varnish effectiveness in the primary dentition: A quasi-experimental study. J Dent Child 2011;78(3): Who is in Charge? ADS Administration has overall responsibility for this quality improvement project. Sharity Ludwig, Director of Community Dental Programs, has responsibility for delivery system changes. Jeanne Dysert, Chief Operating Officer, has responsibility for incentives. Who is Evaluating the Project? The University of Washington is evaluating the project. The results of the project will be made available to all members of the Advantage Community. The results will be published regardless of the outcome. How can I get More Information? Contact Sharity Ludwig, SharityL@advantagedental.com or your Regional Manager Community Liaison, Nikole Zogg, NikoleZ@advantagedental.com. st nd *Sealants will be placed, regardless of risk in intervention counties, on 1 and 2 graders consistent with the Oregon Health Authority s Sealant program. BETTER CARE BETTER ACCESS BETTER VALUE 442 SW Umatilla Ave., Suite 200 Redmond, OR p f

11 CHARTER: Central Oregon Health Council Community Advisory Council The Community Advisory Council (CAC) is chartered by the Central Oregon Health Council (COHC) Board of Directors to advise and make recommendations to it on the strategic direction of the organization. The overarching purpose of the CAC is to ensure the COHC remains responsive to consumer and community health needs. The CAC is intended to enable consumers, which will comprise a majority of the CAC, to take an active role in improving their own health and that of their family and community members. The CAC will provide guidance and feedback to the COHC in the following areas: 1. COHC Work Plan 2. Regional Health Improvement Plan 3. Regional Health Assessment 4. Development, implementation and evaluation of innovative initiatives, programs, services and activities The CAC will assist the COHC through the following roles and activities: 1. Serve as a conduit for residents of each geographic area in the region to ask questions and raise concerns 2. Identify opportunities to improve population health in the Central Oregon region 3. Advocate for COHC preventive care practices 4. Maximize engagement of those enrolled in the Oregon Health Plan ( OHP ) 5. Provide advice to help COHC link the community s medical and non- medical services to overcome barriers to health 6. Provide a link back to community constituents to aid in achieving the COHC Vision and Guiding Principles Members of the CAC will be recruited to represent the diversity of the Central Oregon community and may include race/ethnicity, age, gender identity, sexual orientation, disability, and geographic location as a criteria for selection. CAC members should possess a collaborative working style, and provide expertise and insight in the areas of social services, public safety and community resources. Individuals with a broad community perspective on health matters will be preferred. 11

12 CHARTER: Central Oregon Health Council Community Advisory Council The Community Advisory Council (CAC) is chartered by the Central Oregon Health Council (COHC) Board of Directors to advise and make recommendations to it on the strategic direction of the organization. The overarching purpose of the CAC is to ensure the COHC remains responsive to consumer and community health needs. The CAC is intended to enable consumers, which will comprise a majority of the CAC, to take an active role in improving their own health and that of their family and community members. The CAC will provide guidance and feedback to the COHC in the following areas: 1. COHC Work Plans 2. Regional Health Improvement Plan 3. Regional Health Assessment 4. Development, implementation, and evaluation of innovative initiatives, programs, services, and activities The CAC will assist the COHC through the following roles and activities: 1. Serve as a conduit for residents of each geographic area in the region to ask questions and raise concerns 2. Identify opportunities to improve population health in the Central Oregon region 3. Advocate for preventive care practices 4. Maximize engagement of those enrolled in the Oregon Health Plan ( OHP ) 5. Provide advice to help the COHC link the community s medical and non-medical services to overcome barriers to health 6. Provide a link back to community constituents to aid in achieving the COHC mission, vision, and values Members of the CAC will be recruited to represent the diversity of the Central Oregon community. Selection criteria may include race/ethnicity, age, gender identity, sexual orientation, disability, and geographic location. CAC members should possess a collaborative working style and provide expertise and insight in the areas of social services, public safety, and community resources. Individuals with a broad community perspective on health matters will be preferred. The CAC shall consist of at least 51% OHP consumer members. An OHP consumer member is defined as: Any individual who is a resident of the CCO region for Central Oregon and who has been a member of OHP at any point in the last two years prior to applying to be a CAC member; or A legal guardian of a consumer who is a dependent child or adult, or a legal sponsor of an immigrant may also be considered a consumer member for purposes of CAC representation; or A person who is uninsured and regularly utilizes safety net health services such as a community health clinic, hospital emergency rooms, and mental health crisis response services. To ensure the CAC represents the true voice of OHP consumers, all CAC members must reapply after serving a four-year term. The CAC chair and CAC vice chair shall each serve concurrent two-year terms. At the end of each term, the CAC shall make a recommendation to the COHC Board of Directors for members to serve as CAC chair and vice chair. [Members may serve no more than two terms as chair or vice chair.] [Consider potential co-chair language.] 12

13 CCO Update for the Community Advisory Council 10/1/15 Submitted by: Leslie Neugebauer, Central Oregon CCO Director Quality Incentive Measure (QIMs) We are well underway with workflows and strategies in an effort to meet as many 2015 QIMs as possible as well as proactively putting processes in place for the QIMs that will be added in We are currently projecting that the following QIMs for 2015 are in danger of not being met: Adolescent Well Care Visits, Alcohol and Drug Misuse (SBIRT screenings), Dental Sealants, and Effective Contraceptive Use. We are working both internally and with provider clinics to determine what strategies may assist with meeting these measures for In 2016 two QIMs will be added: Childhood Immunizations and Tobacco Prevalence. Consumer Assessment of Healthcare Providers and Systems (CAHPS) Results CAHPS is a survey that asks consumers to evaluate their experiences with health care. In 2015 PacificSource did not meet the two QIMs related to CAHPS. The CAHPS: Access to Care target was 88% and our 2015 final results were 79.4%. We are currently reviewing proposals to implement a standardized plan to measure provider access points and determine potential gaps/shortages within all service delivery areas (medical, dental, behavioral) in the region. The CAHPS: Satisfaction with Care target was 83.3% and our 2015 final results were 83.1%. As of August 1 st, 2015 we moved our Customer Service department in house which we are hopeful will assist with improving our consumer satisfaction with the CCO. We are also reviewing proposals for a consumer satisfaction survey re: provider care. Consumer Confidence Project In 2013 a group of health reform advocates created the Consumer Confidence Project in an effort to improve CCO governance transparency and ensure that consumers experiences are drawn on to make policy decisions. Together, with the Oregon Public Health Institute, this project s pilot reviewed CCO s websites and member handbooks to determine if key indicators in the areas of Person- Centered Services, Responsiveness to Members and Community, Transparency of Governance, and Accessibility of Information were represented. The results from this pilot were published in August of 2015 and we have already taken steps to incorporate the recommendations into our updated member handbook and website. If you are interested in reading more about the pilot project and its results you can find them here: 13