Oregon s Health System Transformation & The Innovator Agent Role

Transcription

1 Oregon s Health System Transformation & The Innovator Agent Role Joell E. Archibald, RN, BSN, MBA Estela Gomez, MSW Belle Shepherd, MPH OHA Transformation Center Innovator Agents

2 Background: Oregon s Health System Transformation Oregon s health system transformation seeks to achieve the triple aim: better health, better care, lower costs. Transformation began with Coordinated Care Organizations (CCOs) o CCOs are networks of all types of health care providers (physical health care, addictions and mental health care, and dental care) who work together to serve Oregon Health Plan (Medicaid) members. Next step of transformation is to spread the coordinated care model to other payers.

3 The Coordinated Care Model Integrated and Coordinated Care Global Budget with Fixed Rate of Growth Metrics (with Incentives) Flexibility Local Accountability & Governance

4 Before and After CCOs Fragmented care Before CCOs Disconnected funding streams with unsustainable rates of growth No incentives for improving health (Payment for volume not value) Limits on services Health care delivery disconnected from population health Limited community voice & local area partnerships With CCOs Coordinated, patient-centered care One global budget with a fixed rate of growth Metrics with incentives Flexible services CCO Community Health Assessments and Improvement Plans Local accountability and governance, including a Community Advisory Council

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6 Oregon s Medicaid Program Commitments to CMS Reduce the annual increase in the cost of care (the cost curve) by 2 percentage points. Ensure that quality of care improves. Ensure that population health improves. Establish a 1 percent withhold for timely and accurate reporting of data. Establish a quality pool. 6

7 Measurement Strategy OHA has committed to measuring and reporting on multiple measure sets. Note there is significant overlap between the measure sets. 33 State Performance Measures 17 CCO Incentive Measures 16 Core Performance Measures Child Health Insurance Program (CHIP) Core Set Medicaid Adult Quality Core Set US Department of Justice Measures 7

8 CCO Incentive Metrics Annual CCO performance on 17 measures tied to incentive funding ( quality pool ). Measures selected by the Metrics & Scoring Committee. Measures were the same for 2013 and 2014; two new metrics were added, and two were dropped for Measure Specifications + Methodology online at 9

9 What is the Transformation Center? OHA s hub for health system innovation and improvement Transformation Center Goals: o Increase the rate and spread of transformation in Oregon s health system o Transformation Center s role is not to be the experts, but to help good ideas travel faster o Build a learning network that connects CCOs, providers and communities o Support the spread of the coordinated care model to other payers o Help OHA transform internally to better support the coordinated care model

10 Transformation Center s Work CCO Innovator Agents Learning Collaboratives Transformation Plan Support Health System Transformation Fund Grants CCO Summit Good Ideas Bank Council of Clinical Innovators

11 CCO Innovator Agents High-level OHA positions embedded in the CCO community Serve as a single point of contact for the CCOs with the agency and help bust bureaucracy within OHA Support the CCO as it implements its transformation plan Support CACs and CHP work Act as champions of change, not regulators Connect regularly with other Innovator Agents to share best and emerging practices and for shared problem solving

12 How do CCO Innovator Agents assist in CCO transformation? Community Ascertain the health needs of their community Serve as a region-specific expert CCO Identify gaps of health resources Assist in transformation itself OHA Link the needs of OHA, the CCO and the community Build stakeholder engagement 15

13 Significant accomplishments to date Tri-county and bi-cco collaboration on member care Same-day DHS meetings and access to time sensitive data Alternative payment methodology to achieve mental health integration Statewide CAC collaborative CCO and county collaboration on behavioral health Sub-cabinet briefings on system challenges CCO and community consensus on non-emergent medical transportation Communityacquired pneumonia risk stratification tool Rule changes on alternative payment methodology Giving voice to tribal concerns to CCO 16

14 Learning Collaboratives Transformation Center learning collaboratives allow CCOs to: o Share best and emerging practices o Engage in shared problem solving Participation in one statewide learning collaborative is required in contract and our waiver others are voluntary Current Transformation Center learning collaboratives: o Medical Directors and Quality Improvement Coordinators (focused on Incentive Metrics) o Community Advisory Council members (includes CAC Summit) o Providers serving patients with complex care needs CCO CEOs meet regularly to share and learn from each other

15 CCO Transformation Plans Each CCO was required to develop a transformation plan geared to the needs of the community it serves. CCOs are finishing up on work in their plans and have submitted plans for for review. o Plans present how CCOs will work to improve health outcomes, increase member satisfaction and reduce overall costs. o Transformation plans encourage continuous quality improvement they will and should evolve over time. The Transformation Center reviews progress and offers support in implementation.

16 Areas of Transformation Transformation plans demonstrate a CCO s strategies to transform delivery of care in their communities in eight areas: Integration of care Patient-centered primary care home Alternative payment methods Electronic health records/health information exchange Communications and member engagement Meeting culturally diverse needs of members Eliminating disparities Community health

17 Health System Transformation Fund $30 million for budget for a strategic investment in CCOs funds extended to 12/30/15 o Funding for innovative projects related to CCO transformation plans and overall goals of transformation o Awards range from $1.3 to $3.6 million (based on CCO size) CCOs unanimously agreed to use $3 million of these funds to leverage 90% federal funding to invest in statewide technology services.

18 Transformation Fund Projects Nearly every CCO is funding multiple projects. A wide array of projects across the 16 CCOs reflect the individual strengths and needs of each CCO community. Some common themes are: o Health information technology/health information exchange o Patient-centered primary care homes o Care coordination o Alternative payment models o Community grant programs

19 Council of Clinical Innovators Statewide multidisciplinary cadre of innovation leaders, consultants and mentors who: o Participate in a year-long learning experience o Actively work with project teams to implement health care transformation projects in their local communities Fellows develop skills in leadership, quality improvement, implementation and dissemination science, creating a network of expertise supporting Oregon s coordinated care model Second cohort currently in selection process

20 Transformation Center: What s Next? Supporting connections between CCOs and: o Early Learning Hubs o Local Public Health Departments Fostering work within CCOs: o Behavioral health integration o Dental integration o Health equity o Patient engagement o Community Health Improvement Plan implementation CCO Summit 2015 Spreading the coordinated care model to other payers

21 CCOs & CACs CCOs are required to establish Community Advisory Councils (CACs), which: o Identify and advocate for preventive care practices to be utilized by the CCO o Oversee a community health assessment (CHA) and adopt a community health improvement plan (CHIP) to serve as strategic guidance for the CCO to address health disparities and meet health needs for the communities in their service area(s) o Annually publish a report on the progress of the CHIP o Include representatives of the community and of each county government served by the CCO, and > 50% Medicaid members

22 CCOs & CACs 37 CACs within the 16 CCOs AllCare Health Plan: 3 Cascade Health Alliance: 1 Columbia Pacific CCO: 5 Eastern Oregon CCO: 13 FamilyCare, Inc: 1 HealthShare of Oregon: 1 Intercommunity Health Network: 3 Jackson Care Connect: 1 PacificSource Central Oregon: 1 PacificSource Columbia Gorge: 1 PrimaryHealth of Josephine Co: 1 Trillium Community Health Plan: 2 Umpqua Health Alliance: 1 Western Oregon Advanced Health: 1 Willamette Valley Community Health: 1 Yamhill County Care Organization: 1 28

23 Community Health Improvement Plan (CHP) Contractual requirements o Identify multiple partners to work on CHP strategies o Hospitals, school health, community based organizations, mental health, dental health, public health, Office of Equity and Inclusion o Identification and prioritization of health disparities in communities including those defined by Race/Ethnicity and language, disability, age, gender, sexual orientation and other factors. o Should include reps from these populations in the improvement strategy implementation/work o Report on annually, redo every 5 years with CHA

24 Oregon CCO CHP Priority Areas (16 CCOs) Mental health integration (13 CHPs) Maternal health, early childhood and youth (11 CHPs) Access to Care (8 CHPs) Health equity and socioeconomic disparities (7 CHPs) Oral health (7 CHPs) Healthy housing and the built environment (7 CHPs) Public health, chronic disease and chronic illness prevention (6 CHPs)

25 CHPs: Implementation Strategies Access to care (41 strategies) Health equity (33 strategies) Workforce development (32 strategies) Integration of services (31 strategies) care coordination (21 strategies) Oral/dental health (28 strategies) Substance abuse prevention/cessation (28 strategies) Mental health (27 strategies)

26 Ongoing work for CCOs o Medicaid Expansion: Total OHP Membership as of: 12/31/13: 614,183 1/1/14: 866,955 2/28/15: 1,044,073 Implement Alternative Payment Methodologies Incorporate CHIP recommendations into CCO work Analyze and design approaches addressing disparities Integration of: o Oral Health (all CCOs effective July 1, 2014) o MH Residential Services (potential 2016 integration) o Medical Transportation (all CCOs effective Jan 1, 2015) o Targeted Case Management (integration delayed)

27 Questions? Joell Archibald, Estela Gomez, Belle Shepherd, 4/13/2015