Progress Highlights. January

Transcription

1 Progress Highlights January March 2014

2 Goals & Outcomes at a Glance Training & TA Quality Data Transparency* Equity Social determinants Policy agenda Viability Value National influence Service & payment models Green: Completed. Key CHC value* CCO collaboration Access Yellow: Barriers encountered; one or more outcomes not achieved or will be delayed. Red: Priority has changed; needs to be removed as a goal. Employers of choice Community demand Access for the uninsured *Goal partially achieved; see details in report. 1

3 Quality Assure all CHCs in Oregon provide excellent care and are providers of choice. Goal 1: Support all Oregon CHCs to engage in robust training & technical assistance and peer learning in meaningful, data-driven, patient-centered practice transformation, including the integration of behavioral and oral health. General Training Two statewide trainings (spring and fall Quadruple Aim Symposia) offered sessions addressing CHC management, operations, quality and payment initiatives, and patient-centered communications. Ninety-three percent of CHCs were in attendance at one or both events. Provided ten trainings for health center boards. All trainings included information on the 19 Bureau of Primary Health Care (BPHC) requirements for CHCs. Partnered with Northwest Regional PCA (NWRPCA) regarding ICD-10 training. Patient-Centered Communications & Patient-Centered Medical Home (PCMH) Model Provided patient-centered office visit training and motivational interviewing workshops to our members and completed a series of individualized clinic trainings in patient-centered communication. Fifty-three percent of clinics enhanced their skills through trainings in patient-centered communications. Continued our focus on the key tenets of the PCMH - leadership, care teams, data and care coordination. One hundred percent of OPCA s community health centers (CHCs) have been certified under the state s medical home program, one CHC has achieved level three accreditation under the National Committee for Quality Assurance (NCQA) program, and one CHC has achieved NCQA level two accreditation. OPCA has also increased its in-house NCQA expertise. OPCA leads eight clinics (representing six community health centers) in the FQHC Advanced Primary Care Practice Demonstration Project (APCP) from the Centers for Medicare & Medicaid Services. APCP sites have submitted or will submit NCQA medical home applications. Collaborated with Oregon s Patient-Centered Primary Care Institute (PCPCI) by providing a series of webinars for stakeholders statewide and through active executive participation in the PCPCI-sponsored expert learning network, supporting primary care practice transformation. Facilitated the kick-off session of the PCPCI Technical Assistance Expert Learning Network. Provided a PCPCI webinar on Using Data for Quality Improvement, Creating Great Organizational Alignment, and Integrating Behavioral Health. Collaborated with the Oregon Health Authority (OHA) on project year four of the Patient Self-Management Collaborative (PSMC). All PSMC sites demonstrate a positive trend in establishing/adapting the principles of self-management as the foundation of patient-centered care. 2

4 OPCA s participation in the Safety Net Medical Home Initiative (SNMHI) ended in April. Initiative accomplishments included: 14 of 15 CHCs completed the initiative. 100 percent of initiative participants are certified under the state s medical home program. 33 percent of participating sites demonstrated an at or above/positive trend in changes in reported quality performance measures. We created and implemented a durable framework to guide effective transformation within and beyond the safety net. We facilitated significant changes in health care delivery and culture among participating practices. We developed a cohort of safety-net sites to serve as exemplars and leaders in medical home transformation. We developed a comprehensive library of public domain resources and tools created by and for primary care practices. The final year of the SNMHI included a QI project with five clinics. Each received two days of Lean training, six months of access to a QI website (Tomorrow s HealthCare) and QI project facilitation by OPCA staff. Peer Networks Facilitated meetings and/or communications for the following peer networks: Executive directors, medical directors & providers, dentists, data/quality improvement, outreach & enrollment workers (OEWs). Ninety-four percent of health centers have staff members engaged in one or more peer networks. More than 50 percent participated in peer network activities focused on oral or behavioral health integration. Special Populations An OPCA staff member keeps current on trends, threats and opportunities affecting special populations served by CHCs. The staff member works closely with the Primary Care Office to enhance the flow of information to clinics. We also partner with NWRPCA to ensure sufficient special population training for CHC staff members. Partnering with Multnomah County Health Department in sharing successful practices for providing appropriate, barrier-free care to individuals with HIV. Behavioral and Oral Health Integration Launched a pilot program to train a total of five Oregon CHCs in the use of the SBIRT tool (for Screening, Brief Intervention and Referral to Treatment) in Year 1 (more are joining in 2014). SBIRT helps clinics screen all patients for mental/behavioral health issues and use of tobacco, alcohol or drugs. Focused on oral health integration through a DentaQuest-funded initiative, Strengthening the Oral Health Safety Net. Facilitated quarterly face-to-face peer network meetings with dental directors; provided leadership trainings for dental home transformation and practice integration; collaborated with local and state training partners to incorporate dental-centric examples into curricula; facilitated and participated in the steering committee of the Oregon Community Foundation Oral Health Strategic Plan,

5 Goal 2: Encourage maximum participation in a transparent learning community where cost, quality, access, staff engagement and patient experience data/indicators are defined and shared openly to inform improvement. Pulled together three cohorts of data transparency work groups comprising all but three of Oregon s CHCs. Moved from understandable CHC concern about sharing data transparently to enthusiastic openness! Data has been shared within the cohorts around quality metrics. Cohorts are reviewing organizational differences and rankings across the state. They meet to discuss the data and share best practices as they work to improve measures relating to: depression screening; diabetes; emergency department utilization; hypertension; SBIRT screening; staff engagement; social determinants of health. Oregon s CHCs had great success with hypertension improvement. We achieved 72.4 percent controlled, exceeding our five-year goal of 65 percent. Additionally, 100 percent of our CHCs have met one or more of the Healthy People 2020 goals. We did not meet our goal of improving PAP rates to 57 percent statewide. Although many CHCs are working to improve their PAP rates, most are now more focused on those measures adopted by the CCOs as incentive metrics. In keeping with this area of focus, our Data Transparency Groups adopted CCO incentive measures as a determination of CHC value. Krista Collins joined OPCA as our data analytics and quality improvement specialist. Krista and her team are central to OPCA s work in defining value, helping health centers use performance indicators to demonstrate value, connecting CHC workflow to measurable improvement, and assisting in creating strategies that build payment based upon high-quality services. Dedicated additional resources to data analysis through a team comprising Brandon Lane, Diane Lechner and Bob Maxwell with more recent contributions from Jessica Yen, OPCA s social determinants of health manager. Used a program developed in Colorado to begin pulling and analyzing UDS trends more easily, allowing us to compare multiple factors and share results. Next steps will have health centers reporting and sharing their own data and workflows. Goal 3: Support the financial and operational viability of current and future CHCs, including an emphasis on process improvement. During the 2013 state legislative session, defeated efforts to restrict the process of contracting with Coordinated Care Organizations (CCOs) to provide services for oral health care. All CHC sites experiencing financial challenges received ongoing support to turn around the situation, in partnership with the BPHC. By the end of 2013, Oregon s CHCs were free of financial going concerns. Additionally, 52 percent had cost increases less than the national CHC average. Led successful CHC trip to Capitol Hill in 2013, culminating in no sequester cuts to health centers. Organized and led a 2014 visit to Capitol Hill by 13 representatives from Oregon s health centers. Attendees met with health policy staff members for every member of Oregon s Congressional delegation. Attendees educated Congressional staff members about the important work being done by Oregon s health centers. OPCA staff hosted 10 fiscal officers group teleconferences and provided four face-to-face orientations for new CFOs. Attended six bi-monthly meetings of the state Division of Medical Assistance Programs. Added face-to-face CFO trainings with experts to help CHCs remain free of going concern issues while becoming educated on ICD-10 coding. Hired Matt Payne as operations manager. He has extensive experience in health center operations administration in Colorado. All executive leaders and board chairpersons were made familiar with BPHC requirements. 4

6 Value Support models that improve community health center value and efficiency. Goal 4: Lead and influence national conversations about CHC value and the CHC role in health care transformation to position Oregon s health centers and OPCA effectively for resources to support transformation and align payment reform. More than 15 states are interested in implementing the Oregon Alternative Payment Methodology (APM) model and have asked OPCA for assistance. OPCA has provided on-site consulting services to California, Indiana, Michigan, Montana and Wisconsin. We are in preliminary discussions with several other states to provide webinar or on-site services. The National Association of CHCs (NACHC) contracted with OPCA to review, and provide advice on, a payment reform paper in development. Presented our work in APM, the advanced care model (ACM), and social determinants of health at several NACHC, NWRPCA and other CHC conferences and payment reform workgroup meetings. Presented our payment reform strategy at NACHC strategy meetings, as well as the NACHC Policies & Issues Forum, in combination with information about the advanced care model. Met three times with Jim Macrae of the BPHC and his staff to review progress on our APM project. The BPHC is committed to helping make the project successful. Craig Hostetler was asked to serve as one of the vice chairs of the NACHC Policy Committee, based on OPCA s work on payment reform. Goal 5: Support Oregon CHCs in preparation for and leading the implementation of new service delivery and payment models. In March of 2013, OPCA s APM pilot went live at three Phase I sites Mosaic Medical, OHSU Family Medicine at Richmond, and Virginia Garcia Memorial Health Center. The new financial model is working. We are preparing analyses to demonstrate success relative to the model requirements remaining budget-neutral, for example, for both the state and the clinics. A second APM pilot phase is scheduled to launch in July and will include four more health centers: CHCs of Benton & Linn Counties, Coastal Family Health Center, Multnomah County Health Department and Yakima Valley Farm Workers Clinic. Once Phase II begins, the majority of community health center patients in Oregon will be included in the APM program. An APM work group troubleshoots billing and payment issues. Members provide support to one another in developing new financial management systems to track capitated payment and patient enrollment. 5

7 Led a concurrent process to develop quality, cost and utilization metrics and associated reports. Developed agreements with the state for reporting timelines and procedures. Reporting and metrics continue to evolve under the model. A methodology to attribute and reassign patients, if needed, has been developed. We are in the process of planning the implementation prior to Phase II. Now turning our focus to collaborating with our pilot clinics on transforming the model of care under APM. Hosted a summit to begin developing an approach to an ACM for population health. Staff members from Oregon s CHCs listened in while a group of national leaders with years of health care experience discussed possible approaches. They generated ideas - backed by evidenced-based medicine - that health centers can use in considering advanced care concepts and tools. We re convening a learning community of interested health centers to develop the ACM. We will plan and facilitate robust quarterly learning events and opportunities, provide access to nationally recognized experts on the cutting edge of health care transformation, and facilitate peer networking and sharing of best practices. Goal 6: Define and promote CHC value among partners and patients, supported by robust process and outcome data and strategic communications. Data transparency learning community adopted CCO incentive measures as a determination of CHC value. CHC value project is not yet completed. Anticipating the launch of an updated strategic communications plan when the project wraps up in spring CHC value communicated to target audiences through a variety of channels, including: E-bulletins on PCMH/Technical Assistance & Training work (Transformations) and OPCA s policy work (Weekly Legislative Update - readership grew 28 percent over the 2013 legislative session and an additional 17 percent over the 2014 session); OPCA website; comprehensive summary of CHC legislative priorities; key talking points for both conservative and liberal audiences; new fact sheet series with data and info about CHCs and patients in each state and federal legislative district; 60+ personalized introductory and thank-you videos for legislators. Media coverage of CHCs prompted by OPCA s news releases, conversations with reporters and/or work with CHCs included: Oregonian, Portland Business Journal, Bend Bulletin, Oregon Coast Daily News, Medford Mail-Tribune, El Hispanic News, Ashland Daily Tidings, East Oregonian, The Lund Report, KFLS radio. Goal 7: Support CHCs in their efforts to build collaboration and partnerships with key community stakeholders in the CCO environment through education, identification of best practices and peer learning. Held CCO-related learning sessions at spring and fall 2013 Quadruple Aim Symposia and at OPCA s fall strategic planning retreat. Created a messaging guide for CCOs and other key external audiences, based on the findings of a health center stakeholder survey. Distributed the guide via hard copy and a webinar presentation for all OPCA members. 6

8 Made a presentation on innovative CHC/CCO partnerships at Lincoln County Health Center s strategic planning meeting. Commissioned a report on the 340B program that highlighted innovative CHC/CCO partnerships in the area of prescription drugs. Participated in Portland metro area CCO meetings in partnership with the Coalition of Community Health Clinics and in collaboration with Health Share of Oregon, to address the issue of CCO patient assignment. Working with CHCs and CCOs to address the issue of dental patient assignment. PacificSource has developed best practices, and we are working with them to see if their strategy would be a good fit for other CCOs. Created a user-friendly grid that provides a summary of the innovative aspects of each CCO s transformation plans. 7

9 Access Assure that Oregon s health centers can meet demand for their services. Goal 8: Assist Oregon CHCs in becoming employers of choice, and assist health centers in addressing future workforce needs. Created and facilitated a Dental Student Rotations Roundtable at the request of CHC dental directors. Working collaboratively with preceptor sites and OHSU faculty to enhance the value and impact of dental rotations in Oregon CHCs. Participated in the Oregon Recruitment and Retention Workgroup with OHSU, the Office of Rural Health, Area Health Education Centers and the Oregon Primary Care Office (PCO) to streamline workforce activities in Oregon. Workgroup members are responding collaboratively to workforce issues and opportunities. Inviting students and faculty from AT Still University s Portland D.O. program to attend OPCA trainings. Partnered with the Wright Center s Oregon Community Health Center Residency Program. Included residents in training opportunities. Provided facilitative leadership training to 58 percent of CHCs. Conducted a survey of all executive directors regarding their workforce needs as they relate to OPCA. Responses indicated interest in salary/market surveys, engagement strategy and compensation philosophy. Trained all SNMHI participants in staff engagement. Facilitated all-staff surveys for each SNMHI clinic. The PCO added OPCA s materials to its Clinician Recruiting and Retention Toolkit. Worked closely with CHCs that measure staff engagement. Helping clinics add more frequent, actionable metrics through webinars, s and our data transparency groups. Reaching out to all new CHC managers/leaders and planning to match them with mentors as they desire. Ensured that all new CHC leaders felt informed and part of a larger movement, with many experts to contact. All new CHC executive directors received the CHC orientation manual in their first month on the job. Ongoing CFO training is imbedded in OPCA webinars, events and monthly phone calls. Board trainings now highlight ways to enhance organizational culture and improve retention, plus the concept of employer of choice and its importance as a driver of change. Offered webinars and s on employee engagement strategies and creating cultures that help recruit and retain great staff members. 8

10 Goal 9: Support CHC efforts to adapt to changing demand in their communities. Assisted Bandon clinic (now a CHC!) and Winding Waters Clinic with information about grants, health center requirements, non-profit creation, budget design, need determination, and how to project needs and services. Worked with all communities interested in the establishment of a health center: Bandon, Florence, Grant County, Lane County, Oakridge and Portland. Continue to interact with a rural health clinic interested in pursuing CHC status in the next one to two years. Goal 10: Promote access for the uninsured as health care reform is implemented, including undocumented individuals. Provide ongoing training and information for all OEWs to help them enroll patients in the Oregon Health Plan and qualified health plans. Worked with OHA and Cover Oregon to provide the latest updates for OEWs during the turbulent rollout of the health insurance exchange. Between July and December, OEWs at health centers assisted an estimated 43,000 Oregonians in the enrollment process and enrolled an estimated 16,000. Worked in partnership with the Oregon Latino Health Coalition to achieve statewide expansion of the CAWEM-plus program to provide prenatal services to all residents of Oregon. Created and distributed internal and external outreach projections for all CHCs in Oregon. Holding conversations on new enrollees, high demand and creating capacity. 9

11 Equity Advance health equity for all. Goal 11: Support CHCs in addressing population health and the social, behavioral and environmental determinants of health. Partnered with NACHC, the Association of Asian Pacific Community Health Organizations and the Institute for Alternative Futures and received funding to support work around social determinants, patient complexity and areas of intervention. Hired a social determinants of health manager, Jessica Yen, who has been engaged in national conversations around risk adjustment, tool creation, innovative programs regarding social determinants, imbedding these measures in clinics, and operationally defining terms such as patient complexity, risk adjustment and social determinants of health. OPCA s It Takes a Neighborhood initiative supports, in two pilot communities, a full-time position whose job is to weave a broader, stronger network of working relationships across a health neighborhood (medical, social service, and other non-traditional stakeholders who advance health among a subpopulation in unique ways). The Health Instigator (HI) helps break down barriers to advancing health and containing costs and elevates awareness of the fact that social determinants of health constitute some of those critical barriers. Through the work of the HI, barriers within each community have already been broken down with significant impact. For example: ER diversion. New warm handoffs. New services directly impacting the Triple Aim. Spread of critical training that is already saving lives and reducing downstream costs. Cultural competency training for critical service providers. Significant elevation of the health issues faced by two sub-populations that have, in the past, generally not been on the radar of payers. CCOs in each pilot area are actively engaging with the health instigators. As a direct result of the HI s work behind the scenes, plus in-person conversations convened and facilitated by the HI, one of the first APM initiatives proposed by the Salem area CCO will be directed towards serving children with complex special needs. A $450,000 transformation grant will provide coordinated care and wraparound services for these kids and their families. 10

12 In the Portland area, FamilyCare has invested a significant amount in the homeless youth system. As a result of HI-led conversations, grant-writing and on-going support, they are funding a nurse and navigator who serve across the system. The FamilyCare community advisory council (CAC) now has a homeless youth among its membership. The seat is uniquely held jointly by the youth and the health instigator, so that the HI may support the youth to fully engage. The CAC has been so impacted by what they have learned from this youth and the HI that they have made transitional youth their key CHIP focus area. The evaluation team is excited by the initiative s qualitative results and is beginning to undertake quantitative analysis as It Takes a Neighborhood enters its final year. Efforts are underway to obtain funding that will support: 1) deepening and spreading learnings from the initiative, 2) the role of the Health Instigator, and 3) long-term sustainability of this approach to better community health. Goal 12: Develop and execute a policy agenda that assures active participation of CHC s in health reform implementation, including the issue of payment and measurement for social, behavioral and environmental determinants of health and development of a culturally competent, primary care workforce to meet future needs. In the 2013 legislative session, we passed a bill to improve the continuity of care for patients who transition between CCOs and Cover Oregon. Curtailed efforts by OHA to divert funds from Oregon s 340B prescription drug program. Funded a comprehensive report on the value-add of the 340B program for Oregon s CHCs and for the state. Now partnering with OHA to address issues that gave rise to OHA s initial efforts. Provided expertise and guidance to organizations representing underserved communities. Helped them accomplish their legislative priorities. In the 2014 legislative session, we helped pass bills that will require OHA to study the costs and impact of a Basic Health Plan for Oregon, appropriate funding for a primary care loan forgiveness program and require certain health plans to cover refills of prescription drugs. OPCA also influenced bills that mandate pilot projects to provide used durable medical equipment to medical assistance recipients and subsidize the costs of commercial health coverage for children with family incomes from percent of federal poverty guidelines. 11 Oregon Primary Care Association