Agenda Delivery System Transformation Committee March 22, 2018 4:30 6:00 pm Samaritan Walnut Building, Endeavor Conference Room Dial in: 866-439-0933 Code: 5093665467 1. Introductions Kim Whitley, COO, Samaritan Health Plans 4:30 2. Transformation Update Transformation and Quality Strategy (TQS) Update p. 9-10 Jenna Bates, Transformation Manager, IHN-CCO 4:35 Volunteers for Q&A 3. Oregon Health Authority (OHA) Update Joell Archibald, Innovator Agent, OHA 4:40 4. Workgroup Updates Current activities Challenges How can the DST help? p. 11-18 Workgroup Chairs 4:45 5. Sexual Assault Nurse Examiner (SANE) Closeout p. 19-24 Patti Kenyon, Clinical Nurse Specialist, Sarah s Place 5:20 6. Request for Proposal (RFP) RFP Packet p. 25-33 7. How to Get the Story Out How to Get the Story Out Grid p. 35 8. Wrap Up Final Evaluation Scorecard for the Sexual Assault Nurse Examiner (SANE) Pilot o 32T32TUhttps://www.surveymonkey.com/r/_SANE U32T32T Kim Whitley, COO, Samaritan Health Plans Kim Whitley, COO, Samaritan Health Plans Kim Whitley, COO, Samaritan Health Plans 5:40 5:55 5:55
COMMONLY USED ACRONYMS AND MEANING Acronym ACEs APM CAC CCO CEO CHIP CHW COO CRC DST ED EHR ER HE IHN CCO LCSW MOU OHA PCP PCPCH PMPM PSS PWS RFP RHIC RPC SDoH SHP SHS SOW THW TQS UCC WG Meaning Adverse Childhood Experiences Alternative Payment Methodology Community Advisory Council Coordinated Care Organization Chief Executive Officer Community Health Improvement Plan Community Health Worker Chief Operations Officer Colorectal Cancer Delivery System Transformation Committee Emergency Department Electronic Health Records Emergency Room Health Equity InterCommunity Health Network Coordinated Care Organization Licensed Clinical Social Worker Memorandum of Understanding Oregon Health Authority Primary Care Physician Patient Centered Primary Care Home Per Member Per Month Peer Support Specialist Peer Wellness Specialist Request for Proposal Regional Health Information Collaborative Regional Planning Council Social Determinants of Health Samaritan Health Plans Samaritan Health Services Statement of Work Traditional Health Worker Transformation Quality Strategies Universal Care Coordination Workgroup 2 of 35
Minutes Delivery System Transformation Committee March 8, 2018 4:30 6:00 Samaritan Health Services Walnut Building: Endeavor (conference room) Dial in: 866-439-0933 Code: 5093665467 Introductions Kim Whitley Present: Kacey Urrutia, Erin Sedlacek, Kim Whitley, Jenna Bates, Charissa White, Clarice Amorim Freitas, Annie McDonald, Bill Bouska, Ronda Lindley-Bennett, Joell Archibald, Tyra Jansson, Kevin Cuccaro, Glenna Hughes, Melissa Cheyney, Molly Mew, Renee Smith Phone: Jennifer Clemens, Danny Magana, Emily Barton Transformation Update Jenna Bates Videoconferencing; instructions on page 9 of the packet. o More testing required. o Contact Bettina Schempf regarding how the instructions for the system her organization uses works. The DST Awareness Survey was sent to past and present DST attendees late February 2018. Open until end of March. Reminder will be sent mid-month. o Over 30 responses in the past week. Oregon Health Authority Update Joell Archibald CCO 2.0 process: o Organized around four keys areas: Maintain sustainable cost growth. Increase value and pay for performance. Focus on social determinants of health and equity. Improve the behavioral health system. o Oregon Health Policy Board will be having meetings from March 2018 through Summer 2018 to elicit public input. o CCOs will apply in early 2019, awarded in 2019. o Most CCOs would like to continue doing the work they are doing, but it is dependent on the process. o Possible regional boundary movements of the CCOs. CCO Incentive Metric Mid-Year Progress Report has been released. o This is an update report; dollars are not tied to this report. o Due to claims runout of 90 days, the state does not start analyzing the data until end of March 2018. o Final report is released in June 2018. o IHN-CCO is the only CCO that has improved on all 8 metrics that there is data for! The Northwest Health Foundation has announced the opening of their Health and Education Fund. The Oregon Pediatrics access line has been successful. There may be an access line geared to adults as well. Request for proposal (RFP) RFP requirements discussion: o Spell out CLAS Standards (Culturally and Linguistically Appropriate Services). o Transformation and Quality Strategy Component and/or an Eight Element of Transformation rather than and. o Bullet out list of requirements versus priority areas. o Include definition of health equity. o Are the metrics required or encouraged? In past years they have been a priority area, but not a requirement. o Change dental to oral. o Combine all the areas into themes; such as TQS #3 and Eight Element #1, Integration of Care. o Blend all other categories that fit into the Community Health Improvement Plan (CHIP). Further discussion regarding keeping the CHIP as a standalone requirement. 3 of 35
o The DST is lacking in clinical representation; how do we try to get the clinical field involved with the DST and pilots? Ideas include: CCO Incentive Metrics engage providers. Try to gear the language towards the medical field, particularly highlight the linkage to the Patient-Centered Primary Care Home (PCPCH). Prioritize Value-based Payment Models for specialty providers. Challenges surrounding this idea were discussed. RFP requirement decisions: o Combine the Eight Elements of Transformation and the Transformation and Quality Strategy (TQS) Components where they overlap, and take it out if it is already covered by one of the CHIP areas (to reduce duplication). o Health Equity and Social Determinants of Health; these are lenses that each proposal needs to address. o CCO Incentive Metrics to go in as a requirement. o Evaluation considerations do not need to be changed. They are to be included in the RFP materials. o If a component, element, or metric fits under one of the Health Impact Areas of the CHIP, fit it there. o Include a statement referring to the TQS Components, the Eight Elements of Transformation, the CHIP Health Impact Areas, and the CCO Incentive Metrics that these things were taken into consideration to create this. Press release for the RFP. Reach out to Marketing to inquire on this. RFP question and answer volunteers: o Kevin Cuccaro (April 26, 2018) o Renee Smith (April 26, 2018) o Clarice Amorim Freitas (both dates) o Melissa Cheyney (May 10, 2018) DST Planning Printing materials: o Decision: The DST is going paperless but will print a limited number of packets during the transition period. o Be mindful of color and how the packet will look for people who can only print in black and white. o Transformation will provide some tablets for use during the DST meetings in case someone would like to access the electronic DST packet but does not have a device. Bring to the next DST to try this out. How to Get the Story Out DST organizational chart: o The workgroups and pilots have been separated out from each other on two different slides. o The slides can be used for any type of event; i.e., a DST member could list all pilots that have to do with Social Determinants of Health for that type of presentation. o Slides can be part of the Toolkit, and can be customized to the focus area needed. Update on the grid: Provide a universally approved logo for use on materials/presentations. We have a logo, working on the tagline. Educational Roadshow Continuing to add to the toolkit. Transformation continues to inform pilots/workgroups of upcoming conferences asking for poster submissions, focused presentations, etc. Create one-page summary documents on key findings, successes, etc. Done. Add a question to the quarterly reporting form asking pilots if they have presented at any local, state, or national conferences and share this information out. Done. o Hire a storyteller to tell the story. This is cost-prohibitive at this time but will be left on the grid for future consideration. 4 of 35
o Potential new addition to the grid: Create a poster template for pilots to capture their work. Makes it easier and less intimidating when considering presenting at a conference. Kevin Cuccaro will email a template example he s used in the past. Next Time Sexual Assault Nurse Examiner (SANE) closeout. o Will be using the new PowerPoint slides recently updated by the DST. Workgroup update. Finalize RFP packet. 5 of 35
This page intentionally left blank 6 of 35
DST 2018 Calendar January 11 th 25 th Strategic Planning Strategic Planning July 12 th 26 th Acronym Pilot Name End Date APM Alternative Payment Methodology 12/31/16 BSS Breastfeeding Support Services 09/30/18 C2C CHANCE 2nd Chance 06/30/18 February 8 th 22 nd APM2 Strategic Planning Strategic Planning August 9 th 23 rd Proposal Presentations Proposal Presentations CHWL Community Health Workers in N. Lincoln 12/31/17 COMPAR Community Paramedic 06/30/18 CSAS Children's SDoH and ACE Screening 12/31/18 DOUL Community Doula Program 12/31/18 March 8 th 22 nd SANE Strategic Planning Workgroups September 6 th 20 th RHEH Decisions EDCT Eating Disorders Care Teams 02/28/18 EHCC Expanding Health Care Coordination 04/30/18 FSP Family Support Project 04/30/18 HEST Health Equity Summits and Trainings 12/31/18 April 5 th 19 th PMP PDBC IPRP SNN October 4 th 18 th Workgroups IICH Improving Infant and Child Health 06/30/18 IPRP Improving the Pain Referral Pathways 06/30/17 OHEV Oral Health Equity for Vulnerable Pop. 06/30/18 PDBC Pre-Diabetes Boot Camp 12/31/17 May 3 rd 17 th 31 st CHWL SPC EDCT November 1 st 15 th 29 th PMP Pain Management in the PCPCH 12/31/17 PPC Pharmacist Prescribing Contraception 05/31/18 PSWT Peer Support Wellness Training 12/31/18 RHEH Regional Health Education Hub 12/31/18 SANE Sexual Assault Nurse Examiner 07/31/17 SDoH Social Determinant of Health Screening 06/30/18 June 14 th 28 th LOI Review/Invite Workgroups Dec. 13 th Jan. 2019 Workgroups Key Tentative closeout Booked closeout Tentative extension Booked extension Tentative miscellaneous Booked miscellaneous Tentative update Booked update Tentative workgroup Booked workgroup SNN School/Neighborhood Navigator 06/30/17 SPC SHS-Palliative Care 09/30/17 THWH Traditional Health Worker Hub 06/30/18 VRxL Veggie Rx in Lincoln County 12/31/18 WPNT The Warren Project: Nature Therapy 04/30/18 YCRC Youth & Children Respite Care 03/31/18 Updated: 3/19/2018 7 of 35
InterCommunity Health Network Coordinated Care Organization Delivery System Transformation (DST) Request for Proposal Timeline Key Request for Proposal (RFP) Released April 9, 2018 Scheduled DST Meeting DST Member Action Pilot Proposer Action Transformation Team Action Question & Answer (Q&A) Session for Pilot Proposers April 26, May 10 MANDATORY Letter of Intent (LOI) Due May 28 5:00 pm LOI Distributed to DST by June 7 LOI Feedback Due from DST by June 14 Invitations Issued to Submit Full Pilot Proposal by June 18 DST Decisions September 6 Pilot Proposal Presentations to DST August 23 Pilot Proposal Presentations to DST August 9 Full Pilot Proposals Due July 30 5:00 pm MANDATORY Technical Assistance Meetings June 25 July 27 Proposers Notified of DST Decision by September 10 Regional Planning Council (RPC) Funding Decisions September 21 Proposers Notified of Pilot Denial or Approval by September 24 Contracting Begins by November 1 Pilot Invoices/Payments Begin January 1, 2019 01/29/18 8 of 35
HEALTH SYSTEMS DIVISION Kate Brown, Governor Memorandum To: CCO Leadership From: Wes Charley (Quality and Compliance Office, Health Systems Division) and Chris DeMars (Transformation Center, Health Policy and Analytics Division) Date: March 6, 2018 Subject: Transformation and Quality Strategy: Response to CCO Leadership Feedback Thank you for sharing your feedback and concerns at the 2/15/18 CCO Leadership meeting regarding the Transformation and Quality Strategy (TQS). The TQS is a joint effort across OHA s Quality Program, Transformation Center, and Health System Division to cover health transformation, quality improvement and quality assurance. Following are OHA s response and decisions based on that conversation. Background: The TQS has combined two CCO deliverables: the CCO Transformation Plan and Quality Assessment and Performance Improvement (CCO Quality Strategy). This streamlined approach aims to support health system transformation by providing CCOs with an opportunity to internally coordinate and align all of their transformation and quality work. The TQS template was developed to support: (1) sharing of CCOs best practices; (2) advancement of CCOs health transformation through aligned innovation and quality methods; and (3) state monitoring of CCOs progress. Per Oregon s CMS 1115 demonstration wavier, Oregon is required to report to CMS on CCOs health transformation activities, and the TQS allows us to satisfy this requirement. In addition, CCOs must submit a TQS to OHA per CCO contract. TQS submissions will be posted to the OHA website. Timeline: For each calendar year, TQS submissions will be due March 16, and six-month progress reports will be due September 30. Technical assistance and additional information: To support CCOs in completing their TQS, OHA provided a five-part webinar series and monthly office hours. Each webinar was recorded and additional office hours are available until the March 16 TQS deliverable date. Please see this flyer for details: www.oregon.gov/oha/hpa/csi- TC/Documents/TQS-webinar-flier.pdf. All TQS resources are posted on the Transformation Center website, including reporting templates, examples, FAQ (see below), a guidance document, and information about technical assistance and recorded webinars: www.oregon.gov/oha/hpa/csi-tc/pages/transformation- Quality-Strategy.aspx. 9 of 35
OHA responses and updates to the TQS template and guidance documents were aggregated and recorded within a TQS FAQ document. The FAQ document is available at: www.oregon.gov/oha/hpa/csi-tc/documents/tqs-general-faq.pdf (last updated 1/26/17) The templates and guidance document are cross-posted on the OHA CCO Contract Forms website: www.oregon.gov/oha/hsd/ohp/pages/cco-contract-forms.aspx Please contact Lisa Bui (lisa.t.bui@state.or.us or 971-673-3397) with any questions. Follow-up decisions from February 15 CCO Leadership meeting: While the TQS is required per both the 1115 waiver and CCO contract, the 2018 TQS data-collection tool is considered a trial. OHA will convene a CCO TQS work group in April to provide feedback to OHA. Specifically, the work group will work with OHA to: 1) assess how well the 2018 submissions aligned with the OHA TQS goals; 2) develop the process for providing CCO feedback on TQS submissions; and 3) provide recommendations for changes to the TQS data-collection tool moving forward (i.e., for 2019 and beyond). This work group will meet up to six times between April-August, 2018. Note that volunteers for this work group had already been requested during prior QHOC meetings and TQS technical assistance webinars, but the CCO Leadership feedback OHA received on 2/15 provided additional clarity regarding the work group s role. OHA asks that CCO Leadership email the Transformation Center (Transformation.Center@state.or.us) by COB on Thursday, March 15, with the name of their TQS work group representative. Finally, at the 2/15 meeting we also heard that CCOs would like opportunities to share their transformation work beyond what is possible through the TQS. To that end, the Transformation Center will be sending out a survey that will include a request for feedback on how the Center can best support CCOs in telling their transformation stories. Thank you again for your feedback. We look forward to working with you on TQS improvements over the coming months. 10 of 35
IHN-CCO Delivery System Transformation (DST) Workgroup Summaries Workgroup Name Chairperson(s) Brief Description Alternative Payment Methodologies (APM) Carla Jones, Reimbursement Manager, IHN-CCO/Samaritan Health Plans Served as a communication mechanism and collaborative workgroup for the community and IHN- CCO through the development of APMs. APM has transitioned into a forum where IHN-CCO and community partners continue to collaborate on strategies for successful implementations of APM models. Health Equity (HE) Social Determinants of Health (SDoH) Traditional Health Workers (THW) Universal Care Coordination (UCC) Bettina Schempf, Executive Director, Old Mill Center Clarice Amorim Freitas, Coordinator, Linn Benton Health Equity Alliance/Willamette Neighborhood Housing Services Supports delivery system transformation that identifies and reduces health disparities and advances health equity by: supporting the culturally diverse needs of members; supporting quality improvement focused on eliminating racial, ethnic, linguistic, and other disparities in access, quality of care, experience of care, and outcome; and supporting IHN-CCO s Community Health Needs Assessment and Community Health Improvement Plan. Sherlyn Dahl, Executive Director, Advances the development of and promotes the transformational integration of Social Community Health Centers of Benton Determinants of Health into the health delivery care setting with an initial focus on Patientand Linn Counties Centered Primary Care Home (PCPCH). Miranda Miller, Director of Primary Care, Samaritan Health Services Renee Smith, Executive Director, Family Advances the development of THWs in the transformation of healthcare to advance the Triple Tree Relief Nursery Aim. Promotes utilization of THWs to address social determinants of health. Kelly Volkmann, Health Navigation Program Manager, Benton County Health Services Kelly Hower, Director of Clinical Services, The Corvallis Clinic Tanya Grant, Director of Care Management, Samaritan Health Services Convenes and aligns community around a common referral process that can be electronically captured and made available to the Primary Care Physician at the time of service to capture Social Determinants of Health in an electronic form, have a common assessment form for all programs that have assessments, and reduce duplication of services along with helping members navigate the healthcare system (and potentially other systems). 11 of 35
This page intentionally left blank 12 of 35
Health Equity (HE) Scope of Work Document Workgroup purpose: The IHN CCO Health Equity Workgroup supports delivery system transformation that identifies and reduces health disparities and advances health equity by: supporting the culturally diverse needs of members (cultural competence training, provider composition reflects member diversity, Certified Traditional Health Workers and Traditional Health Workers composition reflect member diversity); supporting quality improvement focused on eliminating racial, ethnic, linguistic, and other disparities in access, quality of care, experience of care, and outcomes; and supporting IHN CCO s Community Health Needs Assessment and Community Health Improvement Plan. Workgroup Chair/Chairs: Name: Organization: Phone Email: Number: Miao Zhao Albany InReach 541 812 4059 mzhao@samhealth.org (Co Chair) Services Bettina Schempf (Co Chair) Old Mill Center for Children and Families 541 757 8068 Bettina_schempf@oldmillcenter.org Meeting Frequency: Monthly 4 th Thursday of the month from 2.30 4pm Quarterly joint meeting with Traditional Health Worker Workgroup Short Term Goals: 1. Approval of Strategic Plan 2. Complete Strategic Plan Actions as planned Long Term Goals: A. DATA: Increase the availability and knowledge of quantitative and qualitative data to inform, prioritize, and monitor strategies to meet the needs of culturally diverse members and to reduce health disparities. B. TRAINING: Support and champion cultural competence and health equity trainings for the IHN CCO Health Equity Workgroup, IHN CCO staff, IHN CCO providers, and other community stakeholders. C. DIVERSE WORKFORCE: Support and encourage IHN CCO provider and staff composition that reflects member diversity. D. TRADITIONAL HEALTH WORKERS (THW): Increase, retain, and sustain support for THW to address health disparities across IHN CCO services and in Linn, Benton and Lincoln counties. E. COMMUNICATION: Ensure regular communication between the IHN CCO Health Equity Workgroup, IHN CCO staff, IHN CCO DST Steering Committee, IHN CCO CAC, other stakeholders and IHN CCO workgroups about health disparities and health equity activities in the community. Social Determinants of Health: The workgroup s goals and actions consider social determinants of health as potential barriers to health equity and as opportunities to address health disparities. 13 of 35
Health Equity (HE) Scope of Work Document Timeline: Due Dates: Action to be Completed: 10/6/2017 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers April 1, 2017 through September 30, 2017 time period) 4/6/2018 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers October 1, 2017 through March 31, 2018 time period) 10/5/2018 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers April 1, 2018 through September 30, 2018 time period) Any Additional Information: Health Equity Strategic Plan Reading List or Resource List: Documents available on Basecamp https://3.basecamp.com/3114134/projects/1126880 Communities in Action: Pathways to Health Equity (2017) The National Academies of Sciences, Engineering, and Medicine http://www.nap.edu/24624 14 of 35
Social Determinants of Health Workgroup (SDoHWG) Scope of Work (SOW) Workgroup purpose: Develop and promote the transformational integration of Social Determinants of Health into the health care delivery setting by creating and promoting connections between Patient Centered Primary Care Homes (PCPCH) and community resources and agency relationships. Workgroup Chair/Chairs: Name: Organization: Phone Number: Email: Sherlyn Dahl Community Health Centers of 541 766 2131 sherlyn.dahl@co.benton.or.us Benton and Linn County Miranda Miller Samaritan Health Services 541 768 4900 mmiller@samhealth.org Meeting Frequency: Monthly Short Term Goals: 1. Create an organizing framework to use for development of strategies at the practice, community, and policy level 2. Present recommendations to the Delivery System Transformation (DST) Committee for future pilots 3. Identify best practices 4. Map community resources 5. Provide educational recommendations Long Term Goals: 1. Provide educational recommendations 2. Learning session summit 3. Influence the direction and provide input to IHN CCO for the 5 year CCO application Timeline: Due Dates: Action to be Completed: 12/11/2017 Receive Blank Scope of Work (SOW) for Workgroup scope and goals. 04/06/2018 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers October 1, 2017 through March 31, 2018) 10/05/2018 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers April 1, 2018 through September 30, 2018) 04/05/2019 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers October 1, 2018 through March 31, 2019) 10/04/2019 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers April 1, 2019 through September 30, 2019) Any Additional Information: Reading List or Resource List: PREPARE Tool ACE Q (CYW) 15 of 35
Traditional Health Workers (THW) Scope of Work Document Workgroup purpose: Advance the development of THWs in the transformation of healthcare to advance the Triple Aim. Workgroup Chair/Chairs: Name: Organization: Phone Email: Number: Kelly Volkmann (Chair) Benton County Health Services 541 766 6839 Kelly.volkmann@co.benton.or.us Renee Smith (Co Chair) Family Tree Relief Nursery 541 979 6580 rsmith@familytreern.org Meeting Frequency: Monthly The second Wednesday of the month, 2:30 4:00 at the new IHN CCO building Short Term Goals: 1. If funded, implement the THW training center in the Linn Benton area that will serve the mid Willamette area. 2. Work with the Health Disparity Subcommittee on an ongoing quarterly basis to align goals and strategies. Long Term Goals: 1. Improve the THW delivery system, allowing THWs to better support and educate members in navigating the healthcare system and ensure appropriate, timely care. Timeline: Due Dates: Action to be Completed: 2/13/2017 Receive Blank Scope of Work (S.O.W.) for Workgroup scope and goals. 3/30/2017 Submit completed S.O.W. document to Transformation@samhealth.org for DST review. 4/7/2017 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers October 1, 2016 through March 31, 2017 time period) 10/6/2017 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers April 1, 2017 through September 30, 2017 time period) 4/6/2018 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers October 1, 2017 through March 31, 2018 time period) 10/5/2018 Semi Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers April 1, 2018 through September 30, 2018 time period) Any Additional Information: The THW Subcommittee is waiting to hear if their proposal to to create a CHW Training Hub in Benton County to train and supervise CHWs and Health Navigators (HNs) for primary care and community agencies in the IHN CCO region of Linn, Benton, and Lincoln counties has been accepted. This will determine the direction of the work of the committee for the year to come. 16 of 35
Universal Care Coordination (UCC) Scope of Work Document Workgroup purpose: Convene and align community around a common referral process that can be electronically captured and made available to the Primary Care Physicians at the time of service to capture Social Determinants of Health in an electronic form, have a common assessment form for all programs that have assessments, and reduce duplication of services along with helping members navigate the healthcare system (and potentially other systems). Goals of the Universal Care Coordination Summit: Collaborate to identify common practices and strategies for community partners and Patient-Care Primary Care Homes to improve care coordination. Determine next steps to improve care coordination in our community. Form a workgroup of committed individuals to advance care coordination practices in our community. Workgroup Chairs: Name: Organization: Phone Email: Number: Tanya Grant Samaritan Health 541-768-5900 tgrant@samhealth.org Services Kelly Hower The Corvallis Clinic Kelly.Hower@corvallis-clinic.com Meeting Frequency: 3 rd Friday a month from 10:00-11:30 am Short Term Goals: Have a resource for services Develop common language across regional healthcare systems and community services Long Term Goals: 1. 2. Timeline: Due Dates: Action to be Completed: TBD Chairs receive Blank Scope of Work (S.O.W.) for Workgroup scope and goals. TBD Submit completed S.O.W. document to Transformation@samhealth.org for DST review. 10/6/2017 Semi-Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers April 1, 2017 through September 30, 2017 time period) 4/6/2018 Semi-Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers October 1, 2017 through March 31, 2018 time period) 10/5/2018 Semi-Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers April 1, 2018 through September 30, 2018 time period) 17 of 35
Due Dates: Action to be Completed: 04/05/2019 Semi-Annual Progress Report due to Transformation@samhealth.org for DST review. (Report covers October 1, 2018 through March 31, 2019 time period) Any Additional Information: Reading List or Resource List: 18 of 35
SEXUAL ASSAULT NURSE EXAMINER August 2016 July 2017 IHN-CCO TRANSFORMATION PILOT SUMMARY Overview: With funding from InterCommunity Health Network Coordinated Care Organization (IHN- CCO), the Sexual Assault Nurse Examiner (SANE) pilot improved access to care for victims of person crimes or abuse, more than half of which are IHN-CCO members. Before implementation of SANE, those that experienced sexual assault reported to a hospital Emergency Department (ED) where they, more often than not, experienced long wait times (up to 48 hours in some cases); were sent outside the area for care (typically Salem or Eugene); or chose to forego medical care and evidence collection all together. The pilot developed pathways within the Samaritan Health Services (SHS) system through inperson education of SHS clinic and ED staff and physicians, reducing wait times for sexual-assault patients. Additional patient trauma due to lengthy wait times and/or care provided by untrained staff was also lessened. The ultimate goal is a reduction in mental and physical health impacts related to timely and specialized care provided following an assault. Key Outcomes: Reduced wait times for sexual assault patients Follow-up process created to ensure patients receive appropriate care Improved ED throughput by freeing up ED beds Educated the medical community and the community at large on sexual assault issues Continuance of the program through ongoing community and SHS support To learn more, visit www.ihntogether.org. 19 of 35
SEXUAL ASSAULT NURSE EXAMINER August 2016 July 2017 IHN-CCO TRANSFORMATION PILOT SUMMARY Next Steps: The SANE program continues out of Samaritan Albany General Hospital as Sarah s Place, serving Benton, Lincoln, and Linn Counties. For patient privacy, comfort, and security, Sarah s Place is located in its own area at Samaritan Albany General Hospital, away from the ED. Sarah s Place is open to patients twenty-four hours a day, seven days a week. Sarah s Place employs specialized nurses to provide immediate medical treatment to patients who have experienced sexual assault. Other resources include additional counseling, patient support, and transportation. Sarah s Place provides education to schools, faith-based organizations, medical facilities, and community events. Sarah s Place team members are active in community organizations that focus on prevention of sexual abuse, such as county sexual assault resource teams, multidisciplinary teams for child and elder abuse, the Oregon Sexual Assault Task Force, and prevention efforts at Oregon State University. Organizations around the state have reached out to Sarah s Place regarding program setup, sexual assault prevention, and community outreach. Sarah s Place is open 24/7, at Samaritan Albany General Hospital. Call 541-812-4220 or visit www.samhealth.org/sarahsplace for more information. To learn more, visit www.ihntogether.org. 20 of 35
IHN CCO DST Final Report and Evaluation Sexual Assault Nurse Examiner Summary: The aim of the proposed Sexual Assault Nurse Examiner (SANE) pilot is to improve access to care for victims of person crimes or abuse, more than half of which are IHN CCO members. Before implementation of SANE, those that have experienced sexual assault reported to a hospital Emergency Department (ED) where they more often than not, experienced long wait times (up to 48 hours in some cases), were sent outside the area for care (typically Salem or Eugene), or chose to forego medical care and evidence collection all together. The pilot develops pathways within the Samaritan Health Services system through in person education of Samaritan clinic and ED staff and physicians. This reduces wait times for sexual assault patients and mitigates additional patient trauma due to lengthy wait times and/or care provided by untrained staff. Ultimately, this will lead to a reduction in future mental and physical health impacts related to the care provided directly following an assault. A. Budget: Total amount of pilot funds used: $171,596 Please list and describe any additional funds used to support the pilot. We used all of the funds allotted for us in every category. Additional funding was provided by Samaritan for construction and equipment; approximately $250,000 to construct a space, and $130,000 to purchase furniture and equipment. Additional costs include day to day operational activities/staffing/supplies, which were funded by Samaritan. B. Provide a brief summary of the goals, measures, activities, and results and complete the grid below. Overall, this has been a success. The clinic has been well received in the community and partnerships have been formed with many community agencies including; CARDV, ABC House, OSU, Military One Source, 211, as well as most of the Linn and Benton School districts. In addition to outside organizations, we are frequently contacted by medical providers within the medical community for questions about resources or care for their patients. Samaritan Health Services remains committed to supporting this important work. We have been sought out by various organizations throughout the state for information of how to build a program in their community. Goal Measure(s) Activities Final Results Develop pathways within the Samaritan systems, through in person education of Samaritan clinic and ED staff and physicians Knowledge surveys Survey sent out to clinic and ED staff and physicians quarterly to gauge their familiarity with the SANE department and the referral process Survey response numbers were as follows: Q3 2016 had 47 responses; Q4 2016 had 38 responses; Q1 2017 had 18 responses; Q2 2017 had 10 responses. The percentage of respondents that were somewhat familiar with Sarah s Place has decreased from 50% to 20% this quarter, and the number of people who were extremely familiar rose from 27% to 34%. Reduce wait times for sexual assault patients SANE patient turnaround time Manual tracking by SANE coordinator Ongoing education with When the patient arrives during times that Sarah s Place is staffed the wait 21 of 35
IHN CCO DST Final Report and Evaluation Mitigate additional patient trauma due to lengthy wait times and/or care provided by untrained staff Increase the percentage of sexual assault patients that seek/receive follow up care Patient experience surveys The number of assault patients scheduled for follow up visits in the SANE department staff, CARDV, and law enforcement. SANE staff to place calls to 100% of patients following initial visit, at the following intervals: 24 48 hours 1 week 1 month CARDV collects patient feedback. Epic report We have started to see patients for follow up care as of July 26, 2017. time is 5 minutes. When staff is notified by another hospital of a patient being transferred the wait time is also 5 minutes. Median wait time after hours is down to 30 minutes from 40 minutes if staff has not been notified or if the patient selfpresents. This remains unchanged since last report. We continue to call patients following discharge. Many patients call us to ask questions, thanks us, and to discuss problems with follow up care. Most patients are not interested in talking to us at the 1 month mark. CARDV continues to give us positive feedback about our services and they have noted that patients tell them the time at Sarah s Place has been a positive one. The exam itself is still difficult but the surroundings and privacy are very much appreciated. We have seen very little change in the number of patients seeking follow up care with Samaritan Providers. We have scheduled two patients as of 8/4/17; both patients expressed gratitude that they did not have to tell their history to an additional provider. Improve throughput in Samaritan s EDs by sending sexual assault patients to Length of stay for assault patients in the ED Epic report During the month of July we saw 8 patients for acute sexual assault decreasing the time in an emergency 22 of 35
IHN CCO DST Final Report and Evaluation the SANE department and freeing up ED beds department by 32 hours. Approximately 45% of our patients had IHN, Medicare, or Medicaid as insurance. C. What were the most important outcomes of the pilot? I believe the most important outcome of our pilot was the education to both the medical community and the community at large. Sexual violence is occurring at epidemic proportions and we are all paying for it both emotionally and financially. D. How has the pilot contributed to Triple Aim of improving health; increasing quality, reliability, and availability of care; and lowering or containing the cost of care? Multiple studies have been done which show positive outcomes for patients when a SANE provides the exam both for the health outcome as well as for the criminal justice system. When patient receives patient centered care that is trauma informed we are able to give them information about their rights and alleviate some of their concerns, thus improving mental health as well as public health concerns. They receive the proper medications to prevent sexually transmitted infections, the spread of blood borne pathogens, and unwanted pregnancy. When those fears are decreased it helps to lower their fears and anxiety allowing the patient to focus on getting better, in this case lowering their chance of acquiring PTSD. With Sarah s Place available 24 hours a day, frees up a tremendous amount of bed space in the various EDs which increases the ability for the ED to see more patients. It also saves the amount of time the staff previously spent looking for a facility that was able to provide this specialized care which increases patient satisfaction for the ED and for the sexual assault patient. E. What has been most successful? All patients have access to a SANE nurse. For the reasons stated above, the health care out comes have improved. Also, Samaritan Health Services is in compliance with the laws of the state. F. Were there barriers to success? How were they addressed? Distance from the Coast hospitals and the patients from there not wanting to travel to the Valley. Despite contracts being set up to provide free transportation, the patients are not willing to come this far. We continue to be a resource by phone for the nursing and medical staff at both Coastal hospitals, but it does not solve the need to help patients have local access. We continue to try to problem solve this issue. Patients continue to not follow up with their provider. This is potentially a public health risk and we continue to work on ways to encourage patients to seek this important step in their health care. We are working with the Infectious Disease doctors who are doing a study to determine why patients started on HIV Prophylaxis are not following up with them. This will hopefully give us more information how we can help patients. G. How readily would the pilot be scalable or replicable? Describe cautions and considerations when considering scaling, or replicating the Pilot. (i.e. Success dependent on personality/skills set, or activities appropriate under certain conditions like size, target population, etc.) This pilot could easily be replicable and we have had other communities ask how they can do the same. Unfortunately Oregon has a large population insured by IHN and because we are the number 2 state in the nation for sexual violence and rape, every community needs this service. But to build it a firm commitment must be in place by the company. 23 of 35
IHN CCO DST Final Report and Evaluation H. Will the activities and their impact continue? If so, how? If not, why? Definitely! We will continue to provide community education as well as working with the schools to teach everyone about this wonderful resource. One of the ways to prevent this horrific crime is to talk about it. As people become more aware of our services it provides an opportunity to talk amongst ourselves as employees and as citizens and with our families. 24 of 35
In compliance with the Americans with Disabilities Act, this document can be made available in alternate formats such as large print, Web-based communications, and other electronic formats. To request an alternate format, please send an e-mail to Transformation@samhealth.org. InterCommunity Health Network Coordinated Care Organization Issues the Following Request for Pilot Proposals Date of Issuance: April 9, 2018 Letter of Intent Due Date: Proposal Due Date: May 28, 2018 at 5:00 pm July 30, 2018 at 5:00 pm via electronic submission to: Transformation@samhealth.org Issuing Office: Point of Contact: Transformation Department, IHN-CCO Transformation Department IHN-CCO 2300 NW Walnut Blvd Corvallis, OR 97330 Transformation@samhealth.org 25 of 35
TABLE OF CONTENTS REQUEST FOR PROPOSALS... 3 Purpose... 3 REQUIRED LETTER OF INTENT... 3 TIMELINE... 6 PILOT REQUIREMENTS, PROPOSAL REVIEW, AND EVALUATION CONSIDERATIONS... 4 Health Equity... 5 Social Determinants of Health... 5 Additional Evaluation Considerations... 5 BUDGET... 6 Funds Cannot be Used to Support the Following... 6 TECHNICAL ASSISTANCE... 7 PILOT PROPOSAL PRESENTATIONS... 7 PILOT CONTRACTING PERIOD... 7 DST MEETING PARTICIPATION... 7 REQUIREMENTS OF THE PILOT PROJECT... 7 Progress Reporting... 7 Invoicing and Activity Reporting... 7 DST Presentations... 7 Workgroup Participation... 8 PILOT PROPOSAL DETAILS... 8 26 of 35
InterCommunity Health Network Coordinated Care Organization (IHN-CCO) is committed to improving the health of our communities by building on current resources and partnerships within the tri-county region to support transformation of the delivery system. IHN-CCO and community partners, through the Delivery System Transformation (DST) Committee, welcome innovative ideas and collaborative strategies to ensure all individuals have equal opportunities to be healthy where they live, work, learn, and play. IHN-CCO is committed to improving the health of our communities through the Triple Aim of better health, better care, and lower cost. REQUEST FOR PROPOSALS IHN-CCO and the Delivery System Transformation (DST) Committee of the Regional Planning Council invite interested providers and agencies in Benton, Lincoln, and Linn counties who positively impact the health outcomes of IHN-CCO members to submit pilot proposals that transform the healthcare delivery system. Transformation is defined as keeping the Patient-Centered Primary Care Home (PCPCH) at the center of healthcare delivery, but includes creating different relationships, community connections, and linkages outside of the traditional health services setting. Transformation pilots should include upstream health and be willing to risk trying something different. Even failed projects provide a learning opportunity. Transformation is constantly changing and is not static, has elements of innovation, but is broader and involves system change. Purpose Promote and strengthen partnerships and create new linkages that support transformation of the healthcare delivery system in the tri-county region through collaborative workgroups and pilots Expand and integrate collaborative partnerships that are aligned with CCO goals and the Triple Aim Promote, foster, support, share innovation, and expand the model of the Patient-Centered Primary Care Home as the foundation of the CCO s transformation of health care delivery REQUIRED LETTER OF INTENT A non-binding Letter of Intent (LOI) is required to be considered for funding. Please submit the LOI form to Transformation@samhealth.org no later than May 28, 2018 at 5:00 pm. The Letter of Intent form can be found at www.ihntogether.org/transforming-health-care/request-for-pilotproposals or by emailing Transformation@samhealth.org. 27 of 35
PILOT REQUIREMENTS, PROPOSAL REVIEW, AND EVALUATION CONSIDERATIONS The DST is interested in testing new and innovative methods of transforming the healthcare system through pilot projects. The components below are a combination of the Transformation and Quality Strategy Components and Eight Elements of Transformation as defined by the Oregon Health Authority (OHA), the Community Health Improvement Plan (CHIP) Health Impact Areas, and CCO Incentive Metrics. Pilots must address at least one of these areas as well as incorporate health equity and social determinants of health. Access to Healthcare: o An example is meeting a gap for pain treatment with a new and innovative strategy o CCO Incentive Metric: Improving access to care: Got care right away for an illness, injury, or condition and/or got an appointment for routine care as soon as needed Behavioral Health: o Severe and Persistent Mental Illness (SPMI): Improve adult SPMI services through treatment plan and designated primary coordinator of services CCO Incentive Metric: Decreased emergency department (ED) utilization among members with SPMI o Stress and Anxiety Child Health: o CCO Incentive Metrics: Improved rates of weight assessment and counseling in children and adolescents Improved developmental screening rates Assessments for children in Department of Health Services (DHS) custody Childhood immunization status: Increased number of members that had all of the recommended vaccinations Chronic Disease Prevention and Management: o Social Determinants of Health o CCO Incentive Metrics: Improved rates of weight assessment and counseling in children and adolescents Decreased cigarette smoking prevalence CLAS (Culturally and Linguistically Appropriate Services) Standards and Provider Network: Diverse workforce responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs CCO Incentive Metric: Decreased ED utilization for all IHN-CCO members Health Equity: Identify and address inequities in services, policies, practices, and procedures to eliminate racial, ethnic, and linguistic health disparities o Data (with local public health and diverse community, to include race, ethnicity, and language) o Cultural Competency (care compatible with cultural/linguistic needs; to include access to services for aged, blind, disabled, complex medical needs, high health needs) Health Information Technology o Health Information Exchange (among network providers) o Analytics (provider performance, effectiveness, and cost efficiency of treatment) o Patient Engagement (electronic interaction, engagement in improving health, and patient portals) Integration of Care (physical, behavioral, and oral health care) Maternal Health o Timeliness of prenatal care: Improved rate of women receiving prenatal care in the first trimester 28 of 35
Patient-Centered Primary Care Home (PCPCH): Whole-person care addressing patient s/family s physical and behavioral healthcare needs Provider Supports Social Determinants of Health (SDoH): Address SDoH between the healthcare system and the community Special Health Care Needs (SHCN): Access to integrated and coordinated care for members with intensive care coordination needs Value-based Payment Models: Increase payment models that align payment with health outcomes Health Equity Identify how your pilot project will promote health equity and reduce health disparities. Include how health equity data will be tracked for IHN-CCO members served during the pilot project timeframe. Possible tracking categories include; age, race/ethnicity, disability status, mental health status, language, gender identification, rural or urban, housing status, household income, employment status, education level, food security status, and more. Health Equity means that everyone has a fair and just opportunity to be as healthy as possible. Health Equity broadens the disparities concept by asking, Why are some populations at greater risk of illnesses and preventable deaths than others? This question leads to a deeper analysis and exploration of the causative factors that contribute to disparities. Health equity is achieved when every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Social Determinants of Health Pilot proposals should describe how they will incorporate a Social Determinants of Health (SDoH) lens in their pilot project. SDoH are the conditions in which people are born, grow, live, work and age per the World Health Organization (WHO). These conditions include housing, food, employment, education, and many more. SDoH can impact health outcomes in many ways, including determining access and quality of medical care. Additional Evaluation Considerations In the process of selecting pilot projects for funding, the DST will give priority to proposals that meet the following criteria and qualities (criteria listed are also reflected in the pilot proposal scorecard): Create opportunities for innovation and new learning for the DST Yield measurable outcomes that are new or different from previously funded pilot projects Establish new connections within and between the healthcare delivery system and the community Plan to sustain and continue project after DST funding ends Exhibit consideration of alternative funding sources Clearly articulate what part of the Medicaid population is affected and how Target areas of healthcare associated with escalating healthcare costs Develop and validate strategies for collaboration and creating interconnections between community services and healthcare systems Demonstrate clear linkage to the Patient-Centered Primary Care Home 29 of 35
TIMELINE Activity Expected Date(s) Request for Proposal (RFP) Announcement April 9, 2018 Question and Answer (Q&A) Sessions April 26, 2018 and May 10, 2018 Letter of Intent (LOI) Due Required May 28, 2018 by 5:00 pm Invitations Issued to Submit Full Pilot Proposal By June 18, 2018 Technical Assistance Meeting Required June 25, 2018 to July 27, 2018 Pilot Proposal Due July 30, 2018 by 5:00 pm Pilot Presentations to the DST Committee August 9, 2018 and August 23, 2018 DST Committee Decisions September 6, 2018 Pilot Proposers Notified of DST Decision By September 10, 2018 Regional Planning Council Funding Decisions By September 21, 2018 Proposers Notified of Pilot Denial or Approval By September 24, 2018 Transformation Department Creates Pilot Contracts By November 1, 2018 Pilot Contracts Finalized By November 30, 2018 Pilot Invoicing/Payments Begin January 1, 2019 Although we do our best to adhere to this timeline, it is subject to change as circumstances occur. BUDGET Transformation of the healthcare delivery system is process driven by outcomes. Pilot budgets should be written in terms of outcomes not positions. Cost Allocation or Indirect Rate: Indirect cost may not exceed 15% of the Total Direct Costs. Expenses, such as equipment and/or supplies, should not be included in the Indirect Expenses category but should be itemized in the other budget categories. IHN-CCO reserves the right to request additional detail on cost allocation or indirect rates. Funds Cannot be Used to Support the Following Construction or renovation Equipment costs in excess of $20,000 Vehicle purchases Work for which results and impact cannot be measured Current organizational expenses 30 of 35