Population Health in Oregon s Health System Transformation Cara Biddlecom, MPH Health System Transformation Lead National Health Policy Forum December 11, 2015 PUBLIC HEALTH DIVISION Office of the State Public Health Director
Brief history 2009: House Bill 2009 Consolidated state health care purchasing into one agency Created the Oregon Health Policy Board 2010: Oregon s Action Plan for Health Population health included as a long-term goal 2011: House Bill 3650 Created the framework for Medicaid coordinated care organizations (CCOs) 2012: CCO start up Senate Bill 1580 approved the CCO Implementation Proposal 1115 Waiver was submitted and approved CCO procurement, certification and Medicaid member enrollment
Medicaid coordinated care organizations (CCOs) 16 CCOs serve over 90% of Medicaid members provide coordinated physical, mental and dental health care benefits to Medicaid members receive funds through a global budget that grows at a fixed rate are responsible for health outcomes and paid for performance on quality measures are required to develop agreements with local public health authorities Over 25% of Oregonians are enrolled in Medicaid
Oregon s Coordinated Care Model Integrated and Coordinated Care Global Budget with Fixed Rate of Growth Metrics (with Incentives) Flexibility Local Accountability & Governance
PUBLIC HEALTH DIVISION Office of the State Public Health Director
Incentive measures CCOs receive funds out of their quality pool (4% of aggregate payments made to all CCOs) based on their performance on quality measures Adolescent well visits Screening, Brief Intervention and Referral to Treatment (SBIRT) Colorectal cancer screening Effective contraceptive use among women who do not desire pregnancy Dental sealants Childhood immunization status Tobacco use prevalence
Community Advisory Councils Each CCO required to establish a Community Advisory Council Must consist of at least 51% consumer membership Seat for Community Advisory Council member on the CCO Board of Directors Responsible for overseeing the development of a community health assessment and community health improvement plan
Community health assessments and community health improvement plans Community health assessments and community health improvement plans are required of multiple stakeholders: Nonprofit hospitals CCOs State and local health departments per Public Health Accreditation Board standards and measures Partners utilize a collective impact model to improve population health
SIM Model Testing award 42-month, $45M award to spread elements Oregon s Coordinated Care Model and support health system transformation, April 2013-September 2016 ~$5M to the Public Health Division to: Enhance population health surveillance efforts (Medicaid BRFSS; BRFSS race/ethnic oversample; Oregon Healthy Teens survey/yrbs) Further develop and enhance a web-based public health assessment tool Support local public health authorities and CCOs to implement evidence-based population health practices
Local public health and CCO partnerships SIM-funded community prevention grant program Required participation from at least one CCO and at least one local public health authority Implement evidence-based strategies in both health system and community settings Align with CCO metrics, community health improvement plan priorities, etc. Framework for new funding opportunities Tobacco Master Settlement Agreement grants School-Based Health Center Innovation grants
Example: tobacco prevention Community interventions Tobacco retail license policies Tobacco-free social service organizations Health system interventions 5As training for primary care providers Referrals to the tobacco quit line Enhancement and promotion of evidencebased tobacco cessation benefits
Example: opiates Community interventions Distribution of naloxone rescue kits to people at risk of an opiate overdose Social marketing to influence patient expectations for pain management Health system interventions Standardized opiate prescribing guidelines for providers Access to Medication- Assisted Therapy for opiate addiction Coverage for alternative pain management therapies
Health system transformation 3.0: public health modernization What we re facing: Large disparity in level of county funding resulting in limited capacity in many areas Reliance on Federal categorical funding A focus on individual service delivery at the cost of providing community wide interventions 95% of Oregonians are now insured, but public health was built to provide a safety net for Oregonians who were previously uninsured 13
What this means for the future of public health in Oregon Better integration of governmental public health with a transforming health care system. Improved coordination and clarity of roles between local and state. Basic public health assurances in place for everyone in Oregon. Local flexibility in determining additional public health service. Improved sustainability for governmental public health services over time.
Questions? cara.m.biddlecom@state.or.us (971) 673-2284