How do CCOs work Where are we in the transformation process How it will affect you and your clients How can you play a role LEGACY HEALTH Why Transform Why Now Fragmented siloed systems ID: 626959
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Slide1
Coordinated Care Organizations
How do CCOs work?
Where are we in the transformation process?
How it will affect you and your clients?
How can you play a role?Slide2
LEGACY HEALTHSlide3
Why Transform? Why Now?
Fragmented,
siloed
systems
Unsustainable health care costs
Not great health outcomes
State budget woesSlide4
System Challenges:
Influence Factors on Health Status
Social 15%
Environmental 5%
Human Biology 30%
Lifestyle & Behavior 40%
Medical Care 10%
Source: McGinnis J.M., Williams-Russo, P.,
Knickman
, J.R. (2002).
Health Affairs, 21(2), 83Slide5
Eight year old, Malik, lives with asthma.
Thanks to a Coordinated Care pilot project and his Community Health Worker,
Malik learned how to manage his asthma daily. Now he spends more time playing with his friends and less time in the hospital.Slide6
Vision of CCO Implementation
[The Triple Aim]
[A CCO]Slide7
“I think you should be more explicit here in Step two.”Slide8
… And dentistsSlide9
[Insane] CCO Development Timeline
July ‘11
January ‘12
March ‘12
April ‘12
May/Jun ‘12
July ‘12
August ‘12
Nov ‘12
Jan ‘13
Feb ’13
January ’14
HB 3650 signed into lawOHPB’s Implementation Plan published, SB 1580 signed into lawCCO Letters of Intent submitted, RFA published
Application for CCO Certification dueReadiness ReviewExecute CCO Contract with OHA- Go Live!FFS enrolled into CCOsTransformation Plan draft due
Transformation Plan implementation beginsMedicaid population expansionSlide10
Key Components of CCO Development
Geographic/Demographic Scope
Business & Operations
Information Systems
Utilization Management
Administration
Claims Processing
Customer Relations
Workforce Development
Local Governance
Board of Directors
Community Advisory CouncilClinical Advisory Panel
Model of CarePhysical, mental, oral health integrationSocial service networking/integrationDelivery system transformationKeeping people healthyFinancing
Global BudgetCapitalizationRiskRevenueAlternative Payment MethodologiesSlide11
Why would Oregon’s health systems agree to do all this (just for Medicaid)?
~18% of Oregonians are enrolled in Medicaid today
Will jump to 25% after ACA Medicaid expansion in 2014
The Governor is working to fold all publicly funded health coverage into the CCO model
PEBB & OEBB
If that happened, ~40% of Oregonians would have care paid for and coordinated through CCOs
$1.9 Billion in federal investment
accounts for 19% of the state’s Medicaid budget this bienniumSlide12
Community Advisory Council
M
ajority consumers
CAC member sits on Governing Board
Duties include:
Community Needs
Assesment
Community Health Improvement Plan
We are looking for community members NOW!
Contact your local CCO to join or attend meetings.Slide13
What does Transformation look like?
The fundamental questions for stakeholders:
Can we do more with less?
Can we do more of what works?
Can we let go of what doesn’t?
How do we together foster communities that support the best possible lives for everyone in Oregon?Slide14
Thank you!
Rose
Englert
Sr. Manager, Regulatory AffairsCareOregon
14Slide15
15
List of CCO Maps and Governing Boards:
http
://
www.oregon.gov/oha/OHPB/Pages/health-reform/certification/index.aspxSlide16
CareOregon Affiliated CCOs
Health Share of Oregon
Columbia Pacific CCO
Jackson Care Connect
Yamhill County Care Organization
PrimaryHealth
of Josephine CountySlide17
What Does It Take To Be A CCO?
Corporate Structure/Governance
Community Advisory Council
Coordinate physical, behavioral, & oral health
Experience managing financial risk
Minimum financial reserves
Primary care medical homes
HIT strategy
Written agreements with counties, public health & Area Agency on AgingSlide18
CCO Possibilities
Ability to reduce preventable conditions
Widespread use of primary care health homes
Improved outcomes due to enhanced care coordination and care delivered in most appropriate setting
Reducing errors and waste
Innovative payment strategies
Use of best practices and centers of excellence
Single point of accountability for achieving results
18Slide19
Minimum Standards to Evaluate CCO Transformation
Integration, Primary Care, Payments
Implement a health care delivery model that
integrates
mental health and physical health care and addictions
.
Implement
Patient-Centered Primary Care
Homes
.
Implement consistent
alternative payment methodologies
that align payment with health outcomes
.Slide20
Minimum Standards to Evaluate CCO Transformation
Assessments, Improvement, & IT
Prepare a strategy for developing a Community Health Assessment and adopt an annual
Community Heath Improvement Plan
.
Develop a plan for encouraging electronic health records;
health information exchange
; and meaningful use.Slide21
Assure communications, outreach,
Member engagement
, and services are tailored to cultural, health literacy and linguistic needs.
Assure that the
culturally diverse
needs of Members are met; provider and
new health care workers
reflect member diversity.
Develop a
quality improvement plan
focused on eliminating disparities in access, quality of care, experience of care, and outcomes.
Minimum Standards to Evaluate CCO Transformation
Reflecting Diversity, Addressing Disparities