2019 CCO Transformation and Quality Strategy: Social Determinants of Health January 23, 2018 Presented by: Sara Beaudrault, Policy Analyst Amanda Peden, Transformation Analyst
Webinar Agenda 1. Provide overview of TQS purpose and deliverables 2. Define social determinants of health and social determinants of health equity 3. Provide examples of social determinants of health interventions 4. Q&A 2
Why we do this work… 3
TQS foundational principles TQS is a means for CCOs to report health transformation and quality work. The work is determined, developed and implemented by the CCOs with the direction from the CACs, community, and CCO leadership. OHA’s role is monitoring, spreading best practices and providing technical assistance for implementation with community and state subject matter experts. The Oregon Health Authority recognizes that the programs and projects included in the CCO Transformation and Quality Strategy submissions are a showcase of current CCO work addressing TQS components that aim to make significant movement in health system transformation. Additionally, OHA recognizes that the work highlighted in the TQS is not a comprehensive catalogue or full representation of the CCO’s body of work addressing each component. CCOs are understood to be continuing other work that ensures the CCO is meeting all OARs, CFRs, and CCO contract requirements. The template addresses three key principles: 1. Meets CFR, OAR, 1115 waiver and CCO contractual requirements 2. Pushes health transformation through alignment with quality and innovation 3. Decrease administrative burden • Supports OHA’s use of information to monitor CCOs’ progress to benchmarks. • Incorporates narrative style and specific/measurement methods. • Combines two annual deliverables from prior years 2012-2017. 4
Deliverables schedule • TQS due annually on March 16 (effective January – December) or closest business day. • TQS progress report due on September 30 (progress for January – June) or closest business day. 5
Components and subcomponents 1. Access 5. Health Information Technology – – Access: Availability of Services Health Information Exchange – – Access: Cultural Considerations Analytics – – Access: Quality and Patient Engagement Appropriateness of Care 6. Integration of Care Furnished to all Members 7. Patient-Centered Primary Care – Access: Second Opinions Home – Access: Timely 8. Severe and Persistent Mental 2. CLAS Standards and Provider Illness Network 9. Social Determinants of Health 3. Grievances and Appeals System 10.Special Health Care Needs 4. Health Equity and Data 11.Utilization Review – Data 12.Value-based Payment Models – Cultural Competence 6
2019 TQS TA and Documents • All technical assistance and guidance documents are on the OHA Transformation Center website: www.oregon.gov/oha/HPA/dsi- tc/Pages/Transformation-Quality-Strategy-Tech-Assist.aspx – Template – Guidance document – Health Equity Lens Guidance document – FAQ – Sample TQS – Webinar recordings 7
2019 TQS Guidance Document 8
What are the social determinants of health (SDOH)? Oregon’s Medicaid Advisory Committee defined SDOH and the underlying social determinants of health inequities: • Social determinants of health: The social, economic, political, and environmental conditions in which people are born, grow, work, live, and age. These conditions significantly impact length and quality of life and contribute to health inequities. • Social determinants of health equity: Systemic or structural factors that shape the unfair distribution of the social determinants of health in communities. These structural factors are evident in social norms, policies, and political systems, both historical and current. Institutionalized racism is one example. Looking for examples? See next slide… 9
SDOH Graphic - Medicaid Advisory Committee May 2018 SOCIAL DETERMINANTS OF sexism racism HEALTH EQUITY ▪ Access to healthy foods/protection from food ▪ “swamps” Poverty ▪ Employment ▪ Access to transportation (non-medical) ▪ Food insecurity ▪ Quality, availability, and affordability of housing ▪ ▪ Diaper insecurity Crime and violence (including domestic violence) ▪ ▪ Access to quality childcare Environmental conditions ▪ ▪ Housing instability, including Access to the outdoors/parks homelessness ▪ Access to banking/credit ▪ Access to health care ▪ Culturally and linguistically appropriate care ▪ Health literacy ▪ Social integration ▪ Early childhood ▪ Civic participation/community engagement education and ▪ Meaningful social role (e.g. meaningful work) development ▪ Discrimination (e.g. race, ethnicity, culture, ▪ Language and literacy gender, disability) ▪ High school graduation ▪ Citizenship/immigration status ▪ Enrollment in higher ▪ Corrections education ▪ Trauma (e.g. adverse childhood experiences) SOCIAL DETERMINANTS OF Homophobia & transphobia ableism ageism HEALTH EQUITY 10
Why Social Determinants of Health (SDOH) in the TQS? • Addressing SDOH is Factors that determine health outcomes* critical to health system transformation 20% • Oregon’s 2017 -2022 40% Medicaid 1115 waiver 30% SDOH prioritizes SDOH 10% • It aligns with CCO and Social & Economic Physical environment community priorities Healthy behaviors and existing initiatives Clinical care (quality and access) 11
Three tips for strong SDOH initiatives • Recognize the link between SDOH and health disparities • Identify and address member and community needs/priorities • Collaborate with community partners and follow their lead 12
2018 TQS areas of opportunity: Overall Overall: Background/rationale link to the program and/or project across components General OHA feedback: The background/rationale in the quality assessment was often missing an analysis of the CCO’s local community. Without that analysis and a demonstrated gap, it is difficult to show why a project or program would achieve the desired outcome. 13
2018 TQS areas of opportunity: Overall Overall: Explanation of how specific projects and/or programs will address identified gaps across components General OHA feedback: • Missing enough detail to help understand how a project will result in improvement. • For example, if the only activity is to collect data on members with SDOH needs, it is unclear how the activities will lead to improvements for the members. Similarly, if the only activity is to address SDOH needs of individual members, it is unclear exactly how that will make improvements to SDOH needs across the member population. 14
2018 TQS areas of opportunity: Social determinants of health Social Determinants of Health: Missed linkages to clearly demonstrate how specific projects addressed social determinants of health (SDOH). Examples of strong SDOH projects: Included a clear emphasis on addressing the needs of the CCOs’ greatest needs members. • CCO sits on the executive committee of a collective impact organization that works toward a trauma-informed community. Within this collaborative work, the CCO also implemented ACEs training efforts for CCO staff. • CCO partially funded Collaborative Learning for Educational Achievement and Resiliency (CLEAR) program implementation. CLEAR provides ongoing training of teachers and school staff to implement trauma-informed practices in schools. 15
2019 TQS Guidance Document and Sample TQS • TQS Guidance Document • Sample TQS for SDOH 16
More examples from CCOs • Veggie Rx: patients and families are screened for food insecurity and issued Veggie Rx vouchers which can be filled for whole fruits or vegetables at farmers markets and grocery – SDOH: Food Insecurity – Partners: food banks, food distributors, local public health authorities, community-based organizations, FQHCs, schools • Re-entry support: Housing supportive services, employment services, and other re-entry services for justice-involved individuals – SDOH: Corrections – Partners: community-based organizations, corrections, housing partners • ACES training: support of school-based training on ACEs and trauma-informed care – SDOH: Trauma – Partners: Community-based organizations, local government, schools 17
Resources • Oregon Medicaid Advisory Committee SDOH report and recommendations for CCOs: https://www.oregon.gov/oha/HPA/HP- MAC/Documents/MAC_AddressingSDOH_CCOmodel_Recommend ations_FINAL.pdf • Health Leads SDOH Roadmap: https://healthleadsusa.org/resource- library/roadmap/ • Social Interventions Research and Evaluation Network (SIREN) Evidence Library: http://sirenetwork.ucsf.edu/tools/evidence-library • Commonwealth Fund’s ROI Calculator for Addressing SDOH: http://tools.commonwealthfund.org/roi-calculator • Center for Health Care Strategies: Social Determinants of Health Resources and Projects 18
Q&A • Please type your questions and comments into the “Questions” box on your GoToWebinar control panel. • We will update our Frequently Asked Questions after each webinar in this series. 19
Recommend
More recommend
