Imagine Better health outcomes and quality of life for Oregonians, - - PowerPoint PPT Presentation
Appendix H Imagine Better health outcomes and quality of life for Oregonians, supported by: A sustainable model for Community Self Management Programs that promotes equity, access, quality, and cost savings through a flexible and evolving
Appendix H
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stay healthy, and live better with existing mental & physical conditions
settings
conditions
Oregon Tobacco Quit Line
Living Well, Tomando Control de Su Salud, Positive Self-Management
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*Ory MG, Ahn S, Jiang L, Smith ML, Ritter P, Whitelaw N & Lorig, K. (2013). Medical Care 51(11), 992-998.
Appendix H
interviews informed the Hub strategy
Business Plan.
refined the strategy, including desired services and partner characteristics.
look at how to most efficiently use community resources & align with health system transformation
sustainable statewide model that honors community needs and strengths.
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Appendix H
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– Flexible – Collaborative – Innovative
better care, lower costs
Appendix H
Patient Centered Patient Centered
Engage, activate and empower patients
Community Based Community Based
Promote clinical- community linkages
Statewide Access Statewide Access
Invest health care funding to expand access
Equity Equity
Provide culturally & linguistically proficient services
Triple Aim Triple Aim
Support better care and better health at lower cost
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Working Assumptions
Appendix H
Partnerships with Central Payment / Data System
management program partnerships assure:
assurance
shared core functions:
reporting
Hub Infrastructure
umbrella entity supports local self-management programs:
registration
stop shop” for payers:
provider network access
reporting
assurance
responsible for quality and access
payment agreements & processes
functions
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Appendix H
Core Functions
State (OHA) Statewide Entity Regional Partner- ship CCOs Local Self- Mgmt Providers Access, Equity and Quality Oversight
x x x
Program Content Licensing
x
Administrative/Infrastructure Funding
x
(seed funding)
x
(ongoing)
x
(ongoing)
Program Funding
x x x
Payer Contracting
x x
Provider Network Administration
x
(technical assistance)
x x
Program Marketing
x x x
Registration, Data Management and Payment Processing
x
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with Central Payment/Data System
Appendix H
Strengths
management
reforms for large non-OHP populations (PEBB/OEBB, commercial market) Weaknesses
established
Appendix H
Core Functions
State (OHA) Statewide Entity Regional Partner- ships CCOs Local Self- Mgmt Providers Access, Equity and Quality Oversight
x x x
Program Content Licensing
x
Administrative/Infrastructure Funding
x
(seed funding)
x
(ongoing)
Program Funding
x x x
Payer Contracting
x x
Provider Network Administration
x
(TA)
x
Program Marketing
x x
Registration, Data Management and Payment Processing
x
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Hub Infrastructure
Appendix H
Strengths
standardized payment process
public employees
public RFP Weaknesses
Coordinated Care Organizations
Appendix H
Core Functions
State (OHA) Statewide Entity Regional Entities CCOs Local Self- Mgmt Providers Access, Equity and Quality
x x
Program Content Licensing
x
Administrative/Infrastructure Funding
x
(seed funding)
x
(ongoing)
Program Funding
x x
Payer Contracting
x
Provider Network Administration
x
(TA)
x
Program Marketing
x x
Registration, Data Management and Payment Processing
x
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May be involved – varies by region
Appendix H
Strengths
Weaknesses
diminish as complexity increases
Appendix H
(possible additional funding through pending grant proposal)
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Strengths
management
system reforms for large non-OHP populations (PEBB/OEBB, commercial
market)
Weaknesses
still being established
priorities Appendix H
and ‘proof of concept’ for Partnership Model (#1)
business partnerships between CCO’s and other payers and self-management program providers
case and identify models for statewide development
third-party administrator for billing capacity & data management
regional self-management provider partnerships
CCO(s) are active participants, with special consideration for commercial and/or public payers involvement
requirements and assistance to support business development and connection to billing structure
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Appendix H
A regional partnership receives OHA funding A regional partnership receives OHA funding Partnership assesses local service and quality gaps, and plans a sustainable business model Partnership assesses local service and quality gaps, and plans a sustainable business model OHA provides technical assistance on infrastructure development, marketing and program delivery OHA provides technical assistance on infrastructure development, marketing and program delivery Partnership establishes working agreements; develops processes to assure quality, equity and access Partnership establishes working agreements; develops processes to assure quality, equity and access
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Appendix H
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Partnership Pilot
Proof of concept: generates models for broader implementation Prepares community self-mgmt. providers to collaborate and contract with payers Tests platform in collaboration with payers and community self-mgmt. providers Invests in building capacity, network and infrastructure Offers additional support for challenged areas Evolves the delivery system and payers to support self- management Prepares regions to better respond to community needs and
Appendix H
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November 2014
regional partnership & centralized system requests for proposals
March 2015
& grantees selected
development begins
June 2015
assessments complete
September 2015
place
live
Centralized Data & Billing System
Key actors: third-party administrator (contractor), statewide non-CCO payers
Regional Self-Management Partnership Pilot Grants
Key actors: Self-Management program delivery organizations, CCOs, local public health
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Essential - By September 2015:
create functional business relationships
meets current stakeholder needs for registration, payment processing and data collection
board (CCOs, PEBB & OEBB carriers)
Intermediate - By 2017:
completion rates
access
programs for Oregonians experiencing chronic disease disparities
program delivery capacity
Aspirational - By 2020:
sustainability for self- management program delivery organizations
available statewide
Triple Aim:
quality of life
chronic conditions
costs
Appendix H
Value Stream | Confidential
1 Receive services Referral source/ access point
services (contract with providers)
services
participants
Data System
processing for all but OHP
reporting on
services?
management services
marketing of program to participants Pay for programs delivered to employees & dependents
What do they do? Why would they participate?
Participant Self-management program delivery
Health systems Local public health Local primary care CCOs
(Regional)
Slim Hub
(3rd Party Statewide)
Payer Employer
(Large employer PEBB/OEBB) Regional Partnership
better/ get control
they should go
‒ Lower out of pocket ‒ Better quality
service delivery portfolio
paid to offer these services, reduce admin burden, increase financial sustainability
health systems see this as a valuable community service
their system
service offering
competitive advantage Admin fee on transactions (financial sustainability) Simplifies their ability to offer programs to constituents statewide
employees & dependents
Provide services Regional Partnership
care, better
health
know they work
their performance metrics
lowering cost for intermediate + long term strategy
OHA Key Questions
What would entice you to be actively engaged in self- management programs? Do you have the necessary infrastructure to bill and report services &
How could self- management programs assist you meet your benchmarks? What infrastructure would community self-management partners need to contract with you? What self- management programs would you be willing and wanting to pay for? Why? What self- management programs would you be willing and wanting to pay for? Why? What systems do you need to bill and report services & outcomes?
Appendix H
1
stay healthy, and live better with existing mental & physical conditions
settings
conditions
Oregon Tobacco Quit Line
Living Well, Tomando Control de Su Salud, Positive Self-Management
Appendix H