Medicaid Advisory Committee July 27 th , 2016 Oregon State Library - - PowerPoint PPT Presentation

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Medicaid Advisory Committee July 27 th , 2016 Oregon State Library - - PowerPoint PPT Presentation

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Medicaid Advisory Committee July 27 th , 2016 Oregon State Library Salem, Oregon 1 Time Item Presenter 9:00 Opening remarks Co-Chairs MAC membership 9:05 Co-Chairs Co-Chair transition Alyssa Franzen, MAC, Matt Sinnott, 9:10

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Medicaid Advisory Committee

July 27th, 2016

Oregon State Library Salem, Oregon

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Time Item Presenter 9:00 Opening remarks Co-Chairs 9:05 MAC membership  Co-Chair transition Co-Chairs 9:10 Oral Health Work Group presentation and discussion Alyssa Franzen, MAC, Matt Sinnott, Willamette Dental Group 9:45 Public Health Modernization Cara Biddlecom, OHA 10:15 Break 10:25 CCO Metrics 2015 Performance Report Sarah Bartelmann, OHA 10:55 General Assistance Program update Erika Miller, DHS 11:10 OHA access monitoring  Presentation  Feedback Jamal Furqan, OHA 11:45 Public Comment – FFS Access Monitoring Plan and General 11:55 Closing comments Co-Chairs

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Oral Health Work Group: Progress-to-Date

Alyssa Franzen, Care Oregon, MAC Liaison Matt Sinnott, Willamette Dental Group, Oral Health Work Group Co-chair

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Oral Health Work Group Meeting #1 July 7, 2016

Meeting goals:

  • 1. Introduce charge and

goals for the work (see Guiding Document)

  • 2. Develop a

comprehensive list of barriers to oral health access

  • 3. Identify key elements
  • f an oral health care

access framework

Desired products:

  • 1. Draft oral health care

access definition

  • 2. Draft oral health care

access framework model

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Goal #2: barriers to oral health care access in OHP

We asked: What barriers do you know or imagine that may prevent Oregon Health Plan (OHP) members from accessing oral health services in OHP? Consider barriers from perspectives such as: consumer/family perspective, provider, and health care

  • rganization/delivery
  • More than 50 barriers brainstormed
  • Areas covered included:

– Providers – supply, distribution, administrative barriers (e.g. credentialing process) – Enrollee/patient – knowledge/oral health literacy, attitudes (fear), cultural – Utilization – missed appointments, sites of care, patient experience of getting care – Structural/population health – state policy, disease burden in population

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Key elements starting point: MACPAC Framework for Health Care Access in Medicaid

Medicaid and CHIP Payment and Access Commission (MACPAC). (2011). Report to the Congress on Medicaid and CHIP, Chapter 4: Examining Access to Care in Medicaid and CHIP. Available at: https://www.macpac.gov/wp- content/uploads/2015/01/Examining_Access_to_Care_in_Medicaid_and_CHIP.pdf

Main access elements Evaluating/ measuring access

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Goal #3: key elements of oral health care access framework

  • Small group categorization activity: how do barriers reveal

key elements of oral health care access?

  • Many barriers can be categorized under multiple elements

– For example, availability of transportation/child care can be seen as a barrier for individual enrollees, a factor in relative availability of services, and a factor in utilization of services

  • MACPAC framework doesn’t have everything we need
  • Group identified new elements to encompass structural,

systems of care, and population health barriers

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  • 1. Brainstorm

barriers

  • 2. Identify key

elements & categorize barriers

Work Group Co-chairs & Staff

  • 1. Compile

discussion

  • 2. Develop

draft products: definitions & model framework Review draft products & provide feedback (July 27) Finalize definition & framework model (August 11)

Work Group MAC

Process: developing the products

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  • Provider supply and distribution
  • Provider characteristics
  • Provider participation in Medicaid
  • Provider administrative factors

(e.g. credentialing)

  • Oral health integration/care

coordination

  • Availability of transportation/child

care

  • Visits/missed appointments
  • Sites of care
  • Patient-centered care
  • System navigation and patient

experience

  • Affordability of services

(coverage/benefits)

Access

  • Oral health
  • utcomes
  • Equity

Oral Health Care Access Framework DRAFT

  • Coverage
  • Policy system issues

Structural/ Systems of Care Enrollees

  • Oral health/system

navigation literacy

  • Complex and high oral health

care needs

  • Attitudes/perception
  • Cultural background/equity
  • Lower incomes/assets

(cost/fear of cost)

  • Population health/disease

burden

  • Social determinants of health

Population Personal/ Environmental Factors Potential/Realized Access Factors

Availability (Potential)

Utilization (Realized)

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Option 1: Oral health care access in the Oregon Health Plan is the availability, affordability, member awareness, and timely use of quality oral health services, integrated within a plan for patient-centered overall care at appropriate sites and from qualified providers (including specialists) who meet the needs of individual patients, including oral disease preventive services at regular intervals and treatment services when needed, to reduce disparities and achieve the best possible health outcomes. Option 2 (short version): Oral health care access in the Oregon Health Plan happens when members are aware of, seek, and successfully and equitably receive timely and quality oral health preventive services and needed treatment at appropriate sites and from providers who meet their needs, integrated into a plan for their overall health, in order to produce the best possible health

  • utcomes.

Proposed definitions of oral health care access in the Oregon Health Plan

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Next Steps

Timing

MAC provide feedback on draft definitions and draft oral health access framework model Today MAC establish guidelines for Oral Health Work Group indicator prioritization and measure selection Today Work Group review and finalize recommended definition and framework model, incorporating MAC feedback August 11 Work Group identify priority indicators of access and recommend measures, according to MAC guidelines August 11 Work Group discuss and finalize recommendations to MAC September 20 MAC discuss and finalize memo to OHA regarding a framework for access to oral health care in OHP September 28

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MAC feedback on draft products

  • Does the model framework for oral health care

access in OHP encompass every element/factor committee members feel should be included? Are there additional considerations committee members would like to raise?

  • Is there anything missing from the oral health access

definitions? Which definition does the committee prefer? Any other feedback on these?

  • Other feedback on the progress to date?
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Draft guidelines for Oral Health Work Group access indicator selection

  • Indicator prioritization: Prioritize top five indicators for each

framework element: Draft considerations for prioritization/selection:

(1) Consistency with recommendations of stakeholder groups (e.g. Dental Quality Metrics Work Group, CCO Oregon Dental Work Group) (2) Support of Triple Aim: importance of care coordination as a critical component of oral health care access (3) Health equity and access for vulnerable and underserved populations within OHP

Access (oral health

  • utcomes,

equity)

Availability (Potential) Utilization (Realized)

1 2 3

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PUBLIC HEALTH DIVISION Office of the State Public Health Director

Public Health Modernization

Medicaid Advisory Committee July 28, 2016 healthoregon.org/modernization

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Public health modernization will ensure basic public protections critical to the health

  • f all in Oregon and future generations –

including clean air, safe food and water, health promotion and prevention of diseases, and responding to new health threats.

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What will be different?

Before modernization

  • Significant gaps in public

health capacity provided based on where you live

  • Programs hindered by

limited and inflexible funding

  • Public health system

designed to provide individual level services

After modernization

  • Foundational level of

service provided for everyone

  • Programs supported by

diverse funding sources that allow local needs to be met

  • Public health is

accountable for the health

  • f the community

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A foundation for achieving the Triple Aim

Oregon’s Action Plan for Health, 2010

“We need a health system that integrates public health, health care and community-level health improvement efforts to achieve a high standard of

  • verall health for all Oregonians,

regardless of income, race, ethnicity or geographic location. To achieve this, we must stimulate innovation and integration among public health, health systems and communities to increase coordination and reduce duplication.”

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Public Health Modernization Framework

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House Bill 3100 (2015)

  • Legislators used the recommendations from the

Modernizing Oregon’s Public Health System report to introduce House Bill 3100.

  • House Bill 3100:

– Adopted the foundational capabilities and programs for governmental public health. – Changed the composition and role of the Public Health Advisory Board on January 1, 2016. – Required an assessment of how foundational capabilities and programs are provided and what additional resources are needed.

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Public health modernization assessment: purpose

  • Answer two key questions:

– To what extent are the foundational programs and capabilities of public health modernization being provided today? – What resources are needed to fully implement the foundational programs and capabilities?

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Programmatic gaps in current governmental public health system

PHD LPHAs

Extra-Large Large Medium Small Extra-Small P-CDC P-EPH P-PHP P-CPS C-AEP C-EPR C-COM C-PAP C-HEC C-CPD C-LOC

Significant Implementation Partial Implementation Limited Implementation Minimal Implementation

  • These results, when viewed collectively for all

foundational programs and capabilities, show that implementation is uneven across the system.

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Programmatic gaps in current governmental public health system

  • This assessment provides detailed information about

programmatic gaps for all 11 foundational programs and capabilities:

– E.g., environmental health:

Environmental Public Health

19% 71% 9% 0% 3% 43% 36% 19% Conduct Mandated Inspections 73% 26% 1% 0% Promote Land Use Planning 38% 32% 29% 2% Identify and Prevent Environmental Health Hazards 19% 71% 9% 3% 73% 38% 43% 26% 32% 36% 1% 29% 19% 2%

Limited Implementation Minimal Limited Partial Significant

POPULATION BY LEVEL OF SERVICE State Activities Local Activities

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Full implementation cost findings

Preliminary annual additional increment of cost of full implementation of foundational programs and capabilities: $105M Annual current spending on foundational programs and capabilities: $209M

This is a preliminary point-in-time, planning-level estimate for implementation under the current governmental public health system and does not represent the final cost needed to fully implement public health modernization. This cost estimate will be revised over time as efficiencies in public health system are implemented.

$1M in current spending $1M in additional increment of cost of full implementation

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Criteria for selecting priorities

The Public Health Advisory Board used the public health modernization and the following criteria to identify priorities for public health modernization for the 2017-19 biennium:

  • 1. Health impact
  • 2. Service dependency
  • 3. Equity
  • 4. Population coverage
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Recommended priorities for 2017-19

  • Communicable diseases
  • Environmental health
  • Emergency preparedness
  • Health equity
  • Population health data
  • Public health modernization planning
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Public Health Modernization Framework

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Implementation efforts

Local public health authority funding formula: HB 3100 requires a formula for the equitable distribution of funds. Initial formula includes the following variables:

  • Population size
  • Disease burden
  • Health status
  • Racial and ethnic diversity
  • Poverty
  • Limited English Proficiency

The funding formula also includes matching funds for local investment and a quality pool.

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Implementation efforts

Accountability metrics: HB 3100 requires the use of incentives to encourage effective provision of public health services. To the extent feasible, the final public health quality measure set will align with the work of:

  • Statewide public health initiatives (e.g., Oregon’s State

Health Improvement Plan)

  • National public health initiatives (e.g., CDC’s Winnable

Battles)

  • Coordinated care organizations
  • Early learning hubs
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Implementation efforts

Regional public health modernization meetings: Using funding from the Robert Wood Johnson Foundation, regional public health modernization planning meetings will be convened from September 2016-January 2017. The purpose of these meetings is to:

  • Engage elected officials, CCOs, early learning hubs,

community-based organizations and other stakeholders in moving forward a new model for public health

  • Identify barriers and opportunities for collaboration

across jurisdictions

  • Begin the process of developing local public health

modernization plans

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For more information

Cara Biddlecom, Interim Policy Officer (971) 673-2284 cara.m.biddlecom@state.or.us healthoregon.org/modernization

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BREAK

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CCO Metrics 2015 Performance Report

Medicaid Advisory Committee July 27, 2016 Sarah Bartelmann Office of Health Analytics

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  • Includes state and CCO level performance on 50 metrics
  • Measures reported for members with disability, with

mental health diagnosis, and with severe and persistent mental illness.

www.oregon.gov/oha/Metrics/Pages/HST-Reports.aspx

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Oregon Health Plan Population

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Oregon Health Authority Quality & Accountability

Core Performance Measures

  • From Oregon's 1115 waiver - some focus on population health.
  • No financial incentives or penalties associated with them.

State Performance Measures

  • Annual assessment of statewide performance on 33 measures.
  • Financial penalties to the state if quality goals are not achieved.

CCO Incentive Measures

  • Annual assessment of CCO performance on 17 measures.
  • Quality pool paid to CCOs for performance.
  • Compare performance to prior year.
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2015 Quality Pool Distribution

To earn their full quality pool payment, CCOs had to:  Meet the benchmark or improvement target on at least 12 of the 17 measures (including EHR adoption); and  Have at least 60 percent of their members enrolled in a patient-centered primary care home (PCPCH). Money left over from quality pool went to the challenge pool. To earn challenge pool payments, CCOs had to:  Meet the benchmark or improvement target on the four challenge pool measures: depression screening, diabetes HbA1c control, SBIRT, and PCPCH enrollment.

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Meeting goals and what they mean

The Metrics and Scoring Committee establishes a benchmark and/or improvement target for each incentive measure. The Committee reviews measures and targets each year. Benchmarks: These are national-level benchmarks, set for exceptionally high achieving Medicaid programs. We expect these to be reached in the long term, rather than short term (5 to 10 years.) They may shift slightly year to year as national performance shifts or be increased as needed. Improvement targets: In addition to the benchmark, an improvement target is calculated for each incentive measure. The improvement target is unique for each CCO and focuses on reducing the gap between the CCO’s prior year performance and the benchmark by 10%.

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How did CCOs do?

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New! CCO Summary Reports

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New measure

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New measure

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Modified measure

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Next steps

  • Expand analysis and reporting of data stratified by disability and

mental health diagnoses.

  • Mid-year progress report will be published January 2017
  • New incentive measures in 2016

– Cigarette smoking prevalence – Childhood immunization status

  • 2017: No changes to measure set
  • Committee is considering adding more transformational measures for

2018

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For more information

2015 Performance Report www.oregon.gov/oha/Metrics/ Measure Specifications www.oregon.gov/oha/analytics/Pages/CCO-Baseline-Data.aspx Contact us at metrics.questions@state.or.us

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Oregon FFS Access Monitoring Review Plan (DRAFT) July 27th 2016 Jamal Furqan, Health Systems Division

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Access Monitoring Review Plan Requirements

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Data, sources, methodologies, baselines, assumptions, trends and factors, and thresholds that analyze and inform determinations of the sufficiency of access to care, which may vary by geographic location within the state and will be used to inform state policies affecting access to Medicaid services such as provider payment rates. (42 C.F.R. §447.203(b)(1))

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7 Regions

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Monitoring Specific Service Categories

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Primary Care (including dental) Behavioral Health Obstetrics Other? Home Health Physician Specialty Services

Access to Care

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Oregon must complete a regional study of the following components

Comparative Rates & Reimbursement Analysis (ASU) Access Measurements & Metrics (HPA) Beneficiary & Provider Complaints Analysis (HSD) Characteristics

  • f the

Beneficiary Population (HPA)

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Criteria for Open Card OHP Eligibility

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  • Dual eligible members (Medicare and Medicaid) have option
  • American Indian/Alaskan Native Tribal members have option
  • Non-citizens with CAWEM eligibility always FFS
  • Children in DHS custody have option
  • Newly eligible members admitted as an inpatient at hospital are FFS
  • Medically fragile children 19 and younger have option
  • Newly eligible members needing organ transplant have option
  • Continuity of Care Exemptions

– Pregnant members have option – Provider request for member to be open card - OHA review – No other reasonable alternative as determined by OHA

  • Member has major medical private insurance (third party liability)

– Always FFS

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The FFS Population

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12761 4233 13844 10482 36080 76846 1545 65425

Total Open Card Members Central Oregon Columbia Gorge Eastern Oregon North Coast Southwest Tri-County Unknown Willamette Valley Central Eastern Gorge North Coast Southwest Tricounties Willamette Valley State Avg 19% 22% 23% 21% 18% 18% 19% 19% 12,563 13,893 4,224 10,276 34,787 75,582 63,784 216,517* *There were 1,545 persons with an unknown, missing or out of state

residence.

Percent of Oregon Health Plan Population on Open Card by Region, February 2016

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FFS population continued…

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12% 54% 17% 16% 26% 24% African American American Indian or Alaskan Native Asian or Pacific Islander Caucasian Hispanic Other / Unknown

Percent of Oregon Health Plan Population on Open Card

State Average = 19% Open

Age Open Card Managed Care Total Pct Open Card < 1 1,807 24,353 26,160 7% 01-5 11,180 109,997 121,177 9% 06-12 18,452 145,710 164,162 11% 13-18 18,295 103,552 121,847 15% 19-21 8,858 40,230 49,088 18% 22-35 51,872 201,615 253,487 20% 36-50 47,119 149,821 196,940 24% 51-64 28,356 128,720 157,076 18% 65+ 30,578 26,425 57,003 54% Total 216,517 930,423 1,146,940 19%

FFS members by age group FFS members by race/ethnicity

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Tri-County Willamette/ North Coast Central/ Eastern South west All Regions FFS vs CCO

  • 34.6%
  • 24.3%
  • 8.2%
  • 17.9%
  • 24.2%

FFS vs Medicare

  • 30.7%
  • 29.6%
  • 30.2%
  • 28.7%
  • 29.8%

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Primary Care Specialist Services

Tri-County Willamette/ North Coast Central/ Eastern South west All Regions FFS vs CCO

  • 14.0%

3.5%

  • 5.0%
  • 15.3%
  • 7.1%

FFS vs Medicare

  • 16.7%

3.8%

  • 12.1%
  • 25.6%
  • 12.1%

Tri-County Willamette/ North Coast Central/ Eastern South west All Regions FFS vs CCO

  • 14.1%
  • 14.8%
  • 5.8%
  • 5.5%
  • 11.6%

FFS vs Medicare

  • 5.3%
  • 6.6%
  • 8.2%
  • 11.0%
  • 7.2%

FFS Reimbursement Rate Comparisons

Obstetric and Neonatal Services

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FFS Reimbursement Rate Comparisons continued…

Behavioral Health

Tri-County Willamette/ North Coast Central/ Eastern South west All Regions FFS vs CCO

  • 45.0%
  • 25.5%
  • 2.4%
  • 15.1%
  • 28.1%

FFS vs Medicare

  • 17.6%
  • 19.6%
  • 12.9%
  • 9.1%
  • 15.0%

Dental Services

Tri-County Willamette/ North Coast Central/ Eastern South west All Regions FFS vs CCO

  • 35.2%
  • 32.7%
  • 26.9%
  • 37.1%
  • 32.4%

FFS vs ADA

  • 65.2%
  • 64.7%
  • 62.5%
  • 62.6%
  • 63.3%

Home Health Services

  • For Home Health services, OHA reimburses providers based on revenue codes
  • Due to the relative size of data, regional comparisons are not available for Home Health

Revenue Code Revenue Code Description Average Actual Reimbursement Rate Average CCO Reimbursement Rate % Difference 421Physical therapy visit $145.14 $137.44 5.60% 424Physical therapy evaluation or reevaluation $146.95 $128.74 14.20% 431Occupational therapy visit $154.45 $147.80 4.50% 434Occupational therapy evaluation or reevaluation $153.95 $133.41 15.40% 441Speech-language pathology visit $182.49 $169.44 7.70% 444Speech-language pathology evaluation or reevaluation $173.97 $171.71 1.30% 551Skilled nursing visit $184.39 $148.68 24.00% 559Skilled nursing evaluation $152.26 $135.21 12.60% 571Home Health Aide visit $54.19 $32.46 66.90%

$149.75 $133.88 16.91%

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Access to Care Beneficiary Complaint Trends

January 2015 – May 2016

20 40 60 80 100 120 140

# of Access Complaints Month of Complaint Urban Regions Access Complaint Trend Tri-Counties Willamette Valley Linear (Tri-Counties) Linear (Willamette Valley)

10 20 30 40 50 60

# of Access Complaints Month of Complaint Rural Regions Access Complaint Trend Central Oregon North Coast Southwest Linear (Central Oregon) Linear (North Coast) Linear (Southwest)

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Access to Care Beneficiary Complaint Trends cont…

January 2015 – May 2016

5 10 15 20 25

# of Access Complaints Month of Complaint Frontier/Rural Regions Access Complaint Trend Columbia Gorge Eastern Oregon Linear (Columbia Gorge) Linear (Eastern Oregon)

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Access Measures: Utilization

Calendar Year 2015

Measure CCO results Open Card results

Adolescent Well-Care 35.7% 13.8% Child/Adolescent Access to Primary Care All ages 89.5% 72.9% 12 to 24 months 94.8% 79.3% 25 months to 6 years 86.7% 66.7% 7 to 11 years 90.1% 73.9% 12 to 19 years 90.6% 75.7% Well-child Visits (first 15 months of life) 62.8% 29.2% Follow-up after MH hospitalization 87.7% 66.0% Follow-up ADHD meds Initiation phase 61.0% 42.3% Continuation and maintenance phase 68.9% 45.1% Initiation and Engagement for SUD Treatment Initiation phase 37.7% 35.4% Engagement phase 18.8% 15.8% Use of dental sealants in 6- 14 year olds with mental illness 17.2% 2.8%

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Access Measures: CAHPS Survey Results

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

Measure Medicaid Total FFS Source

Adult Child Adult Child

Access to emergency and urgent care

84% 92% 89% 94%

CAHPS Health Plan Survey

Access to Routine Care

77% 84% 80% 88%

CAHPS Health Plan Survey

Access to Specialist

75% 88% 82% 89%

CAHPS Health Plan Survey

Access to Personal Doctor

80% 88% 79% 92%

CAHPS Health Plan Survey

Access to urgent Dental Care

44% 52% 41% 52%

CAHPS Health Plan Survey

Access to a Regular Dentist

57% 79% 57% 79%

CAHPS Health Plan Survey

Access to timely MH services

74% 82% 78% 79%

Mental Health Services Survey, 2015

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Access Measures: Physician Workforce Survey

2015 Physician Workforce Survey - No FFS break-out. Provider availability measures specifically pertaining to FFS population will be introduced in 2016 Physician Workforce Survey.

Measure Population Source

Providers accepting new Medicaid patients 88% (Adult + Child) Physician Workforce Survey, 2015 Provider currently with Medicaid patients under their care 90% (Adult + Child) Physician Workforce Survey, 2015

Reasons providers are not accepting new Medicaid patients

Reimbursement rate 83% Balancing payers 77% Administrative requirements 77% Patient load 74% Liability insurance 23% Complex needs of patients 64% Non compliance of patients 69%

Ease of referral for Medicaid patients by providers*

Specialist 64% Ancillary services 45% Non-emergency hospital services 59% Diagnostic imaging 77% Inpatient mental health services 27% Outpatient mental health services 31% Inpatient substance use disorder services 18% Outpatient substance use disorder services 24%

*Providers responding “Usually” or “Always” to survey question

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Primary Care Access Review

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  • Reimbursement Rates: 24% below CCOs; 30% below Medicare

– Tri-County CCOs paying 35% more than FFS on average – Central/Eastern Oregon CCOs paying slightly more than FFS

  • Access Complaints: trending downward overall

– Tri-county complaints spiked in Oct-2015 but reverted to baseline – Most regions experienced peak in complaints in Q1 2015

  • Access Measurements

– Utilization: FFS members utilizing primary care at much lower rate than CCO members; 33.6 percentage points below for Well-Child Visits – CAHPS: FFS members report experiencing slightly better access to primary care – Physician Workforce Survey: 88% of all physicians accepting new Medicaid patients in 2015

  • Top reason for not accepting new Medicaid members is Reimbursement

Rate, followed by Balancing Payers/Administrative Requirements

  • Only 45% report ease referring to Ancillary Services
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Physician Specialist Access Review

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  • Reimbursement Rates: 7% below CCOs; 12% below Medicare

– FFS paying more than CCOs in Willamette/North Coast regions – Southwest and Tri-County reimbursing about 14-15% more than FFS

  • Access Complaints: trending downward overall

– Tri-county complaints spiked in Oct-2015 but reverted to baseline – Most regions experienced peak in complaints in Q1 2015

  • Access Measurements

– No utilization measure currently – CAHPS: FFS members report experiencing slightly better access to specialists, and emergency services – Physician Workforce Survey: 88% of all physicians accepting new Medicaid patients in 2015

  • Only 64% of primary care physicians report referring Medicaid patients to

specialists is ‘usually’ or ‘always’ easy

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Dental Services Access Review

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  • Reimbursement Rates: FFS dental rates significantly below CCO

and American Dental Association (ADA) fee schedule

– FFS reimbursements 27% or more below CCOs in all regions – FFS reimbursements more than 60% below ADA fee schedule in all regions

  • Access Complaints: trending downward overall

– Tri-county complaints spiked in Oct-2015 but reverted to baseline – Most regions experienced peak in complaints in Q1 2015

  • Access Measurements

– No utilization measure currently – CAHPS

  • Less than 50% of FFS members report adequate access to urgent dental

services; however same as CCO members

  • Only 57% of adults report adequate access to regular dentist

– Physician Workforce Survey: Only oral surgeons captured in 2015

  • Plan to incorporate dentists in 2016 survey
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Behavioral Health Access Review

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  • Reimbursement Rates: Tri-County CCOs paying 45% more than

FFS; CCOs average 28% more than FFS overall

– Central/Eastern Oregon CCOs paying only 2.4% above FFS

  • Access Complaints: trending downward overall

– Tri-county complaints spiked in Oct-2015 but reverted to baseline – Most regions experienced peak in complaints in Q1 2015

  • Access Measurements

– Utilization: CCO utilization much higher than FFS in most measures

  • F/u after MH hospitalization 22 percentage points higher for CCO members
  • F/u on ADHD medications also around 19-23 percentage pts higher
  • Similar utilization for Initiation and Engagement for SUD Treatment

– CAHPS: FFS members report similar or better experience accessing timely MH services as CCO members – Physician Workforce Survey: Providers report the most difficulty referring Medicaid members to inpatient AND outpatient MH and SUD services

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SLIDE 99

Obstetric Services Access Review

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  • Reimbursement Rates: CCOs average reimbursement is 11.6%

higher than FFS

– Central/Eastern and Southwest average 5-6% higher – Tri-County and Willamette/North Coast average 14-15% higher

  • Access Complaints: trending downward overall

– Tri-county complaints spiked in Oct-2015 but reverted to baseline – Most regions experienced peak in complaints in Q1 2015

  • Access Measurements

– No utilization measure currently – CAHPS: FFS members report similar or better experience accessing emergency and urgent care, routine care, and a personal doctor. – Physician Workforce Survey: Only 59% of providers report ease in referring Medicaid recipients to non-emergency hospital services

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SLIDE 100

Home Health Services Access Review

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  • Reimbursement Rates: Average actual FFS reimbursement is

about 17% higher than CCO reimbursements

  • Access Complaints: trending downward overall

– Tri-county complaints spiked in Oct-2015 but reverted to baseline – Most regions experienced peak in complaints in Q1 2015

  • Access Measurements

– No utilization measure currently – CAHPS: FFS members report similar or better experience accessing emergency and urgent care, routine care, and a personal doctor. – Physician Workforce Survey: Only 45% of providers report ease in referring Medicaid recipients to ancillary services

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SLIDE 101

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  • For each service category, OHA is developing analysis of the

number of providers/clinics that served FFS members in CY 2015

Additional Component in Development

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SLIDE 102

Questions?

Jamal Furqan 503-945-6683 Jamal.Furqan@state.or.us

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SLIDE 103

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Public Comment

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SLIDE 104

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Meeting Calendar 2016

  • August 11th – Oral Health Workgroup, Salem (2-5pm)
  • Sept. 20th – Oral Health Workgroup, Wilsonville (9-12pm)
  • September 28th – Medicaid Advisory Committee, Salem (9-

12pm)

  • October 26th – Medicaid Advisory Committee, Salem (9-12pm)
  • December 7th – Medicaid Advisory Committee, Salem (9-

12pm)