SLIDE 17 Improved Access
General expectations/vision Source
1
Adequate, timely and appropriate access to hospital and specialty services will be required. OHPB Implementation Plan
2
In selecting one or more coordinated care organizations to serve a geographic area, the authority shall: (a) For members and potential members, optimize access to care and choice of providers; (b) For providers, optimize choice in contracting with coordinated care organizations; and (c) Allow more than one coordinated care organization to serve the geographic area if necessary to optimize access and choice under this subsection. HB 3650
3
Consumers can get the care and services they need, coordinated locally with access to statewide resources when needed, by a team of health professionals who understand their culture and speak their language; A holistic approach that focuses
- n the patient, not the symptoms, and emphasizes preventive care and healthy lifestyles.
2010 Action Plan
4
The goals of the CCO will be moving from fragmentation to organization and delivering the right care in the right place at the right time to patients who are meaningfully engaged. RFA, Transformation Plan Access Outcome Measure Data Source Notes
5
Access to care overall (6 subcategories) Summative waiver evaluation, metrics 2016 report, OHIS REPORT
- 1. members w/ any health care 2. getting care
quickly (adults) 3. getting needed care (adults)
- 4. physicians accepting new medicaid pts. 5.
physicians caring for mediciad pts 6. pt w/ medicaid coverage
6
Access to primary care Summative waiver evaluation, PRIMARY CARE REPORT Access decreased slightly, likely due to Medicaid expansion 1. Members with any primary care 2. Children and Adolescents' access to primary care (1-6) 3. Children and adolescents access to primary care (7-19) 4. Adults access to primary care (20-44) 5. Adults access to primary care (45-64)
7
Access to behavioral health care Summative waiver evaluation
8
Access to dental care: Members with any dental visit; members with a preventive dental visit Waiver summative evaluation; Oral Health in Oregon CCOs metrics report
9
Access to care (CAHPS) statewide - patient experience measure 2016 Metrics Report, summative waiver eval Incentive Measure
10
Ambulatory care - ED utilization 2016 Metrics Report, summative waiver eval Incentive Measure
11
Follow-up after hospitalization for mental illness 2016 Metrics Report, summative waiver eval Incentive Measure
12
Prenatal and postpartum care 2016 Metrics Report, summative waiver eval Incentive Measure
13
Outpatient utilization 2016 Metrics Report, summative waiver eval State Performance Measure
14
Compliance: Participation in Learning Collaborative if unable to meet access metric Transformation Center If OHA identifies Contractor as underperforming on access, quality or cost against performance and outcome metrics established under this Contract, Contractor will be required to participate in an intensified learning collaborative intervention. Questions for Broader Analysis: What role did workforce capacity play in these measures? In cases where larger workforce gaps are at play, does the CCO have any responsibility to incentivize / recruit new providers? What role did coordination of care play?
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