Medicaid Advisory Committee March 25, 2015 General Services - - PowerPoint PPT Presentation

Medicaid Advisory Committee

March 25, 2015

General Services Building Salem, Oregon

Time Item Presenter 9:00 Opening Remarks

• Introduction of new members
• Committee memo, OHA Report on SB 1526
• Approval of minutes – January 2015

Co-Chairs 9:15 2015 Legislative Update Brian Nieubuurt, OHA 9:20 OHA Ombuds Advisory Council: Update Ellen Pinney, OHA 9:35 OHA Transformation Center

• Update on CCO Community Advisory Councils (CACs)

Adrienne Mullock, OHA Tom Cogswell, OHA 10:10 Health Share Community Advisory Council

• Health Share’s CAC membership and community engagement

activities

• Council priority areas and implementation activities outlined in the

CHIP Sandra Clark, staff; Amy Anderson, member 10:40 BREAK 10:50 Oregon Health Authority: Updates

• Oregon Health Plan (OHP) Enrollment and Redeterminations
• Coordinated Care Organizations (CCOs)

Rhonda Busek, OHA 11:00 Committee Strategic Planning and Draft Work Plan

• Review Committee Charter
• Proposed 2015 work plan & meeting calendar
• Brainstorm future policy topics

Co-Chairs; staff 11:30 Public Comment or Testimony Co-Chairs 11:35 Closing comments Co-Chairs; staff 11:40 Adjourn Co-Chairs; staff

2015 Legislative Update

Brian Nieubuurt Legislative Coordinator for Health Care Programs, OHA

OHA Ombuds Advisory Council Update

Ellen Pinney, OHA Ombudsperson

Community Advisory Council (CAC)

Adrienne Paige Mullock, MPH, CHES, RYT Transformation Analyst

3/25/15

Agenda

• Overview of the CACs
• Summary of the CHPs
• Senate Bill 436
• Focus for 2015
• CAC Summit 2015

3/24/2015 6

Total CACs Around the State = 36

• AllCare Health Plan: 3
• Cascade Health Alliance: 1
• Columbia Pacific CCO: 3
• Eastern Oregon CCO: 13
• FamilyCare, Inc: 1
• HealthShare of Oregon: 1
• Intercommunity Health

Network: 3

• Jackson Care Connect: 1
• PacificSource Central

Oregon: 1

• PacificSource Columbia

Gorge: 1

• PrimaryHealth of Josephine

County: 1

• Trillium Community Health

Plan: 2

• Umpqua Health Alliance: 1
• Western Oregon Advanced

Health: 2

• Willamette Valley Community

Health: 1

• Yamhill County Care

Organization: 1

Per ORS 414.627

CAC must:

• “Include representatives of the community and of each

county government served by the coordinated care

• rganization, but consumer representatives must

constitute a majority of the membership”

• “Have its membership selected by a committee

composed of equal numbers of county representatives from each county served by the coordinated care

• rganization and members of the governing body of

the coordinated care organization.”

3/24/2015 8

CAC Meetings

• Meet at least once every three months.
• Post a report of its meetings and discussions to the

website of the coordinated care organization and

• ther websites appropriate to keeping the

community informed of the councils activities.

3/24/2015 9

Example: InterCommunity Health Network CCO CAC

Community Advisory Councils (CACs)

• Duties of the CAC include, but are not limited to:
• Identifying and advocating for preventive care practices to

be utilized by the CCO

• Overseeing a community health assessment (CHA) and

adopting a community health improvement plan (CHP) to serve as strategic guidance for the CCO to address health disparities and meet health needs for the communities in their service area

• Annually publishing a report on the progress of the CHP

Community Health Improvement Plan (CHIP)

The activities, services and responsibilities defined in the plan may include, but are not limited to: a) Analysis and development of public and private resources, capacities and metrics based on ongoing community health assessment activities and population health priorities; b) Health policy; c) System design; d) Outcome and quality improvement; e) Integration of service delivery; and f) Workforce development.

3/24/2015 11

Summary of CHIPs

Implementation status:

• Delivered June 30, 2014
• Yearly progress report due June 30, 2015

CCO Community Health Improvement Plans

CHIP: Priority Areas

• Mental health integration (15 CCOs)
• Maternal health, early childhood and youth (11

CCOs)

• Access to care (8 CCOs)
• Health equity and socioeconomic disparities

(8 CCOs)

• Oral health (8 CCOs)

CHIP: Implementation Strategies

• Access to care (41 strategies)
• Health equity (33 strategies)
• Workforce development (32 strategies)
• Integration of services (31 strategies) and care

coordination (21 strategies)

• Oral/dental health (28 strategies)
• Substance abuse prevention/cessation (28 strategies)
• Mental health (27 strategies)

Senate Bill (SB) 436

• Effective July 1, 2013, SB 436 highlighted issues

related to children’s health care and established guidelines for Coordinated Care Organizations (CCOs) to focus on children’s health, to the extent possible, in the development and adoption of their required CCO community health improvement plans.

Findings From SB 436

8 1 % 3 8 % 8 1 % 0% 20% 40% 60% 80% 100%

Early Learning Council Youth Development Council School health providers

Com m unity Health I m provem ent Plan Strategy and Plan for Collaboration w ith Child Health Partners

Findings from SB 436 cont.

9 4 % 8 8 % 0% 20% 40% 60% 80% 100%

Effective and efficient delivery of health care to children Effective and efficient delivery of health care to adolescents

Com m unity Health I m provem ent Plan Strategy and Plan for Coordinating Health Care Delivery to Children and Adolescents

Findings from SB 436 cont.

Findings from SB 436 cont.

Focus for 2015

CAC Leadership Development

• Monthly leadership calls – Chairs/Co-Chairs
• Bi-monthly leadership calls – Coordinators
• Bi-monthly leaderships calls – Steering Committee

Resource Library Development

• Motivational Interviewing
• Logic Models: From Goals to Outcomes
• Collaborative Problem Solving

Community Advisory Councils: Engaged & Active Summit 2015

June 3-4 in Sunriver, OR

The summit will include:

• Opportunities to connect with and learn from other

CAC members

• Strategies for effective member engagement
• A forum for sharing CAC activities and overcoming

challenges

• A time to celebrate and recognize the amazing

work accomplished to date

Questions?

Adrienne Paige Mullock

adrienne.p.mullock@state.or.us www.transformationcenter.org

3/24/2015

Goal in hearing from CACs:

• Learn about the role of CCO CACs including membership, diversity,

and community engagement activities

• Current focus and priority areas as highlighted in the CACs’

community health improvement plans

• Challenges and opportunities to improve from the perspective of

CACs

• Future focus areas related to implementation activities as outlined in

CAC CHIPs

• Other?

23

Health Share of Oregon

CAC involvement in Community Health Needs Assessment & Community Health Improvement Plan

Presentation to OHA Medicaid Advisory Committee Meeting March 25, 2015

Health Share of Oregon

Mission: to develop an integrated community health system that achieves better care, better health and lower costs for the Medicaid population and the Tri- County community

More simply: to create a regional system of care that improves outcomes for the population we serve

Who is a Health Share Member?

236,874 members 23% of our members select language other than English 18,778 African American and African 50,119 Hispanic/Latino 15,376 Asian & Pacific Islander 1,857 Native American

Health Share’s Community Advisory Council (CAC)

CCOs conduct a Community Health Needs Assessment every three years, and update a Community Health Improvement Plan yearly.

Health Share’s CAC involvement is extensive:

• A chartered CHNA/CHP Committee with CAC members, a Board

Member, and community stakeholders meets monthly

• The CAC approves and adopts the CHNA and CHP and ensures

that contractual obligations to OHA are met or exceeded.

Assessment/Improvement Plans are intended to:

• Identify priority health needs through data gathering and

analysis

• Identify and address gaps in available data
• Reduce health disparities and promote health equity
• Improve overall population health

CAC’s role in developing the CHNA and CHP in 2013-2014

CHNA Committee’s tremendous volunteer investment: They met 3 hours every other week for almost two years – a tremendous investment of time and energy by volunteer CAC members! That’s more than hours!

How are CCO Community Health Needs Assessments different?

Many health assessments focus on epidemiological data from the region as a whole. Our assessment comes from the perspective of Oregon Health Plan members.

Foundation for Assessment is Healthy Columbia Willamette Collaborative

www.healthycolumbiawillamette.org

Healthy Columbia Willamette Collaborative

• Fourteen hospitals
• Four local public health departments
• Two coordinated care organizations (Health Share & FamilyCare)
• Four-county region (Clackamas, Clark, Multnomah & Washington)

Improvement for new 2014-2016 CHNA Cycle:

• Community Engagement Workgroup includes CAC members from Health

Share and FamilyCare

• CCO & Hospital Data Workgroup will use additional data available to identify

drivers and indicators of health needs, with emphasis on disparities and on vulnerable populations

Health Share’s Assessment further narrows Health Issues

Community Health Needs Assessment Committee

• f Health Share’s CAC took the Healthy Columbia

Willamette Priorities and asked: “Which of these issues resonate most with our culturally-specific communities?”

Prioritizing health needs Community identified needs Supported by data Strategically aligned

CAC Recommendations

Through the Community Advisory Council’s research and work in the community, the Council recommended to the Health Share of Oregon’s Board of Directors to approve two Community Health Needs to be prioritized and addressed through our Community Health Improvement Plan:

• 1. Behavioral Health 2. Chronic Disease

CAC impacts: Increased emphasis on Community Engagement

 Seek input from communities impacted by disparities about what investments would be most impactful, and matching them to the community’s stage of change;  Align investments with transformation activities underway at Health Share and through Health Share partners;  Measure improvements in health outcomes for members as a result

• f investments;

 Use the Community Readiness Model, a process that included interviewing over 40 Health Share members and community stakeholders for input and identification of level of community readiness to address both priority health needs;  Use findings from community-led self assessments to identify needs and strategies in addition to our CHNA findings.

Community Health Needs Assessment Using A Community Readiness Model

Community Readiness Model: inclusive process that included interviewing over 40 Health Share members and community stakeholders for input and identification of community readiness to address our priority health needs. Community-led self assessments: aligning with community and addressing needs that have been prioritized by communities of color and

• thers experiencing disparities.

Community Advisory Council’s role in developing the CHP

The CAC improved our process:

• Initially we interviewed 20 community

stakeholders and Health Share members under a short timeline

• CAC requested that Health Share take more time

to engage with more consumers

• As a result we interviewed 20 more people, with

more from Clackamas & Washington Counties, more Health Share members, and more people identifying as LGBTQI, living with disabilities, immigrants and refugees.

CAC members improved how we interviewed 40 Member & Community Stakeholders

How do people find information about Diabetes and Heart Disease in the African American and Pacific Islander communities?

What are the barriers to getting Mental Health services in the Native American Community?

Mental Health & Addictions

Stigma (cultural, family, individual) about behavioral health came up in many interviews:

“We … come from a community that has a lot of fear of stigma so people will keep in denial and only when...facing certain problems, that's when they'll be forced to ask for some kind of service, so mostly they do not understand.”

Mental Health & Addictions

Culturally and linguistically appropriate services:

“There's not enough culturally specific counselors, and if you taught counselors who will be able to support community members and because again if you have a Somali person

• r a Latino person and the person who's

supposed to be counseling is from the dominant culture and don't understand the historical cultural aspect of that individual it makes very very difficult for people to trust.”

Chronic Disease related to physical activity and nutrition

Healthy eating and access to better nutrition:

“What's not working is … just being able to access food,

afford foods that they need to eat and just the difficulty

• f behavior changes and lack of education.”

“A lot of people think it's an inevitable thing for us. It's come to the point where people just accept the reality that as you grow older, you will get diabetes, you will get high blood pressure and that's not something that's

• preventable. It's something that our community has

accepted as part of life which is very sad.”

Why Culturally-Specific Traditional Health Workers?

Community perspectives learned through interviews:

• Demonstrated awareness of concept and very high

support in general

• Not

enough culturally and linguistically specific community health workers.

• Not enough outreach, notice of activities is not

widespread or timely or in languages other than English.

• Specific communities have specific needs that the larger

health system can’t address on its own.

• Provide culturally specific education, e.g. cooking classes

that feature recipes the community already cooks.

What Did We Learn From developing the CHNA & CHP?

• Our members and community stakeholders have a

tremendous amount of knowledge and expertise about their health needs and how to solve them

• Staff and Community Advisory Council became

familiar with Community Based Organizations (CBOs)and the work they are doing around health within the communities they serve.

• We have a lot to learn from our members and from
• ur community leaders – working together is key.
• This work takes time, especially when deciding

upon strategies for improvement.

OHP Enrollment, Redeterminations and CCO Update

Rhonda Busek, Interim Director, Medical Assistance Programs, OHA

Committee Strategic Planning and Draft Work Plan

Review Draft Charter

• Charter outlines (refer to handout):

– Authorizing federal and state statutes – Membership requirements in state statute – Scope and Deliverables – Committee Principles – Dependencies – Resources

• Meetings

– 8 meetings in 2015; no meetings February, May, August and November

26

2015 Informational Updates

Recurring (monthly/quarterly)

• OHP Enrollment, Redeterminations

and CCOs

• Legislative Update (during session)
• CMS OHP Quarterly report
• OHA Ombudsperson
• Community Advisory Councils

Annually/Biannually, cont.

• OHA Addictions and Mental Health

Services: Behavioral Health Integration

• Early Learning Council/Health Policy

Board Joint Subcommittee

• Health Care Workforce Committee

Update

• OHA Dental Director
• Coordinated Care Model Alignment

Work Group

• Health Evidence Review Commission

(HERC)

• OHA Office of Equity and Inclusion;

Health Equity Policy Review Committee

27

Annually/Biannually

• Transformation Center
• Metrics and Scoring Committee
• Department of Human Services
• Patient-Centered Primary Care Home

(PCPCH) Program

Upcoming Committee Policy Work: 12-month Continuous Eligibility for Adults

Continuous eligibility is a federal option for states that allows income- eligible Medicaid adults to maintain coverage for up to one full year, even if they experience a change in income or family status.

• Prior Work: Recommendation from MAC’s 2014 report on churn to

Health Policy Board.

• Charge: Committee will prepare and submit recommendations to

Oregon Health Authority (OHA) regarding the feasibility of this federal policy option, and outline the potential fiscal impact on the state budget in the next

• Timeline:

– April: Background, including federal guidance and implications – June: preliminary cost-benefit analysis – July: Review and finalize draft recommendation

28

Committee input on additional informational presentations or future policy topics?

29

Public Comment or Testimony