Medicaid Advisory Committee October 26, 2016 Oregon State Library - - PowerPoint PPT Presentation

Medicaid Advisory Committee

October 26, 2016

Oregon State Library Salem, Oregon

Time Item Presenter 9:00 Opening remarks

• Committee transitions

Co-Chairs 9:15 CCO Listening Tour: Part Two

• Presentation
• Discussion of committee recommendations

Stephanie Jarem, OHA 10:15 Break 10:30 Transformation Center and Patient-Centered Primary Care Home Program: Updates from OHA Alissa Robbins & Chris Carrera, OHA 11:00 Oregon Ombuds Advisory Council Ellen Pinney, OHA 11:20 MAC Retreat Discussion Committee Staff 11:50 Public Comment 11:55 Closing comments Co-Chairs

Oregon Health Policy Board CCO Listening Sessions Medicaid Advisory Committee Discussion

Steph Jarem September 28, 2016

Coordinated Care Organizations: The Model

• Locally governed by a partnership

between health care providers, community partners, consumers, and those taking financial risk.

• Consumer advisory council

requirement

• Behavioral health, physical,

dental care held to one budget.

• Responsible for health outcomes

and receive incentives for quality

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Listening Sessions: The Future of Coordinated Care

• The Oregon Health Policy Board is gathering input

from key stakeholders, including consumers, advocates, and providers about coordinated care in Oregon.

• Input to help shape recommendations for a report to

the legislature and OHA about the future of Oregon’s coordinated care organizations.

• Report release: January 2017

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CCO Listening Sessions around Oregon

Data Time Region Location

9/1/2016 11-1:30 Bend Deschutes National Forest Supervisor's Office Aspen Ponderosa Conference Room 63095 Deschutes Market Road 9/9/2016 4:00-6:30 Tillamook Port of Tillamook Bay Officers' Mess Hall 6825 Officers Row 9/21/2016 5:30-8:00 Rogue Valley (Medford) Inn at Commons Crater Lake and Rogue River Rooms 200 North Riverside Avenue 9/26/2016 12:00-2:30 Eugene Unitarian Universalist Church 1685 West 13th Avenue 10/7/2016 12:00-2:30 Pendleton – Hermiston Eastern Oregon Trade and Event Center 1705 East Airport Road 10/18/2016 4:30-7:00 Portland Ambridge Event Center Ballroom 1333 NE MLK Boulevard

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Next steps: CCO Assessment

November

• Survey closes;

analysis;

• board considers

preliminary results & recommendations

December 2016

• Board approves

recommendations for future of coordinated care

January

• OHPB

recommendations submitted to Legislature

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Coordinated Care: What’s next

• 5 years since implementation of CCOs

– How are we doing? – Where should the next 5 years take us? We need YOUR input to drive Health Transformation 2.0

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Social Determinants of Health/ Flexible Services

How can CCOs can strengthen their efforts to address the social determinants of health (e.g. housing) for members?

For example:

• Are there ways CCOs can change/improve use of flexible

services?

• Do you have innovative ideas for how CCOs can connect with

community-based organizations and resources?

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Integration

One of the goals of health care transformation is to integrate physical, oral and behavioral health.

What evidence are you seeing that health care is more integrated since the launch of the CCOs? How can the CCO model change to encourage greater integration?

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Cultural Competency What changes or improvements are needed to strengthen CCO cultural competency and increase availability of culturally appropriate services for members?

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Governance

• What changes or improvements are needed to

ensure the “right” people are at the table to make decisions at CCOs?

• Should all CCO decision-makers be locally-based and

part of the CCO regional community?

• Are there opportunities to enhance the governance

relationship between CCOs and Consumer Advisory Councils (CACs)?

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Committee Feedback/Memo to Health Policy Board

• Charge to the Board “…shape recommendations about the

future of Oregon’s CCOs…”

• Please identify top three issues or considerations the

committee would like to share with the Health Policy Board

• Group by CCO topic…?(e.g. social determinants, governance,

cultural competency)

• Looking ahead, in your role as community members and

members of the state’s Medicaid Advisory committee, what should Oregon’s CCOs look like to better support health system transformation? 13

Next Steps

Take the full survey:

https://www.oregon.gov/oha/OHPB/Pages/cc-future.aspx

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To learn more….

www.health.oregon.gov

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Transformation Center Update

Alissa Robbins, OHA Chris Carrera, OHA

Agenda

• Health System Transformation & the Transformation Center
• Phase 1: 2013-15
• Phase 2: 2015- today
• Accomplishments
• Patient-Centered Primary Care Home
• Phase 3: Continuing our work in 2017 and beyond

POLICY AND ANALYTICS Transformation Center

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Oregon’s Health System Transformation & The Transformation Center

• Health System Transformation

– Oregon began implementing the coordinated care model in 2012 within coordinated care

• rganizations (CCOs)
• Transformation Center

– Oregon’s hub for health system innovation and quality improvement

• The Transformation Center

helps good ideas travel faster

Oregon’s Health System Transformation & The Transformation Center

• Mission: The Transformation Center is the hub for innovation and

quality improvement for Oregon’s health system transformation efforts to achieve better health, better care, and lower costs for all.

• Goals: The Transformation Center identifies, strategically supports,

and shares innovation at the system, community, and practice

• levels. Through collaboration, we promote initiatives to advance the

coordinated care model.

POLICY AND ANALYTICS Transformation Center

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Transformation Center: Phase 1

• Phase 1 goals (mid-2013

to mid-2015)

– Champion and promote transformation – Build an effective learning network

• Focus on learning collaboratives and large events

– Foster relationships across CCOs

• We learned CCOs wanted deeper dives and more

targeted support

• Needed help reaching goals metrics, alternative payment

models, and behavioral health integration

Transformation Center: Phase 2

• Phase 2 goals (mid-2015 to now)

– Provide targeted technical assistance to support coordinated care model implementation, including:

• Responding to challenges within CCOs based on

performance metrics and evaluation outcomes; and

• Advancing integration of population and behavioral

health within the health system

Phase 2: Accomplishments

• Behavioral Health Integration

– Technical Assistance consultation and follow-up to all CCOs – Project Echo Telementoring Program: pediatric psychiatry; 24 providers from 17 counties participating – Behavioral Health Integration resource library

• Population health

– Supported community advisory councils’ member recruitment and retention efforts by:

• Public service announcements for recruitment
• All-day event for CAC leaders to focus on CAC member

recruitment and engagement strategies. – Awarded grants to all 16 CCOs to support implementation of their community health improvement plan priorities .

POLICY AND ANALYTICS Transformation Center

Phase 2: Accomplishments

• Supporting CCO incentive metrics through technical assistance

– Tobacco cessation, childhood immunization, colorectal cancer screening and adolescent well-visits

• Value-based payment models:

– Convening the Senate Bill 231 Primary Care Payment Reform Collaborative, – Supporting the implementation of the Comprehensive Primary Care Plus (CPC+) program for OHA’s Fee-for-Service population. – Additionally, the center awarded grants to two CCOs to implement a value-based payment model for integrated care. – Technical assistance to CCOs

• Health Equity

– National health equity expert consultation with all CCOs across the state – follow-up technical assistance in health equity to those CCOs that request it.

POLICY AND ANALYTICS Transformation Center

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Phase 2: Accomplishments

• Technical Assistance Bank

– 60 requests from 15 CCOs, for a total of 875 expected technical assistance hours.

• Council of Clinical Innovators

– Forty fellows participated in the first three cohorts, representing all 16 CCOs. Twelve fellows are in the current cohort.

• CHIP and Transformation Plan

Analysis

POLICY AND ANALYTICS Transformation Center

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Patient-Centered Primary Care Home Program

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• HB 2009 established the PCPCH Program:
• Create access to patient-centered, high quality care and

reduce costs by supporting practice transformation

• Joined the Transformation Center in late spring 2016
• Site Visits
• Key PCPCH program functions:
• PCPCH recognition and verification
• Refinement and evaluation of the PCPCH standards
• Technical assistance development
• Communication and provider engagement

Oregon’s Primary Care Home Model

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• Core Attributes – Standards - Measures
• Tiers

10 Must-Pass Measures

1.C.0 PCPCH provides continuous access to clinical advice by telephone. 2.A.0 PCPCH tracks one quality metric from the core or menu set of PCPCH Quality Measures. 3.B.0 PCPCH reports that it routinely offers all of the following categories of services: Acute care for minor illnesses and injuries; Ongoing management of chronic diseases including coordination of care; Office-based procedures and diagnostic tests; Patient education and self-management support. 3.C.0 PCPCH has a screening strategy for mental health, substance use, or developmental conditions and documents on-site and local referral resources. 4.A.0 PCPCH reports the percentage of active patients assigned to a personal clinician or team. (D) 4.B.0 PCPCH reports the percent of patient visits with assigned clinician or team. (D) 4.C.0 PCPCH maintains a health record for each patient that contains at least the following elements: problem list, medication list, allergies, basic demographic information, preferred language, BMI/BMI percentile/growth chart as appropriate, and immunization record; and updates this record as needed at each visit. 4.E.0 PCPCH has a written agreement with its usual hospital providers or directly provides routine hospital care. 5.F.O PCPCH has a process to offer or coordinate hospice and palliative care and counseling for patients and families who may benefit from these services. 6.A.0 PCPCH offers and/or uses either providers who speak a patient and family’s language at time of service in- person or telephonic trained interpreters to communicate with patients and families in their language of choice.

Different Levels of Primary Care “Home-ness”

Tier 1 Basic Primary Care Home Tier 2 Intermediate Primary Care Home Tier 3 Advanced Primary Care Home

• Demonstrates performance improvement
• Additional structure and process improvements
• 65 - 125 points and all 10 must-pass criteria
• Foundational structures and processes
• 30 – 60 points and all 10 must-pass criteria

Where are PCPCHs?

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PCPCH Evaluation

• APAC data on 1.2 million patients studied (600,000

PCPCH patients; and, 600,000 non-PCPCH patients)

• Every $1 spent on primary = $13 in savings
• PCPCH x 3 yrs = savings of $28 PMPM
• Savings to Oregon health system = $240 million over

three years.

• Reduction in utilization of emergency department,

hospitalization, and specialty

POLICY AND ANALYTICS Transformation Center

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What’s Next for PCPCH Program

• Revised 5 Tier Model will launch in 2017
• Behavioral Health Home
• Program Evaluation

– Case study of 20 exemplary PCPCHs

• Cost and outcomes of PCPCH study

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Phase 3: Continuing our work in 2017 and beyond

• Continue work in primary

care, behavioral health integration, population health, oral health integration and value- based payments.

• Technical assistance,

sharing innovation, and report analysis will continue

POLICY AND ANALYTICS Transformation Center

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Learn more:

www.TransformationCenter.org

POLICY AND ANALYTICS Transformation Center

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Ombuds Advisory Update

Ellen Pinney, OHA

MAC Retreat Conversation

Retreat Prep Questions What do you want to get out of the committee’s retreat this winter? How can we best use that time?

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Retreat Prep Questions

What is your understanding of the committee’s current work and direction? Do you feel clear about the work? What are your questions?

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Retreat Prep Questions

• What is your perspective on MAC

meetings?

• Are they effective?
• What, if anything, would you change?

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Retreat Prep Questions

Looking ahead to 2017 including the upcoming legislative session, pending federal approval of Oregon’s 1115 waiver demonstration, potential changes to CCOs, what policy topics are of interest to the committee and within statutory scope?

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Retreat Prep Questions

• Would the committee value opportunities

to collaborate on policy shared topics across the Oregon Health Authority and Department of Human Services (DHS)?

• Anything else we haven’t discussed that

you’d like to staff to ponder as part of the planning process?

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December 10th Meeting – Webinar

• Staff in consultation with OHA leadership and co-chairs
• pted to cancel the in-person meeting on December 7th.
• In lieu of in-person meeting, OHA staff will facilitate a
• ne hour webinar from 9-10am. Webinar will serve as an
• pportunity to:

– Engage members in advance of the January retreat – Review a draft of the annual committee report. – Sneak preview of 2017 legislative session

• Early next week, staff will confirm date for the January

retreat

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