Columbia Pacific Coordinated Care Organization (CCO) – Data Summary

Reedsport

Changes in Oregon Health PlanFederal Accountable Act

Healthcare Coordination & Integration

Coordinated Care Organizations

Dual E

ligibi

lity

Global Budgets For All

Primary Care Health Homes

Metrics /

Perform

ance M

easures

Community Advisory Councils

OREGON INTEGRATED &

COORDINATED HEALTH

CARE DELIVERY SYSTEM

Physical Health Mental Health Addictions TX

• Assessment• Diagnosis• Treatment Plan (EBP)

• Pre-set rate per service

• Monitor / Update

OHP Client

• Assessment• Diagnosis• Treatment Plan (EBP)

• Pre-set rate per service

• Monitor / Update

• Assessment• Diagnosis• Treatment Plan (EBP)

• Pre-set rate per service

• Monitor / Update

Oral Health

• Assessment• Diagnosis• Treatment Plan (EBP)

• Pre-set rate per service

• Monitor / Update

Primary Care Health Homes – Center of patients’ coordinated care. Includes a team that works on keeping patients at their healthiest.

• Local Control (different CCO models)

• Coordination – Integrate Physical health, mental health, dental health– single point of accountability

Community Advisory Council – Each CCO convenes a CAC to ensure that the health care needs of consumers are being addressed

• Metrics / Performance Measures – Operate under contracted performance standards with clinical, financial and operational metrics

• Global Budget And Shared Saving – More flexibility to manage dollars

Coordinated Care

Organizations

Why This Why Now?

CCO created a culture which allowed providers to bring these local activities into the next generation of integration

Better Health Care System

Better Health Outcomes

Cost Savings

All OHP Clients At High Risk -

Chronic DiseaseChronic Disease

Coordinated case management – Reduce high end costs

Coordinated case management – Reduce likelihood become chronic

Early Assessment & Identification of High Risk For Chronic Disease

Improve Health System, Improve Health Outcomes, Lower Costs

All OHP Clients At High Risk -

Chronic DiseaseChronic Disease

Coordinated case management – Reduce high end costs

Coordinated case management – reduce likelihood become chronic

Early Assessment & Identification of High Risk For Chronic Disease

All OHP Clients At High Risk -

Chronic DiseaseChronic Disease

Coordinated case management – Reduce high end costs

Coordinated case management – reduce likelihood become chronic

Early Assessment & Identification of High Risk For Chronic Disease

All OHP Clients At High Risk -

Chronic DiseaseChronic Disease

Coordinated case management – Reduce high end costs

Coordinated case management – reduce likelihood become chronic

Early Assessment & Identification of High Risk For Chronic Disease

Savings = reinvestment into system – incentive, etc.

REALLY?

Cost Impact Sample – Using Diabetes for A Single Oregon County:

Number of Persons:

Number of Deaths:

Costs:

9,300

531

$42.6M

If you can prevent 4.67% of people from getting Diabetes:

Number Prevented: 437

Lives Saved: 32

Financial Cost Savings: $2 M

If you can prevent 20% of people from getting Diabetes:

1,860

121

$8.52 M

Cost Impact Sample – Using Diabetes for Douglas County:

If you can prevent 4.67% of people from getting Diabetes:

Number Prevented: 437

Lives Saved: 32

Financial Cost Savings: $2 M

If you can prevent 20% of people from getting Diabetes:

1,860

121

$8.52 M

$8.52 Million Question:What is the likelihood of preventing 5%, 10%, 20% of population from getting

Diabetes?

The risk of Type 2 Diabetes can be reduced by

50-70% by control of obesityAnd by

30-50% by increasing physical activity

• Personal impact cannot be quantified• Can apply model to other chronic diseases – Each has risk

factors which increase the likelihood of illness:

Heart Disease and Stroke Prevention:•No tobacco•Physically active•Healthy weight•Healthy food choices•Preventing / controlling high blood pressure•12 – 13 point reduction in average systolic blood pressure over 4 years reduces heart disease risk by 21%, stroke risk by 37%

Cancer Prevention:•No tobacco•Limiting alcohol•Limited exposure to ultraviolet rays•Diet rich in fruits and vegetables•Maintaining a health weight•Being physically active•Seeking regular medical care

PCP

Oral HealthMental HealthAddictions

Health Integration System

Behavioral Health

Mental Health

Dental Health

Patients

Physical Health

Neighborhood Health

Family

Spiritual Community Providers

Peers

• 15 CCO management areas

18

Community Advisory Councils – Ensure health care needs of consumers are being met. Community / consumer focus within CCO’s work to accomplish vision – Improve Health Care System, Improve Health Outcomes, Lower Costs

Current Goal – Identify 3 priority areas to improve health then identify strategies to reach that goal

Summary of Findings

National / State Studies:

Higher death rates related to:•Cancer•Heart disease•Stroke•Chronic Lower Respiratory Disease•Diabetes•Suicide•Alcohol-Induced Deaths

Higher Rates of Inadequate Prenatal Care

Higher percentage of reporting of depression/anxiety and high blood pressure (CP CCO Medicaid data)

Community Responses:

Conditions create a healthy community:•Jobs•Education / Schools•Environment

Health problems in community:•Alcohol / drug addiction•Not enough doctors•Obesity

• Diabetes• Cancer• High Blood Pressure

3 things to improve community health:•More doctors•Doctor appointments after five o’clock•Expand OHP

Chronic Health Conditions

Percent told they have it by a physician (N=

1,486)

Of those percent currently taking RX for

it

Diabetes 9.7 62.4

High cholesterol 19.1 45

High blood pressure 29.6 57.8

Depression / anxiety 44.2 51.8

Asthma 18.2 51.9

Emphysema / COPD 8.2 50.4

Heart attack / Angina 6.6 50

Congestive heart failure 2 69

Kidney problem 5.1 33.3

Cancer 3.7 50

Chronic Condition Diagnoses – Medicaid-eligible Population (CPCCO Service Area

Leading Cause Of Death….

In Douglas County, this includes the following: •4,553 individuals with 7,632 conditions•60% (2,760) with one condition – either a physical or mental illness•39.4% (1,793) with more than one conditionOf those with more than one condition, 16.5% (751 of the total 4,553) had both a physical and mental health condition

One Two Three Four Five Six

One 339 107 48 18 5 2 519

Two 103 45 14 16 6 1 185

Three 18 11 3 3 1 0 36

Four 6 1 1 0 0 0 8

Five 1 0 1 0 0 0 2

Six 1 0 0 0 0 0 1

468 164 67 37 12 3 751

Number of Physical Health Conditions

Total

Number of Mental Health Conditions

Total

Health Behaviors

Adult Smoking

Adult Obesity

Inadequate Prenatal Care Rate (2007-2011 Avg. Rate : 1,000 Births)

Low Birthweight Rate (2007-2011 Avg. Rate : 1,000 Births)

A Look At Who We Are…

Reedsport

Percent White / Caucasian

Percent Hispanic (all races)

Under Age 18

Percent Male

Community SurveyN = 131

1. In the past year, have you or anyone living in your home used health services at any of the following locations? Please select all that apply:

Percent Number

Hospital 64.1% 84

Urgent care 19.1% 25

Doctor’s office or other outpatient medical clinic 82.4% 108

Veterans health Administration hospital or clinic 6.1% 8

Addictions treatment center 2.3% 3

Dental services 46.6% 61

Public health department 11.5% 15

Mental health / behavioral health or other counseling 7.6% 19

911 9.9% 13

2.

We have good doctors (They care about patients, provide good health care, etc.)

75.6% 99

We have local access to specialty services(A focus on specific area of care like a heart doctor)

31.3% 41

There are good prevention services that help reduce health problems (Services that help people quit smoking or to eat healthy)

50.4% 66

Citizens make use of recreational activities (Helps with exercising and stress reduction, etc.)

42% 55

What conditions exist now in your community to help create or foster good health? Please select all that apply:

3. What do you think are the three (3) most important ways to create a healthier community? Please select only 3

A clean environment 34.4% 45 Mental health treatment 16.8% 22

Access to healthy foods

24.4% 32 Food banks/hunger programs 21.3% 28

Affordable housing 29% 38 Low crime/safe neighborhoods 17.6% 23

Cultural acceptance 2.3% 3 Sports and recreation activities 6.9% 9

Education / Schools 36.6 48 Tobacco prevention / treatment services

6.9% 9

Drug/alcohol prevention and treatment

19.1% 25 Job opportunities and a healthy economy

55.7% 73

Health prevention and wellness education

21.4% 28 Better access to health care services

26% 34

4. What do you think are the three (3) most critical health problems in your community? (those problems which have the greatest impact on overall community health)

Cancer 21.4% 28 Lack of mental health treatment facilities

7.6% 10

Respiratory/lung disease 10.7% 14 High crime rates 0.8% 1HIV/AIDS 1.5% 2 High cost of mental health services 3.1% 4

Diabetes 25.2% 33 Not enough doctors and clinics 32.1% 42Heart disease / stroke 15.3% 20 High cost of health care / lack of

health insurance16.8% 22

High blood pressure 19.8% 26 Too few recreational and exercise facilities

3.8% 5

Tobacco use 9.2% 12 Poor eating habits 15.3% 20

Obesity 32.1% 42 Lack of access to healthy foods 3.1% 4Mental Illness 6.9% 9 Domestic violence 6.1% 8Alcohol/drug addiction 32.1% 42 Lack of transportation to medical

facilities8.4% 11

Dental problems 5.3% 7 Too little affordable housing 9.9% 13

Sexually transmitted diseases

0.8% 1 Child abuse 5.3% 7

Suicide 3.1% 4 Too few educational opportunities after high school (college, trade schools, et.)

13.7% 18

5.

More health education services 26.7% 35

More doctors 60.3% 79

More illness prevention services / Screening 20.6% 27

More alcohol and drug treatment 16% 21

More dentists 10.7% 14

Doctor appointments after 5 pm or on weekends 38.9% 51

More culturally sensitive care 2.1% 4

Transportation assistance 16.6% 22

More mental health services 18.3% 24

Alternative health care 28.2% 37

Expand the OHP (Medicaid) 35.1% 46

More tobacco cessation programs 4.6% 6

If you could pick just three (3) things to improve your community's access to health care, what would they be? Please pick only 3 boxes:

It costs too much 45% 59 Don’t know where to go to get care 3.8% 5

Don’t have insurance 36.6% 48 Afraid of what they might find wrong with me

7.6% 5

Childcare issues 1.5% 2 Do not have a regular doctor 13% 17

Transportation problems

16.8% 22 Couldn’t get appointment quickly enough

25.2% 33

Don’t like doctors 7.6% 10 Have OHP but no doctor 4.6% 6

Waited for the health problem to go away

26% 34 Doctor’s office not open not open when needed

13% 17

6. Think about the most recent time when you or a family member living in your home went without needed health care. What were the reasons why? Please check all that apply

7. Age

8. Gender

Income Race / Ethnicity:

Less than $5,000 11.5% 15 American Indian or Alaska Native

4.6% 6

$5,000 - $15,000 19.8% 26 Asian 0% 0

$16,000 - $25,000 25.2% 33 Black or African American 0% 0

$26,000 - $40,000 15.3% 20 Latino / Hispanic 2.3% 3

$41,000 - $70,000 16% 21 Native Hawaiian or Other Pacific Islander

.8% 1

$71,000 - $100,000 3.8% 5 White 77.1% 101

More than $100,000 3.1% 4

Summary of Findings

National / State Studies:

Higher death rates related to:•Cancer•Heart disease•Stroke•Chronic Lower Respiratory Disease•Diabetes•Suicide•Alcohol-Induced Deaths

Higher Rates of Inadequate Prenatal Care

Higher percentage of reporting of depression/anxiety and high blood pressure (CP CCO Medicaid data)

Community Responses:

Conditions create a healthy community:•Jobs•Education / Schools•Environment

Health problems in community:•Alcohol / drug addiction•Not enough doctors•Obesity

• Diabetes• Cancer• High Blood Pressure

3 things to improve community health:•More doctors•Doctor appointments after five o’clock•Expand OHP

“City-Data.com: Reedsport, OR. 2013.“Community Health Needs Survey, - Reedsport” 2013. Columbia Pacific

Coordinated Care Organization : Community Advisory Council. Oregon.“County Health Rankings and Roadmaps – a Healthier Nation County by

County,” 2013. Robert Wood Johnson Foundation and University of Wisconsin – Population Health Institute.”

“County Health Calculator,” 2013. Robert Wood Johnson Foundation and the Virginia Commonwealth University Center on Human Needs.

“Data Elements for CCOs Reports,” 2013. Oregon Health and Science University. Office of Rural Health.

“Prevention Chronic Diseases and Reducing Health Risk Factors,” 2013. Centers for Disease Control and Prevention. CDC 24/7 : Saving Lives. Protecting People.