Coordinated Care Organizations
• How do CCOs work?• Where are we in the transformation process?
• How it will affect you and your clients?• How can you play a role?
LEGACY HEALTH
Why Transform? Why Now?Fragmented, siloed systemsUnsustainable health care costsNot great health outcomesState budget woes
System Challenges:Influence Factors on Health Status
Social 15%
Environmental 5%
Human Biology 30%
Lifestyle & Behavior 40% Medical Care 10%
Source: McGinnis J.M., Williams-Russo, P., Knickman, J.R. (2002). Health Affairs, 21(2), 83
Eight year old, Malik, lives with asthma.Thanks to a Coordinated Care pilot project and his Community
Health Worker, Malik learned how to manage his asthma daily. Now he spends
more time playing with his friends and less time in the hospital.
Vision of CCO ImplementationIntegration & coordination
of benefits & services
Local accountability
for health & resource allocation
Standards for safe & effective
care
Global budget indexed to sustainable
growth
Redesigned Delivery System
Healthier population
Improved Outcomes
Reduced Costs
[The Triple Aim]
[A CCO]
“I think you should be more explicit here in Step two.”
… And dentists
[Insane] CCO Development TimelineJuly ‘11
January ‘12March ‘12April ‘12
May/Jun ‘12 July ‘12
August ‘12Nov ‘12Jan ‘13Feb ’13
January ’14
HB 3650 signed into lawOHPB’s Implementation Plan published, SB 1580 signed into lawCCO Letters of Intent submitted, RFA
publishedApplication for CCO Certification dueReadiness ReviewExecute CCO Contract with OHA- Go
Live!FFS enrolled into CCOsTransformation Plan draft dueTransformation Plan implementation
beginsMedicaid population expansion
Key Components of CCO DevelopmentGeographic/Demographic
Scope
Business & OperationsInformation SystemsUtilization ManagementAdministrationClaims ProcessingCustomer RelationsWorkforce Development
Local GovernanceBoard of DirectorsCommunity Advisory
CouncilClinical Advisory Panel
Model of CarePhysical, mental, oral health
integrationSocial service
networking/integrationDelivery system
transformationKeeping people healthy
FinancingGlobal BudgetCapitalizationRiskRevenueAlternative Payment
Methodologies
Why would Oregon’s health systems agree to do all this (just for Medicaid)?~18% of Oregonians are enrolled in
Medicaid todayWill jump to 25% after ACA Medicaid expansion
in 2014The Governor is working to fold all publicly
funded health coverage into the CCO modelPEBB & OEBBIf that happened, ~40% of Oregonians would
have care paid for and coordinated through CCOs$1.9 Billion in federal investment accounts
for 19% of the state’s Medicaid budget this biennium
Community Advisory CouncilMajority consumersCAC member sits on
Governing BoardDuties include:
Community Needs AssesmentCommunity Health
Improvement PlanWe are looking for
community members NOW!
Contact your local CCO to join or attend meetings.
What does Transformation look like?The fundamental questions for
stakeholders:Can we do more with less? Can we do more of what works? Can we let go of what doesn’t? How do we together foster communities
that support the best possible lives for everyone in Oregon?
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Thank you!Rose Englert
Sr. Manager, Regulatory AffairsCareOregon
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List of CCO Maps and Governing Boards:
http://www.oregon.gov/oha/OHPB/Pages/health-reform/certification/index.aspx
CareOregon Affiliated CCOs
Health Share of Oregon
Columbia Pacific CCO
Jackson Care Connect
Yamhill County Care Organization
PrimaryHealth of Josephine County
What Does It Take To Be A CCO? Corporate Structure/Governance Community Advisory Council Coordinate physical, behavioral, & oral
health Experience managing financial risk Minimum financial reserves Primary care medical homes HIT strategy Written agreements with counties, public
health & Area Agency on Aging
CCO Possibilities Ability to reduce preventable conditions Widespread use of primary care health homes Improved outcomes due to enhanced care
coordination and care delivered in most appropriate setting
Reducing errors and waste Innovative payment strategies Use of best practices and centers of
excellence Single point of accountability for achieving
results
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Minimum Standards to Evaluate CCO Transformation
Integration, Primary Care, Payments
1. Implement a health care delivery model that integrates mental health and physical health care and addictions.
2. Implement Patient-Centered Primary Care Homes.
3. Implement consistent alternative payment methodologies that align payment with health outcomes.
Minimum Standards to Evaluate CCO TransformationAssessments, Improvement, & IT
4. Prepare a strategy for developing a Community Health Assessment and adopt an annual Community Heath Improvement Plan.
5. Develop a plan for encouraging electronic health records; health information exchange; and meaningful use.
6. Assure communications, outreach, Member engagement, and services are tailored to cultural, health literacy and linguistic needs.
7. Assure that the culturally diverse needs of Members are met; provider and new health care workers reflect member diversity.
8. Develop a quality improvement plan focused on eliminating disparities in access, quality of care, experience of care, and outcomes.
Minimum Standards to Evaluate CCO Transformation
Reflecting Diversity, Addressing Disparities