Health Care Transformation & Coordinated Care Organizations

Presented by Senator Dr. Alan Bates& Paul Phillips, Pac/West

Tuesday, July 26, 2011

Hosted by

• 3rd Term for Governor John Kitzhaber• Senate Democrats hold a small

advantage 16-14• First time: Oregon House was evenly

divided 30-30– Co-Speakers– Co-Chairs (One Democrat/One

Republican) for every Committee

2011 Session Overview

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• Major health care legislation still manages to pass: – Oregon Health Insurance Exchange– Parity of in-patient/out-patient methodologies

payments– Elimination of payments for adverse and/or never

events– Recruitment and retention of physicians– Health Care Transformation

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Health Care Legislation Passed

• The cost of health care rises every year• Oregon has a 3 billion dollar budget hole• Bad economy = more Medicaid clients

IN SHORT:Oregon must help more people

with less money

Why the Need for Health Transformation?

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• Goal: Integration and reduce costs in order to build a sustainable system– The Governor established a work group process– Input was gathered from throughout the State– Turf protection became the focus– A smaller work group established a baseline– The legislature worked on a bill– Eventually leadership took over (Bates, Freeman,

Kotek, Roblan, Hanna, Thompson)

Health Transformation: Process

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• Goal: Provide better care and reduce costs and focus on unique community needs– Break down the delivery silos– Operate inside a global budget– Find cost savings (reduce redundant care, stop

payment for never events, med/mal reform)– Integrate services with Coordinated Care

Organizations (CCOs)– Build on the successes of MCOs like WVP

House Bill 3650: Health Transformation

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• Each silo has their own pot of money

• Services often don’t work together

• Patients and systems can get lost in the shuffle

Old Way of Delivering Care

7(See pg. 2 of handout)

• Work from one global budget for all a patient’s needs

• CCO is one point of contact for the patient to get care they need

• Funding more clear• Flexibility to fund the

programs and care that get results

New Model

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(See pg. 2 of handout)

• Similar to a locally based Managed Care Organization, except will integrate:– Physical health (including prevention)– Mental health– Dental health– Behavioral health

• Provides all health services for Medicaid clients and acute care for dual eligibles

• Organization can be set up through contracts or partnerships

What is a CCO?

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CCO Structure

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(See pg. 3 of handout)

• CCO will be made up of primary care providers, clinics, mental health providers, hospitals, specialists & preventative care programs, etc…

• Services for client will be coordinated by the CCO• Governance: Locally controlled board made up of those

taking financial risk in the CCO• Public Input: Community Advisory Council made up of

community leaders will give feedback to the CCO• No entity has a “veto” power over another (Plan,

County, Hospital, major provider)

How a CCO Works

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• OHA is forming the Transformation process:– Workgroups: CCO Criteria, Global Budgets, Quality

Metrics and Dual Eligibles– Analysis of defensive medicine

• MCOs need to lead the transition to CCOs:• Legislative approval still needed specific to:

• Global budgets• CCO organizationally• Defensive medicine analysis

What’s Next?

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Timeline

13(See pg. 4 of handout)

• The transition time is very short (July 2012)• In less than a year, CCOs will have to be up and

running with a community focus• Work with OHA during the interim will be vital• Oregon will be looking for a leader• WVP and other plans are positioned to be

leaders right along with their community partners and healthcare delivery systems

Timeline

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• WVP has delivered GREAT results– Executive staff and organizational excellence

• WVP offers a unique set of credentials:– We have the physician community thus the professional

expertise and the primary care provider networks to serve our community

– We offer population based management with a proven record of innovation and cost containment

– We are the bridge between facility based management and a healthier community

WVP Well Positioned

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• Transformation has worked in Oregon– SB 27: 1989 The Oregon Health Plan– SB 44: 1991 Expansion of OHP Coverage

• Transformation will work again– HB 3650: 2011 OHP Phase Three

• Transformational success will be based off:– Cooperation– Vision– Removing impediments within regulatory existing system

Summary

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• Transformation will result in Medicaid clients getting the right care at the right time

• Professionals providing care will have more tools to help their patients get healthy

• CCOs will save the system money though better coordination and care

• Community-based care will continue to be the cornerstone of OHP as MCOs lead transition

Summary

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• Don’t wait: Become a CCO now• Start building partnerships with

local providers• Share your vision of a CCO with

everyone• Identify new cost savings in a

coordinated care model• Be a leader: this isn’t a

competition it is a coordination

Summary

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Thank you!

Questions

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