health system transformation: coordinated care ... · transformation plans on key focus areas of...

9
Judy Mohr Peterson, Dir. of Medical Assistance Programs Oregon Health Authority Health System Transformation: Health System Transformation: Health System Transformation: Health System Transformation: Coordinated Care Organizations Coordinated Care Organizations Coordinated Care Organizations Coordinated Care Organizations

Upload: others

Post on 27-Jun-2020

2 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Health System Transformation: Coordinated Care ... · Transformation Plans on key focus areas of change Accountability & Quality Incentive Pool 33 metrics on 7 focus areas 17 metrics

Jud

y M

oh

r P

ete

rso

n,

Dir

. of

Me

dic

al A

ssis

tan

ce P

rog

ram

s O

reg

on

He

alt

h A

uth

ori

ty

Health System Transformation:

Health System Transformation:

Health System Transformation:

Health System Transformation:

Coordinated Care Organizations

Coordinated Care Organizations

Coordinated Care Organizations

Coordinated Care Organizations

Page 2: Health System Transformation: Coordinated Care ... · Transformation Plans on key focus areas of change Accountability & Quality Incentive Pool 33 metrics on 7 focus areas 17 metrics

Co

nte

xt:

Ore

go

n’s

He

alt

h S

yst

em

Tra

nsf

orm

ati

on

Page 3: Health System Transformation: Coordinated Care ... · Transformation Plans on key focus areas of change Accountability & Quality Incentive Pool 33 metrics on 7 focus areas 17 metrics

Health System Transformation

ww

w.h

ea

lth

.ore

go

n.g

ov

�S

ick

ca

re –

no

t h

ea

lth

ca

re

�U

nsu

sta

ina

ble

�P

oo

r o

utc

om

es

for

the

do

llars

th

at

we

sp

en

d

�N

on

-in

teg

rate

d o

r co

ord

ina

ted

ca

re.

�F

ocu

s o

n a

cute

ca

re, n

ot

pro

mo

tio

n o

f h

ea

lth

an

d p

reve

nti

ve c

are

�M

ea

nw

hile

……

……

……

Page 4: Health System Transformation: Coordinated Care ... · Transformation Plans on key focus areas of change Accountability & Quality Incentive Pool 33 metrics on 7 focus areas 17 metrics

Ore

go

n’s

Str

ate

gic

Ap

pro

ach

�T

o m

ov

e a

wa

y f

rom

tra

dit

ion

al b

ud

ge

t b

ala

nci

ng

act

ion

s:�

Cu

t p

eo

ple

fro

m c

are

�C

ut

pro

vid

er

rate

s�

Cu

t se

rvic

es

Page 5: Health System Transformation: Coordinated Care ... · Transformation Plans on key focus areas of change Accountability & Quality Incentive Pool 33 metrics on 7 focus areas 17 metrics

A new vision for Oregon

ww

w.h

ea

lth

.ore

go

n.g

ov

Page 6: Health System Transformation: Coordinated Care ... · Transformation Plans on key focus areas of change Accountability & Quality Incentive Pool 33 metrics on 7 focus areas 17 metrics

Coordinated Care Organizations

ww

w.h

ea

lth

.ore

go

n.g

ov

Page 7: Health System Transformation: Coordinated Care ... · Transformation Plans on key focus areas of change Accountability & Quality Incentive Pool 33 metrics on 7 focus areas 17 metrics

Ore

go

n’s

Str

ate

gic

Ap

pro

ach

C

oo

rdin

ate

d C

are

Org

an

iza

tio

ns

�S

erv

e O

reg

on

He

alt

h P

lan

(M

ed

ica

id)

me

mb

ers

�15

acr

oss

th

e s

tate

�C

oo

rdin

ate

me

nta

l an

d p

hy

sica

l he

alt

h c

are

�G

lob

al b

ud

ge

t

�D

esi

gn

ed

to

en

cou

rag

e w

elln

ess

, no

t ju

st t

rea

t

illn

ess

; Pre

ven

tio

n, c

hro

nic

dis

ea

se m

an

ag

em

en

t,

�F

lexi

ble

se

rvic

es;

co

mm

un

ity

he

alt

h w

ork

ers

�L

oca

l Acc

ou

nta

bili

ty/G

ove

rna

nce

�A

lte

rna

tive

pa

ym

en

t m

eth

od

s

Page 8: Health System Transformation: Coordinated Care ... · Transformation Plans on key focus areas of change Accountability & Quality Incentive Pool 33 metrics on 7 focus areas 17 metrics

Ore

go

n’s

Str

ate

gic

Ap

pro

ach

�T

ran

sfo

rmat

ion

Ce

nte

r�

Pe

er

to p

ee

r le

arn

ing

�In

no

vato

r A

ge

nts

�Le

arn

ing

co

llab

ora

tive

s

�T

ran

sfo

rmat

ion

Pla

ns

on

ke

y fo

cus

are

as o

f ch

ang

e�

Acc

ou

nta

bili

ty &

Qu

alit

y In

cen

tive

Po

ol

�33

me

tric

s o

n 7

fo

cus

are

as�

17 m

etr

ics

for

CC

O q

ual

ity

ince

nti

ve p

oo

l�

1% W

ith

old

for

tim

ely

, acc

ura

te a

nd

co

mp

lete

re

po

rtin

g�

Qu

alit

y im

pro

vem

en

t p

roje

cts

(PIP

s) a

re a

lign

ed

�B

en

d t

he

co

st c

urv

e –

2% p

oin

t re

du

ctio

n in

tre

nd

�If

sta

te d

oe

s n

ot

me

et,

we

lose

ou

r “

De

sig

nat

ed

Sta

te

He

alth

Pro

gra

m”

(DS

HP

) fu

nd

s ($

1.9

bill

ion

ove

r 5

yrs)

Page 9: Health System Transformation: Coordinated Care ... · Transformation Plans on key focus areas of change Accountability & Quality Incentive Pool 33 metrics on 7 focus areas 17 metrics

Ore

go

n’s

Str

ate

gic

Ap

pro

ach

�L

ea

de

rsh

ip a

nd

vis

ion

sta

rtin

g w

ith

Go

vern

or

�C

am

pa

ign

sty

le w

ork

�O

ver

100

sta

ke

ho

lde

r m

ee

tin

gs

an

d t

rib

al

con

sult

ati

on

s w

ith

me

an

ing

ful i

np

ut

ove

r se

vera

l ye

ars

�H

elp

at

stra

teg

ic p

oin

ts f

rom

co

nsu

lta

nts

�W

riti

ng

wa

ive

r; f

aci

lita

tin

g s

tak

eh

old

er

me

eti

ng

s

�C

MS

ne

go

tia

tio

ns

for

wa

ive

r

�In

tern

al r

eso

urc

es;

Co

mm

un

ica

tio

n; C

ult

ure

ch

an

ge

fro

m m

on

ito

rin

g &

re

gu

lati

on

to

“a

cco

un

tab

ility

fo

r sh

are

d s

ucc

ess

”o

f th

e C

CO

s