1. Introductions Kim Whitley, COO, Samaritan

Health Plans

4:30

2. Transformation Update

Community Health Worker 2 Heatmap

CMA Scribes Heatmap

p. 5-6 Jenna Bates, Transformation

Manager, IHN-CCO

4:35

3. OHA Innovator Update p. 7-10 Joell Archibald, Innovator Agent,

OHA

4:45

4. Legislative Update p. 11-15 Bill Bouska, Director of

Community Solutions and

Government Affairs,

Samaritan Health Plans

5:05

5. Dental Mental Integration for Diabetes (DMID) p. 17-23 Britny Chandler, Dental Program

Clinical Coordinator,

Samaritan Health Plans

5:25

6. Proposal Update

Poll Everywhere Test

Questions for Proposers

Kim Whitley, COO, Samaritan

Health Plans

5:45

7. Wrap Up

Scorecard collection

DMID Final Evaluation

https://www.surveymonkey.com/r/DMID

Next Meeting: August 10th proposal presentations

Kim Whitley, COO, Samaritan

Health Plans

5:55

Agenda

Delivery System Transformation Committee July 27th, 4:30 – 6:00pm

Samaritan Walnut Building, Endeavor Conference Room

Dial in: 866-439-0933

Code: 5093665467

Minutes Delivery System Transformation Committee

July 13, 2017: 4:30 – 6:30 Samaritan Health Services Walnut Building: Endeavor (conference room)

Dial in: 866-439-0933 Code: 5093665467

Introductions Kim Whitley Present: Kim Whitley, Jenna Bates, Charissa White, Britny Chandler, Sherlyn Dahl, Christine Mosbaugh, Jeff Blackford, Kacey Urrutia, Rebekah Fowler, Charlie Fautin, Abby Schroff, Scott Balzer, Robert Hughes, Kristy Jessop, Rachel Petersen, Kelly Volkmann, Hilary Harrison, Carla Jones, Bill Bouska, Bettina Schempf, Joell Archibald, Jordan Butler, Clarice Amorim Freitas, Annie McDonald Phone: Miao Zhao, Renee Smith, Miranda Miller

Transformation Update Jenna Bates Physician Wellness Initiative: time only extension approved electronically by the committee. Oregon Health Authority Update: celebrating the metrics outcome of IHN-CCO receiving approximately $10.5 million for the state CCO incentive metrics.

Traditional Health Worker Transformation Update Carla Jones Summary

Three providers are now contracted with and reimbursed by IHN-CCO for Traditional Health Workers(THWs); Benton Community Health Centers, Communities Helping Addicts Negotiate Change Effectively(CHANCE), and Family Tree Relief Nursery.

Reimbursements include:o Patient-Centered Primary Care Home (PCPCH) subcapitation & Case Management payments to

support non-traditional services for members, including care coordination.o Palliative care case rate payments to provide relief for patients & families with a serious condition.o Psychiatric subcapitation to support Mental Health Technical Specialists, case management, and

care coordination services.Alternative Payment Methodology (APM) & IHN-CCO Engagement

Per Member Per Month (PMPM) capitation for members enrolled in the programs.

Performance Metric agreement to determine program continuance in subsequent contracting years.

The CCO has quarterly meetings with contracted providers to discuss member capacity, financial, and qualitymetric reports.

IHN CCO’s Report Card

IHN-CCO will spend $1.4 million on THWs and non-traditional case management and care coordinationservices in 2017.

IHN-CCO ranked as the #2 CCO out of all Oregon CCOs in spending on Other Member Services (non-traditional) in 2016.

Discussion

IHN-CCO Emergency Department (ED) data is useful for the organizations that work as THWs in order to goback and reach out to the members.

o The THW metric reports do not show a positive impact on ED utilization so far, but targetedoutreach may help with this metric.

Addressing funding issues:o The state has some studies that may focus the work in this area.o The Centers for Medicare and Medicaid (CMS) Waiver has areas concentrating on health-related

services that may contribute to moving THW work forward with a focus on Social Determinants ofHealth (SDoH).

o Working on a way to get us the information on working with children who are high-needs or high-risk, which would force the CCO to target those areas and the kind of provider the CCO would needto hire to work with this target area.

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2017 contracts are final, but at the end of the year there will be evaluations to determine how to moveforward with provider contracting.

There are no stand-alone navigation service contracts in Lincoln County.

Community Health Worker Close-Out Kelly Volkmann Summary

The Community Health Worker (CHW) Pilot integrated CHWs and Health Navigators (HNs) within PCPCHs.The CHWs helped create barrier-free access to healthcare, a closed loop referral system for accessingcommunity resources, and taught health care and lifestyle classes.

Key Findings

Benton County Health Services (BCHS) successfully hired, trained, and integrated CHWs and HNs into theirnew clinical care teams.

Touch data shows increasing use of CHW services across all sites; also showed which services CHW mostconnected to.

Important to have a project champion as well as a project lead, ideally clinic manager or supervisor.Successes

Processes and protocols for successful replication were developed and documented.

Developing trusting relationships with other PCPCH agencies and bridging the agency communication gapthat previously existed.

Qualitative evaluation of providers and clients yielded very positive responses that relate directly to theTriple Aim.

Challenges

The pilot is not easily scalable.o It is time and resource intensive to train a health navigator to work effectively and safely as part of a

clinical care team.o This is being partially addressed by the new THW Training Hub pilot that is currently getting started.

The success of this pilot might make it seem like it is easy to insert a CHW/HN into a primary care team, butthere is a huge need for support and technical assistance to the care team as they decide how they want touse their CHW/HN and they get used to having an HN as part of the team.

The CHW/HNs are very carefully trained and are not released to work in an outside agency until they havedemonstrated that they are ready to work independently in their new role.

Sustainability

Currently, the CHW/HNs are being contracted with IHN-CCO through a PMPM payment.

BCHS is working with IHN-CCO to determine if this is the best way to do this and if so, what is the bestmethodology going forward.

Discussion

While the effect of opening up provider time is difficult to measure, it can be shown through the positiveimpact on the rest of the clinic’s IHN-CCO member panel.

Certified Medical Assistant Scribes Close-Out Scott Balzer Summary

This pilot aims to increase provider efficiency and improve provider compliance with regulatoryrequirements for documenting quality of care by training Medical Assistant staff to scribe office visitsallowing the physician to focus on the care of the patient.

Key Findings

Lack of qualified Certified Medical Assistants (CMAs).

No standardized scribe training.

Cost can be offset solely by increased productivity.

Increased provider satisfaction and reduced burnout.Successes

Increased access, more provider time, reduced human resources, offsetting costs, and improved patientsatisfaction.

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Challenges

Sustained productivity and scribe applicants in other communities.

More robust study of quality improvement with the scribe.Sustainability

The scribe pilot will be sustained moving forward pending sustaining increased productivity and reduction ofcosts.

Provider/staff satisfaction and reduced burnout remains at an all-time high within the clinic.Discussion

Experience in CMA Scribe retention and turnover; it can take a month for a provider to get used to aparticular scribe.

The CMAs chart but the provider is still responsible for what is written and must have oversight for all chartnotes and transcription.

Pilot Proposal Presentation Process Decisions

Yes, the committee wants to see proposal presentations and interact with the proposers.o The meetings on August 10, 2017 and August 24, 2017 will be extended by 30 minutes to allow for

more time for the five proposal presentations.

The proposer will complete the entire Pilot Proposal Presentation template, which is due July 24, 2017.

The proposer will be requested to focus on Pilot Summary and Goals for a 5 minute presentation.o Following that, the DST will have questions with a focus on collaboration, state metrics, self-

sustaining, reduction of costs, and improving access.To Do

The Transformation Department will research electronic voting in order to improve the process regardingconfidentiality and avoid the groupthink mentality.

o Poll Everywhere and voting clickers will be researched.

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DST 2017 Calendar

Acrynom Pilot Name End Date

January12th , 26th APM2

Alternative Payment

Methodology (2) 12/31/2016

February9th, 23rd

PMH

11/30/16CAPEI

Child Abuse Prevention &

Early Intervention 12/31/2016

March9th 23rd

CPC

8/31/16CHW2

Community Health

Worker (2) 12/31/2016

April6th, 20th

CVAIS

10/31/16

PPC

5/30/17CRSC

Colorectal Screening

Campaign 12/31/2016

May4th, 18th

COMPAR

12/31/16

WG

DiscussionMHC

Maternal Health

Connections 12/31/2016

June1st, 15th, 29th

YWES

12/31/16

SANE

7/31/17

TFAT

12/31/16TFAT

Tri-County Family

Advocacy Training 12/31/2016

July13th, 27th

CMAS

3/31/17

CHW2

12/31/16

Non-THW

APM

DMID

1/31/17RFP Update

Legistlative

updateYWES

Youth WrapAround &

Emergency Shelter 12/31/2016

August10th, 24th

PSWTP (1st) CSAS VRxL HEST MHEM RHEH (1st) CSL CDP IBSE USSEDMID

Dental Medical

Integration for Diabetes 1/31/2017

September7th, 21st CMAS CMA Scribes 3/31/2017

October5th, 19th CTSG

Chrysalis Therapeutic

Support Groups 6/30/2017

November2nd, 16th, 30th HPC Home Palliative Care 6/30/2017

December14th IPRP

Improving the Pain

Referral Pathway in the

PCPCH 6/30/2017

PWI

Physician Wellness

Initiative 6/30/2017

VRxL: Veggie Rx Pilot in Lincoln County: A Strategic Collaboration Against Food Insecurity

HEST: Tri-County Health Equity Summits and Trainings

IBSE: Improving Breastfeeding Services through Education, Communication, and Connectivity

CDP: Community Doula Program

RHEH: Regional Health Education Hub

MHEM: Mental Health Education Matters SPC SHS - Palliative Care 9/30/2017

USSE: Universal Social Service Entry

CSL: CHANCE Saving Lives

PSWTP: Peer Support Wellness Training Program

CSAS: Children's SDoH and ACE Screening

6/30/2017

7/31/2017

Health & Housing

Planning InitiativeHHPI 8/31/2017

HE WG

Sexual Assault Nurse

Examiner

School/Neighborhood

Navigator (2)SNN2

SANE

RFP Process

Meeting 1 Meeting 2 Meeting 3 (June and November)

2017

CCCM

9/30/16Planning Planning

Planning - Workgroups Planning

Planning Debrief PIHL

12/31/16Top 5

No MeetingHDWorkgroup

Strategic Plan

COMPAR

12/31/16

Pilot Proposal Key: August 10 & August 24 Meetings

Booked extension

KEY

Tenative extension

Booked closeout

Booked update

Booked Transformation

Tentative update

Tentative

Transformation

Tentative closeout

Funding

RFP Process

RFP Decisions

LIO Review

revised 7/26/2017 sj

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Rev 7/25/2017

Final Pilot Closeouts – Scorecard Voting Results

Scorecard

Criteria

Mental Health

Literacy

Mental Health,

Addictions, and

Primary Care

Integration

Behavioral

Health in the

PCPCH

Public Health

Home Nurse

Universal

Prenatal

Screening

Alternative

Payment

Methodology

Primary Care

Psychiatric

Consultation

Licensed Clinical

Social Worker in

the PCPCH

Complex

Chronic Care

Management

Pediatric

Medical Home

Child Pyschiatry

Capacity

Building

Prevention,

Health Literacy,

and

Immunizations

Childhood

Vaccine

Attitude &

Information

Sources

Community

Paramedic

Youth

WrapAround

and Emergency

Shelter

Tri-County

Family

Advocacy

Training

Certified

Medical

Assistant

Scribes

Community

Health Worker

Outcome

Achievement9.46 3.91 6.70 8.20 9.22 7.89 9.23 8.36 7.50 8.67 8.86 8.29 8.60 8.00 8.83 8.29 9.73 9.38

Measurement

Sufficiency8.54 4.64 6.60 7.50 7.89 7.33 8.50 7.82 7.60 8.56 8.71 8.14 8.40 5.67 8.68 7.71 8.27 9.00

Improved Health

Outcomes5.08 6.00 7.80 8.30 8.67 7.33 8.85 8.82 8.00 8.67 8.43 7.71 4.60 7.17 8.50 6.71 7.43 9.07

Reduces Costs 2.00 4.64 5.20 6.10 6.75 1.89 9.33 7.27 7.00 6.56 7.57 6.71 2.20 6.17 6.17 5.14 6.71 7.88

Improved Access 2.15 5.64 7.10 8.60 8.22 7.56 9.92 7.09 8.20 8.67 8.86 8.50 3.20 7.83 9.17 6.29 9.00 8.93

State Metrics 1.77 1.09 3.90 8.00 9.11 7.89 9.69 6.82 6.80 8.63 7.43 7.00 4.60 7.00 7.67 3.43 7.71 6.93

Transformational 6.77 5.55 6.40 7.30 7.25 7.13 9.00 8.36 8.00 8.56 9.29 8.00 4.40 7.33 8.83 7.00 7.64 9.44

Barriers 9.46 8.09 7.00 7.60 8.89 6.56 9.33 7.36 8.60 8.11 8.71 7.57 7.80 8.00 8.50 7.14 8.53 8.88

Scalable 7.92 5.00 6.60 7.78 9.00 7.56 9.42 8.30 7.60 8.67 9.00 7.43 5.00 6.33 8.33 6.57 8.20 6.87

Replicable 9.85 5.80 6.90 8.22 8.78 7.78 9.54 8.00 7.60 8.67 8.57 7.67 5.00 6.67 8.50 6.71 9.29 8.50

Self-Sustaining 3.31 4.60 6.20 7.20 7.78 6.67 9.00 7.09 7.00 8.56 8.43 6.67 4.40 3.67 7.17 4.43 8.57 7.13

Number of Reviews11 10 10 9 9 14 11 5 9 7 7 5 6 6 7 15 16

Very Low Low Mid-Point High Very High

1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00

Graded Color Scale

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Rev 7/25/2017

Certified Medical Assistant (CMA) Scribes Samaritan Family Medicine Residency Clinic

Dates: 10/1/2015 – 3/31/2017 Pilot Funds Used $270,233

CMA Scribes increases provider efficiency and improves provider compliance with regulatory requirements for documenting quality of care by training Medical Assistant staff to scribe office visits allowing the physician to focus on the care of the patient. A new staff classification (CMA 2.0) was to be created reflecting the additional skills and training required to fulfill the duties of this new role that combines traditional CMA duties with documentation of the office visit and assuring appropriate medical home services.

Key Findings: 1. Using certified medical assistants as scribes was too difficult to implement. The lack of staffing and turnover of CMAs within our community does not

create a sustainable situation. 2. Implementing scribes can have a direct impact on provider job satisfaction and efficiency, but have little impact on staff workflow. 3. The cost of scribes can be offset with a small increase in productivity. The increase in provider efficiency allows for additional appointments per clinic day.

The increase in available appointments to patients increases access.

Additional Information: 1. The scribe pilot will be sustained moving forward pending sustaining increased productivity and reduction of costs. 2. The greatest outcome of this pilot was increased provider satisfaction. 3. The impact of scribes is expected to continue. The scribe and CMA have proven to be the most two influential positions for a provider to rely on to reduce

their workload throughout the day.

Community Health Worker Benton County Health Services

Dates: 4/1/2016 – 12/31/2016 Pilot Funds Used $377,245

The pilot provides qualified Community Health Workers (CHWs) and Health Navigators (HNs) as part of the IHN-CCO members care team. CHWs/HNs provide assistance that is culturally and linguistically appropriate to members who need to access services and participate in processes affecting their care. The pilot uses CHWs/HNs who share ethnicity, language, socioeconomic status, and/or life experiences with the residents of the communities they serve to provide a range of services. These services include health education and information, health care system navigation, care coordination, limited case management, outreach, chronic disease self-management education and support, referrals to social service and community resources.

Key Findings: 1. Benton County Health Services (BCHS) successfully hired, trained, and integrated CHWs/HNs into their new clinical care teams. 2. Touch data shows increasing use of CHW services across all sites; also showed which services CHW/HN most connected to. 3. Important to have a project champion, provider or nurse, as well as a project lead, ideally clinic manager or supervisor. 4. Comprehensive list of documents that can be shared with other agencies or CCOs and that can act as a roadmap to integrating CHWs/HNs into a clinical

setting.

Additional Information: Currently, the CHW/HNs are being contracted with IHN-CCO through a PMPM payment. BCHS is working with IHN-CCO to determine if this is the best way to do this and if so, what is the best methodology going forward.

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Innovator Agent Update for IHN CCO Delivery System Transformation (July 27th, 2017)

• OHA’s Metric and Scoring Committee met on Friday, July 21st and finalized the 2018 Quality Pool and Challenge Pool Metrics. 2 Metrics were removed (CAHPS Satisfaction with Care and F/U after MH Hospitalization) and 2 new Metrics were added (Child Obesity and a Disparity Measure related to ED Utilization by OHP Members with SPMI). The Challenge Pool will shift from it’s past clinical focus to 4 of the Quality Pool measures related to Early Childhood Health (Childhood Immunizations, Developmental Screening, Assessments for Children in Foster Care and Timely Prenatal Care. Technical specifications for the measures will be guided by the Technical Advisory Workgroup (TAG). To follow the work of the TAG or listen in on their meetings: http://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Metrics-Technical-Advisory-Group.aspx

• The OHA Office of Equity and Inclusion (OEI) DELTA program is currently recruiting for their next cohort. Participants will meet for one or two full days per month, September 2017–April 2018, while concurrently working on health equity-related projects to bring back to their respective organizations. DELTA is a comprehensive health equity and inclusion leadership program that strategically provides training, networking and consultation to health, community and administrative leaders throughout Oregon. Travel reimbursement and CMEs may be available. DELTA cohort members meet throughout the state for:

• Approximately 40 hours of classroom training and technical assistance around developing, improving, complying with and institutionalizing health equity policies and practices within organizations and the communities they serve;

• Building health-equity resources and cross-sector networking • Identifying individual, transformative and concrete actions to take from training and relationships within the cohort.

Applications are open for health leaders from all Oregon counties. Apply by 5 p.m. August 31. Complete the application here:

http://www.surveygizmo.com/s3/3653394/DELTA-on-line-Application-2017-18

• OHA has released an infographic that will be helpful for those who are applying for OHP or those who are new to OHP/CCO coverage.

The English and Spanish versions are attached, with more languages available based on need. The “Getting to Care” infographic is appropriate for distribution within community and clinical partners and settings. Please feel free to copy and share in your networks.

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No 2018 CCO Incentive Measures

1 Child obesity - BMI, nutrition and activity counseling

2 Diabetes HbA1c control

3 ED utilization - general pop

4 Smoking prevalence

5 Childhood immunizations*

6 Colorectal cancer screening

7 Dental sealants for children

8 Developmental screening*

9 Disparity Measure – ED utilization of members with mental illness

10 Assessments for children in foster care (physical, mental, dental)*

11 CAHPS - access to care (bundled)

12 Controlling high blood pressure

13 Depression screening

14 Effective contraceptive use

15 PCPCH

16 Timely prenatal care*

17 Adolescent well-care visits

*=challenge pool (Challenge pool focuses on early childhood health; Committee wants to get to a measure of kindergarten

readiness in the future).

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See if you qualify.2OHP will process your application. You will get a letter if OHP needs more information. If you have not heard if you qualify within 45 days, call OHP Customer Service at: 1-800-699-9075 (TTY 711).

Renew each year.5Apply.1

Getting started with the Oregon Health Plan (OHP)

Use your benefits.3If you qualify, you can see a doctor, get emergency care and fill prescriptions right away — even before you get your OHP ID card.

You need to renew your OHP every year so you don’t lose coverage. OHP will send you a letter when it is time to renew.

Connect with your CCO. 4

OHP

9042

A (5

/17)

Go to OregonHealthCare.gov to see your options for applying.

If you need help, contact an OHP-certified community partner. To find one:

• Visit OregonHealthCare.gov• Call OHP Customer Service at

1-800-699-9075 (TTY 711).

You will get an approval letter and then a coverage letter from OHP. They will have important information about your coordinated care organization (CCO)*, your OHP ID and more.

*If you have an urgent health problem or if you do not have a CCO, call the OHPNurse Advice Line at 1-800-562-4620 (TTY 711) to find a doctor who acceptsOHP. If you have questions about a CCO, call OHP Client Services at1-800-273-0557 (TTY 711).

A week or two after your OHP coverage begins, you will get a welcome packet from the CCO managing your health care.

Call your CCO:

• If you do not receivethe welcome packet.

• To find a doctor.

Call OHP Client Services at 1-800-273-0557 if:

• You need helpreaching your CCO.

To request this document in other languages, large print, braille or a format you prefer, call OHP Customer Service at 1-800-699-9075.

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Descubra si reúne los requisitos.2El OHP procesará su solicitud. Recibirá una carta si el OHP necesita más información. Si no ha recibido noticias en un plazo de 45 días sobre si reúne los requisitos, llame al Departamento de Atención al Cliente del OHP al: 1-800-699-9075 (TTY 711).

Renueve cada año. 5Presente su solicitud.1

Introducción al Plan de Salud de Oregon (OHP)

3Si reúne los requisitos, puede ver a un médico, recibir atención de emergencia y surtir recetas de inmediato, incluso antes de recibir su tarjeta de identificación del OHP.

Necesita renovar su OHP cada año para no perder su cobertura. El OHP le enviará una carta cuando sea tiempo de renovarlo.

Conéctese con su CCO. 4

SP O

HP 9

042a

(5/1

7)

Visite OregonHealthCare.gov para ver cuáles son sus opciones para presentar su solicitud.Si necesita ayuda, comuníquese con un socio comunitario certificado por el OHP. Para encontrar uno:• Visite OregonHealthCare.gov• Llame al Departamento de Atención al

Cliente del OHP al 1-800-699-9075(TTY, para personas con problemasauditivos: 711).

Usted recibirá una carta de aprobación y, más adelante, una carta de cobertura del OHP. Estas incluirán información importante sobre su Organización de Atención Coordinada (CCO, por sus siglas en inglés)*, su identificación del OHP y más.

*Si tiene un problema urgente de salud o no cuenta con una CCO, llame a la línea deconsejos de enfermería del OHP al 1-800-562-4620 (TTY 711) para encontrar un médicoque acepte el OHP. Si tiene preguntas sobre una CCO, llame a Servicios al Cliente del OHPal 1-800-273-0557 (TTY 711).

Una o dos semanas después de que comience su cobertura del OHP, usted recibirá un paquete de bienvenida por parte de la Organización de Atención Coordinada (CCO, por sus siglas en inglés) que está administrando su atención de salud.

Llame a su CCO:• Si no recibe su

paquete de bienvenida.

• Para encontrarun médico.

Llame a Servicios al Cliente del OHP al 1-800-273-0557 si usted:• Necesita ayuda para

comunicarse con su CCO.

Para solicitar este documento en otros idiomas, letra grande, braille o en un formato que usted prefiera, llame al Departamento de Atención al Cliente del OHP al 1-800-699-9075.

Use sus beneficios.

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Samaritan Health Plans 2017 Legislative Session Summary

July 12, 2017

Highlights: Oregon’s health system moved in a very different direction this session in contrast to what is happening in Washington DC. The Oregon Health Plan and Medicaid program was fully funded to continue current coverage and benefits without increasing requirements for recipients. A women’s reproductive health law was passed and funded that outlines a broad range of services to be provided without cost share, it expanded access to services for women eligible for Medicaid except for immigration status, extends postpartum care for 60 days for women in the CAWEM program, and requires coverage for abortion in nearly all health plans. Cover All Kids legislation and funding will provide medical assistance to children up to 300% federal poverty level who reside in Oregon, it is estimated that over 14,000 children would receive medical assistance in 2017-2019. A reinsurance pool was created to help offset high cost insurance claims and stabilize the individual market. A number of bills were passed focusing on improvements in the mental health system, including some additional funding to the community-based service system.

Missed Opportunities: The legislature was not able to come to agreement controlling the growth of prescription drug costs or increasing the transparency around pricing. This area continues to be one of the biggest drivers to cost in the health care system. Creating policy direction for the future of CCOs was left on the table; the five year contract cycle for CCOs is expiring in 2019 without new legislative direction. There was no movement toward improving the OHP eligibility, enrollment, and re-enrollment process or increasing the populations enrolling in CCOs. There continues to be between 15% and 18% of people eligible for OHP who are not enrolled in a CCO.

Budget: The OHA budget (HB 5026) and revenue (HB 2391B) bills were the first big budget pieces to come together for the legislature and the Governor. The package represents shared sacrifice across the health care sector, both cost containment and new revenue, to fill the $934 million OHP budget gap. The bills include hospital and insurer taxes as well as reductions in CCO rate of growth. Key components include; an insurer premium tax of 1.5%, additional tax of .7% on net revenue of large hospitals, and reductions in the rate of growth in the CCO global budget from 3.4% to 2.58%. For IHN-CCO, the provider tax would be a pass through matching scenario that has been used in the past. These and other actions will maintain the current OHP coverage for eligibility and benefits.

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The OHA has reductions in their fee for service budget, including the removal of $5 million to encourage the movement of around 60,000 individuals to CCO enrollment. There are new Key Performance Measures to track the processing time for eligibility determinations and the percentage of OHP members enrolled in CCOs. There are also two budget notes to conduct a rate review of the mental health residential rates and the other is to provide a report to the Legislature by December 2018 on each regions governance model and single plan of shared accountability for behavioral health system.

A government cost control bill (SB 1067) was passed that focuses on government efficiencies. Health system impacts include PEBB and OEBB to adopt cost growth limits of 3.4% per year and limits hospital reimbursement of in-network hospitals at 200% and out-of-network at 185% of Medicare for most hospitals. This late session bill addresses the state employee health insurance cost growth but does it on the backs of other payers, providers, and hospitals.

Legislation Related to CCOs that Passed

HB 2015: Related to Doula’s. Original language establishes a rate of $350 per pregnancyfor Doula’s. However, OHA was able to increase the FFS rate to this amount as of May1, 2017. This bill requires CCO to make information available about how to access thisservice; OHA shall study and revise rates, and report to OHPB regarding utilization ofDoula services. Effective date January 1, 2018.

HB 2300: Creates Mental Health Clinical Advisory Group to establish medicationalgorithms for prescription drugs to treat mental health disorders. Drugs will still bemanaged FFS through OHA up to 2020.

HB 2303: Changes the date for CCOs to report primary care spending and some othertechnical fixes for OHA. Effective date January 1, 2018.

HB 2310: Provides for continued development of Public Health Modernization efforts,requires OHA to establish metrics to measure progress and clarifies when counties canrelinquish their local public health authority to the state. $5 million allocated for thiseffort.

HB 2398: Prohibits providers from billing OHP recipients for 90 days and they mustrecheck MMIS before billing. Effective date January 1, 2018.

HB 2675: Requires the Community Health Improvement Plan and the CommunityAdvisory Council to focus on the integration of physical, behavioral, and oral health.Effective date January 1, 2018.

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HB 2882: Requires CCO Board membership for a DCO representative. Effective date,June 22, 2017.

HB 3063: Provides funding for mental health housing fund for the development ofcommunity-based housing, including licensed residential treatment facilities, as well ascrisis intervention services, rental subsidies, and other housing-related services forindividuals with mental illness and individuals with substance use disorders.

HB 3090: Requires all hospitals to have discharge policies following treatment for abehavioral health crisis. Effective date, October 6, 2017.

HB 3091: Requires CCOs and group insurers to cover behavioral health servicesdetermined medically necessary. Mental health parity bill. Effective date January 1,2018.

HB 3276: Requires insurers and CCO to cover to cover the costs of health services tocombat a disease outbreak or epidemic. Requires public health director to convene taskforce related to improving health insurance coverage for students and use ofvaccinations during public health emergencies.

HB 3355: Allows specially trained psychologists, who are practicing in a medical setting,to prescribe a formulary of mental health drugs.

HB 3372: Requires CCOs to provide and health assessments within 60 days to childrenand foster care and report data regarding barriers to completion. OHA to report toLegislature on work with DHS and CCOs on action taken to increase completion.Effective date January 1, 2018.

HB 3391: Requires insurers and CCOs to provide coverage of reproductive healthservices for women without cost share, provides OHP coverage for 60 days after givingbirth. Cost is $10 million in general fund.

HB 3440: Addresses treatment for opioid dependency, removes special trainingrequirements for prescribing, dispensing, and distributing naloxone.

SB 419: Establishes a task force on Health Care Cost Review to study the feasibility ofestablishing a hospital rate-setting process. Requires recommendations to be submittedby September 15, 2018.

SB 558: Provides OHP coverage to children regardless of federal citizenship status.Program is not eligible for federal matching funds so the cost is $36 million state generalfunds. Approximately 15,000 children under the age of 19 will be eligible.

SB 754: Makes it illegal to sell tobacco products or vaping supplies to anyone under age21 but it is not illegal to possess those products.

SB 934: Requires all insurers to spend at least 12% of total medical expenditures onprimary care by January 1, 2023. Requires CCOs to submit a plan to OHA to increasespending by 1% per year if below 12%. Effective date January 1, 2018.

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SB 944: Establishes the Youth Acute Behavioral Health Council and Policy Advisor inOffice of the Governor, directs OHA to contract with an Oregon-based non-profit tooperate a 24 hour call center to track capacity placements available for youth needinghigh acuity behavioral health services. Allocates $833,690 general fund.

Legislation Related to Health Plans that Passed

HB 2339: Prohibits out of network health care provider from balance billing patientcovered by a plan or contract for services provided at in-network health care facility onMarch 1, 2018. Requires DCBS to convene an advisory group and report to Legislatureby December 31, 2018 legislative changes needed to implement recommendations.Effective date, June 22, 2017.

HB 2388: Allows DCBS to deny, revoke or suspend registration of pharmacy benefitmanager engages in specified conduct. Effective date, May 17, 2017.

HB 2397: Directs state Board of Pharmacy to establish by rule formulary of drugs anddevices that pharmacist may prescribe and dispense. Effective date, May 18, 2017.

HB 2340: Grants DCBS flexibility to re-admit an insurer to a market within the 5 year banof an insurer leaving a market. Effective date January 1, 2018.

HB 2341: ACA alignment, technical fixes. Effective date, May 25, 2017. HB 2342: Market stabilization bill that allows DCBS to adopt rules not in compliance

with Insurance Code to deal with potential Federal changes that could cause imminentdestabilization of insurance market or risk life or health of residents. Sunsets July 1,2019.

HB 2527: Allows pharmacists to prescribe and dispense self-administered hormonalcontraceptives and bill for consultation. Further refinement of the pharmacistsprescribing policy. Effective date, June 14, 2017.

HB 3091: Requires CCOs and group insurers to cover behavioral health servicesdetermined medically necessary. Mental health parity bill. Effective date January 1,2018.

HB 3276: Requires health benefit plan coverage of health services necessary to combatdisease outbreak or epidemic. Requires public health director to convene task forcerelated to improving health insurance coverage for students and use of vaccinationsduring public health emergencies.

HB 3355: Allows specially trained psychologists, who are practicing in a medical setting,to prescribe a formulary of mental health drugs.

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HB 3391: Requires insurers and CCOs to provide coverage of reproductive healthservices for women without cost share, provides OHP coverage for 60 days after givingbirth. Cost is $10 million in general fund.

SB 271: Modifies the definition of small employer for the purposes of group healthbenefit plans to 50 or less FTE. Effective date January 1, 2018.

SB 368: Prohibits insurer from denying claim for reimbursement of health care servicesprovided to an insured who is in detention pending adjudication by juvenile court.Effective date, October 6, 2017.

SB 419: Establishes a task force on Health Care Cost Review to study the feasibility ofestablishing a hospital rate-setting process. Requires recommendations to be submittedby September 15, 2018.

SB 860: Requires DCBS to examine parity of reimbursement paid by insurers to mentalhealth providers and physicians, and adopt rules to ensure compliance with mentalhealth parity and network adequacy requirements.

SB 934: Requires all insurers to spend at least 12% of total medical expenditures onprimary care by January 1, 2023. Requires CCOs to submit a plan to OHA to increasespending by 1% per year if below 12%. Effective date January 1, 2018.

SB 1067: Cost containment bill to focus on government efficiencies. Health systemimpacts include PEBB and OEBB to adopt cost growth limits of 3.4% per year and limitshospital reimbursement of in-network hospitals at 200% and out-of-network at 185% ofMedicare for most hospitals.

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Final Report and Evaluation Pilot Dental Medical Integration (DMI) for Diabetes

Use the following format to provide a summary of your project. Please include:

A. Amount of pilot funds used. Were additional funds used from other sources? If so, how much?$48,590.51 was spent of pilot funds (42.4% of pilot funds). Pilot activities proved to be less costly thananticipated resulting in a remaining budget of $66,139.49.

• Dental Program Clinical Coordinator: The bulk of funds supported the position of Dental ProgramClinical Coordinator to aid in pilot coordination, data collection and analysis, as well as otherInterCommunity Health Network (IHN) CCO assigned duties. Pilot funds were only allocated for timespent working on pilot designated activities. Samaritan Health Plans and the dental plans found merit inthis position and together contracted funding to sustain this position full time.

• Oral Hygiene kits: The oral hygiene kits included any purchase of a denture care kit, brushing aids, andor electric toothbrush.

• Care Coordination: The cost of care coordination reimbursement for the medical clinics was based onthe fee for service model. The medical clinics received $10 for every dental screening conducted on IHNdiabetic members. The final amount distributed totaled $6,750.

• Direct Mailers: The direct mail piece went out to new members every month as a reminder to our targetpopulation that they had dental benefits and included their dental plan phone number needed to calland schedule an appointment. In August 2016, a gift card incentive was incorporated with the directmailer. Once a quarter the incentive mailers were sent to every eligible member who had not seen theirdentist and every new member each month.

• Lunch and Learns: With each new clinic and each new year a lunch and learn was conducted. A dentalprofessional would conduct a brief 30 minute overview of the links between oral health and systemichealth, what the screening entailed, and the monthly data that would be collected.

• Patient Education: Patient education in the form of clinic posters and educational brochures wereordered to engage members in their coverage of dental benefits.

$66,139.49 $26,258.96

$8,885

$6,750

$3,831.50

$1,982.53

$882.52

Budget spending

Unspent

Dental Program ClinicalCoordinator

Oral hygiene kits

Care coordination

Direct mailers

Lunch and Learns

Patient education

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B. Final Measures and a brief narrative/summary of Goals, Activities, Measures, and Results.

Goal Measure(s) Activities Results to Date

Member Communication. Mailer response rate 2015: Educational and dental assignment/contact reminder mailer.

Target: 50%

Measure Outcome: 5%

2016: Educational and dental assignment/contact incentive mailer.

Lower healthcare cost for IHN-CCO members through delivery system integration.

Medical to dental warm handoffs

Referrals from Medical staff to dental plan/clinic.

Target: 75%

Measure Outcome: 94%

Oral health screening questions asked

Dental screening questions asked by medical staff to determine need for a dental referral.

Target: 90%

Measure Outcome: 97%

Dental to medical warm handoffs

Referrals from Dental staff to medical clinic.

Target: 75%

Measure Outcome: 100%

Medical screening questions asked

Medical screening questions asked by dental staff to determine need for a medical referral.

Target: 90%

Measure Outcome: 86%

Dental Utilization.

Medical utilization.

Patients seen by Primary Care Dentist post medical to dental referral.

- 55% According to pilot tracking data.

Missed Primary Care Dentist appointments after medical warm handoff

- 1.4% According to pilot tracking data.

Number of prophylaxis administered

- To be submitted July 31st, 2017.

Number of periodontal treatments administered

- To be submitted July 31st, 2017.

Patients seen by Primary Care provider post dental to medical referral.

- 89% According to pilot tracking data.

Missed Primary Care Provider appointments after Primary Care Dentist warm handoff

- 0 According to pilot tracking data.

Clinical Outcomes A1C levels – Sample size Chart Reviews

- 61% of Pilot based sample size population showed an improvement in their A1C levels from 2015 and 2016 data.

Probing Depths – Sample size Chart Reviews

- Our chart review findings show that members who utilize their dental benefits are more likely to have improved or sustained a

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Results Narrative:

Numerator- All of the DMI pilot members who responded to the direct mail piece. Denominator- All DMI pilot

population.

Numerator- The number of DMI pilot members screened by PCP/staff. Denominator- The number of DMI

pilot members seen by PCP.

Target 2015 2016

NationalAverageMailer

Response

NationalAverageDigital

ResponseMailer Return Rate 50% 2% 5% 3.70% 0.62%

0%10%20%30%40%50%60%

Mem

ber p

erce

ntag

e

Mailer Response Rate

Target OutcomeDental Screenings 90% 97%

86%

88%

90%

92%

94%

96%

98%

Mem

ber P

erce

ntag

e

Dental Screening Compliance

healthy oral cavity regardless of pilot intervention.

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Numerator- The number of DMI pilot members who receive/accepted a dental referral. Denominator- The number of DMI pilot members screened by PCP/staff that indicated a need for a dental referral.

Numerator- The number of DMI pilot members screened by PCD/staff. Denominator- The number of DMI pilot eligible members seen by PCD.

Numerator- The number of DMI pilot members who received/accepted a medical referral. Denominator- The number of DMI pilot screened by PCD/staff that indicated a need for a medical referral.

C. What were the most important outcomes of your Pilot?

Target OutcomeM2D WHO 75% 94%

0%20%40%60%80%

100%

Mem

ber P

erce

ntag

e

Medical to Dental Warm Handoffs (M2DWHO)

Target OutcomeMedical Screenings 90% 86%

84%85%86%87%88%89%90%91%

Perc

enta

ge R

ate

Medical Screening Compliance

Target OutcomeD2M WHO's 75% 100%

0%

20%

40%

60%

80%

100%

120%

Perc

enta

ge R

ate

Dental to Medical Warm Handoffs (D2MWHO)

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Many of the medical and dental professionals that engaged agreed that the most important outcome that emerged from the pilot was providing oral health patient education, dental resources, and cross-system coordination within a medical office setting. A medical clinic participant stated, “Being able to educate patients about their dental coverage and resources available was the most important outcome of the pilot. Being able to answer questions and give the name and phone number of who to contact was a valuable tool in educating our patients.” Year two of the pilot brought its own success with relief for Edentulous (no teeth) members. In year two, medical clinics were able to better address these members specific needs with a denture care kit (denture brush, denture case, denture adhesive paste, and education) as well as offering an overview of what the Oregon Health Plan (OHP) covered for denture care. In July of 2016, OHP expanded their denture coverage from no denture replacements to one denture replacement every ten years. With the DMI pilot we found it was not only important to educate medical providers on healthy dental habits but also to have open communication between provider and IHN to provide up-to-date dental benefit coverage to ensure consistent communication for IHN members across the region. Along with the importance of educating the patient, soon came the importance of educating the medical provider and staff. With the dental screening being conducted by the medical staff, oral health questions arose which many medical staff did not feel they had the training to answer. At the beginning of the pilot each clinic received a brief dental training from an oral health professional. As the pilot continued into its second year and additional training was requested, it became apparent that continued oral health education for medical providers and staff was essential in breaking down the siloes between medical and dental and moving towards truly integrated care.

D. How has your Pilot contributed to Triple Aim of improving health; increasing quality, reliability, and availability of care; and lowering or containing the cost of care? Lower Cost – According to our cost analysis the variability over the years means that we cannot determine if the pilot participants PMPM costs are rising at a lower rate than non-pilot participants. It is recommended that this data be re-analyzed with 2017 and possibly 2018 claims data to see if it shows a rate of growth difference between non-pilot and pilot participants. Better Access – Our data shows that out of the medical patients who needed a dental referral, 55% made a connection with their PCD post medical intervention. Out of the dental patients who needed a medical referral, 89% made a connection with their PCP post dental intervention. Quality Care – Our pilot measures show successful implementation of oral health screenings and dental referrals by medical office staff. Provider Burnout – Although no measureable tracking was done to collect data for this aim, it is worth mentioning that only 1 out of our 8 medical clinics implemented workflow that required the PCP to conduct the dental screenings. The other 7 clinics implemented workflow that encouraged medical assistants and care coordinators to expand their duties to include oral health screenings and dental referrals. This workflow results in quality care growth without adding more burdens to the PCP. “The dental pilot contributed to the Triple Aim care by helping us identify patients that we needed to educate on resources and options available to them to get them the dental care that they needed. Often times we were seeing the same patients go to the Emergency Dept. to get dental care when what they really needed was to see their dental provider and to be educated on getting proper dental care. By identifying and educating these individuals from the PCP office, we were able to help improve their health, decrease unnecessary ED visits and help improve the quality of their lives.” – Medical clinic pilot participant.

E. What has been most successful? According to the measurable data the dental screening compliance proved to be the most successful activity of the pilot. The dental screening was a two question interface between member and medical staff within a participating pilot clinic. With eight medical clinics participating there were multiple approaches to conducting each screening. The workflows that proved to be most effective include the use of multifaceted phases and interdepartmental staff communication. This approach had limited disturbance of physician time with patients.

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However, the success did not stop at the screening. The medical clinics were supplied with a dental contact list and were able to refer members to the appropriate resource achieving a referral rate of ninety-four percent and exceeding the target rate by nineteen percentage points. Once enough dental claims data was collected, the medical clinics were supplied with a correspondence document that indicated which of their medical patients had a dental visit in the last twelve months. This allowed for even more accuracy and attention to be focused on the patients oral health within a medical office setting. Another success that occurred was within the dental clinics as they achieved a one-hundred percent of members who needed a medical referral from a dental office received one from their dental provider and staff. This was due in part to open communication between the dental plans and the IHN dental coordinators. Leaving open communication between these entities allows for accurate placement and better quality of overall care. The final success was conducted by the Lincoln County participants, implementing DMI screenings, referrals, and data collection within 30 days.

F. Were there barriers to success? How were they addressed? The initial barrier was medical clinic involvement. The idea of dental medical integration was fairly new within our region two years ago and it was often difficult to engage the right clinic participant. The pilot start date was February 1st, 2015 and the first monthly report wasn’t submitted until April of 2015 with spotty reporting until July 2015. To address this barrier dental health education was given as well as hiring a dental program clinical coordinator to coordinate the dental medical integration pilot. This allowed for a continued bi-monthly contact between IHN and the medical clinics allowing for regular data reminders, open communication for questions or difficult care coordination, and overall guidance of implementation. With this open communication the medical clinics were able to voice the concern of another barrier to screening. Many medical clinics participate in other pilots, Quality Improvement Projects, state metrics, as well as Performance Improvement Projects and receive payment for the extra work being done. The pilot budget allowed for payment of care coordination within the medical clinic setting furthering the appeal to implement the much needed service of a dental screening and care coordination. A member’s unwillingness to engage with their dental provider was also presented as a barrier. Patient education was provided, however during the post pilot review it became clear that the education provided had little effect on member’s interest due to the language layout of the brochures. A barrier that quickly emerged was the trial of a dental warm handoff from the medical staff. The original thought for connection between medical staff and dental staff was to engage with a personal phone call from the medical office to the dental plan/clinic to aid in scheduling the patient while they were in the medical office. The main occurrence that recurrently presented was long wait times when calling the dental plans as well as the dental clinics. With most of the medical offices reporting a wait time of an hour the warm handoff requirement was changed to a dental referral. The success of a dental warm handoff occurred within the medical clinics that house an Expanded Practice Co-Located Dental Hygienist (EPDH). All IHN members can receive dental assessments regardless of dental plan assignment by these EPDH’s. However, the referral to the assigned dental home still needed to occur by the medical staff. The co-located EPDH’s were NOT an outcome of the pilot; however it further encouraged provider engagement of dental medical integration. Another barrier emerged in regards to electronic health records (EHR). The medical clinics found it to be difficult and labor intensive to conduct the dental screening. With no flags or reminders within a member’s EHR and no way to officially document the screening results, it left the medical staff to track everything manually. With cross-facility communication the participants were able to share best practices and workflow effectiveness in regards to flagging schedules to ensure that staff knew which members needed a dental screening. An Epic flowsheet was also developed that when accessed showed the screening questions and indicated if a referral was needed after the screening. Another barrier that presented throughout the life of the pilot that deserves further discussion is the closed loop referral. All of the medical clinics voiced concern that after a referral was made there was no correspondent communication to inform the medical provider if that member was seen, by whom, and what for. A correspondence log was trialed for a brief period of the second year, however due to limited employee resources the logs were often returned months later than expected and this pathway did not allow for direct

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communication between the primary care provider and the primary care dentist. This goal was never achieved during the life of the pilot leaving a major barrier to the quality of care for the IHN population.

G. How readily would the pilot be scalable or replicable? Describe cautions and considerations when consideringscaling, or replicating the Pilot. (i.e. Success dependent on personality/skills set, or activities appropriateunder certain conditions like size, target population, etc.)Many aspects and activities of the pilot can easily be implemented system and/or region wide. For example,many of the medical clinics have voiced the importance of the dental screenings and expanding this service to allof their IHN-CCO patients. The concept of dental practices within a medical clinic, what was once foreign andintimidating, has now proved its relevance and its implementation within these medical clinics has naturallyexpanded to aim for a higher goal of entire IHN-CCO clinic population inclusion. However, the barrier of a closedloop referral, universal EHR tracking, appropriate patient and provider education, and employee turnover aremain concerns that when not addressed makes navigating through systems and resources difficult for memberand provider engagement.With the continued efforts of the dental integration workgroup some of these barriers will be addressed.However to ensure the quality of care is not overlooked with dental medical integration a higher level discussionneeds to occur in regards to continued oral health education for medical providers as well as a solution for aclosed loop dental referral and easy communication between primary care providers and primary care dentalproviders.

H. Will the activities and their impact continue? If not, why?Three out of the eight medical clinics have co-located EPDHs and will continue to screen and refer theirmembers to this onsite service.Half of the medical clinics have verbally expressed they will continue dental screenings within their workflow

and expand to include populations other than IHN-CCO diabetics.Many medical clinics explained an added benefit of the pilot was being able to offer an oral hygiene kit afterstressing to the member the importance of oral health and the connection to overall health and wellness. Thebudget allowed for a bulk purchase of oral hygiene kits to help supply the medical clinics with another year oforal hygiene kits. However, supplies will run out and the dental integration workgroup are looking for otherfunding avenues to continue this benefit in the future.All dental plans have expressed they will continue screenings and referrals as needed and continue in the effortof dental medical integration.The direct mail piece activity missed the target of a 50 percent response rate. However, the response rateexceeded the national average by 1.3 percentage point. The dental integration workgroup will further analyzecollected pilot data around this activity and decide at a future date if these efforts were effective.The Dental Integration Workgroup will continue to hold quarterly meetings as well as continue the collaborativeefforts to expand dental medical integration within our region while using the evidence and guidance we havecollected from this pilot.

“This pilot has really been able to help us identify patients that need outreach so we can educate them on theirdental care and help get them connected to their providers! It is a fantastic project and I am so thankful that ourclinic has been able to participate! Making this sustainable so that it can continue and keep moving forwardwould be a great step in the right direction towards holistic care.” – Medical pilot participant.

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