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 populationImproved 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 OregonColumbia Pacific CCOJackson Care ConnectYamhill County Care

OrganizationPrimaryHealth 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