mac social determinants of health survey january …...–ducation (e.g., elhub partner) e –dverse...

MAC Social Determinants of Health Survey

January 2018 Results

June-Sept 2017 Oct Nov Dec

Jan 2018

March April May 23

PHASE 1

PHASE 2

PHASE 1

Committee

background

and work

plan

Final work

products

approved

SDoH

definition

drafted

April 25

Approve final

framework

(Phase 1)

Apr 18

HRS guide(s)

drafted

Mar 12

consultation

with CCOs at

QHOC

Full SDoH

framework

(definition,

roles) drafted

Jan 24

• Priority area(s)

for health

related

services

guide(s)

identified

• Approve draft

framework

Jan 1-15

SDoH

Stakeholder

survey

fielded

SDoH

stakeholder

survey

created

Milestone 1

Milestone 2

Milestone 3

Milestone 4

Milestone 5&6

*We are

here!

What will we do with the data today?

MAC SDOH Timeline & Critical Milestones

Who responded to the survey?

23

66 total respondents

Responses by CCO service area

24

What SDOH-related projects are CCOs and

partners doing?

• Projects focused on:

– Workforce development (e.g., CLAS training, utilizing THWs)

– Food insecurity (e.g., VeggieRx, Kitchen Garden project)

– Housing (e.g., funding partner orgs, supporting transitional housing)

– Infrastructure and training (e.g., health equity strategic plans, SDOH

workgroups, community ed on trauma-informed care)

– Education (e.g., ELHub partner)

– Adverse Childhood Experiences (ACEs)

– Environment (e.g., invest in local parks, improve air quality)

25

70% of partners indicated working with a CCO on addressing

SDOH

Are CCOs and partners targeting specific

populations in their SDOH work?

27

8

1

4

10 0

6

22

1

9

10 0

12

14

2

6

1 10

11

CCOs CACs Partners

How are CCOs & CACs prioritizing/

selecting their work in SDOH?

28

2

6

7

0

14

15

15

0

4

1

13

5

14

18

Leadership priorities (other)**

Through a member survey or screening

Identified promising practice

Through a CAC meeting*

Through CCO and CAC collaboration

Collaboration with partner organization(s)

Through a CHA/other assessment

CACs CCOs

*option for CAC survey, not CCO

**leadership priorities indicated as “other” response

What roles do CCOs play? (CCO responses)

29

Internal

training/

infrastructure

Policy

advocacy

APMs/

VBP

Data

supportWorkforce Collaboration Convener Utilize HRS Direct $$

Economic Stability

(e.g. poverty, food

insecurity,

homelessness)

53.3% 60.0% 33.3% 53.3% 73.3% 93.3% 66.7% 86.7% 100.0%

Neighborhood &

Physical

Environment (e.g.

transportation,

crime/violence)

60.0% 46.7% 33.3% 60.0% 46.7% 93.3% 66.7% 66.7% 80.0%

Education 60.0% 53.3% 26.7% 40.0% 46.7% 93.3% 66.7% 46.7% 93.3%

Community & Social

Context (e.g.

discrimination,

incarceration)

86.7% 46.7% 20.0% 53.3% 66.7% 86.7% 80.0% 53.3% 93.3%

Q: Please indicate the role(s) that your organization currently plays or has played

in the past in each of the identified areas of social determinants of health

Green >75% Blue 50-75%

Peach 35-50% Gray <25%

What roles do CCOs play? (partner responses)

Internal

training/

infrastructure

Policy

advocacyAPMs/ VBP

Data

supportWorkforce Collaboration Convener Utilize HRS Direct $$

No partner-

ship

Economic Stability

(e.g. poverty, food

insecurity,

homelessness) 14.81% 3.70% 11.11% 14.81% 3.70% 40.74% 14.81% 11.11% 18.52% 37.04%

Neighborhood &

Physical

Environment (e.g.

transportation,

crime/violence)14.81% 3.70% 11.11% 11.11% 3.70% 37.04% 7.41% 3.70% 22.22% 55.56%

Education7.41% 0.00% 0.00% 7.41% 0.00% 29.63% 11.11% 3.70% 18.52% 62.96%

Community &

Social Context (e.g.

discrimination,

incarceration) 19.23% 7.69% 3.85% 11.54% 3.85% 38.46% 7.69% 11.54% 19.23% 34.62%

30

Q: Please indicate the role(s) that a CCO currently plays or has played in the past in

each of the identified areas of social determinants of health in which your organization

works.

Green >75% Blue 50-75%

Peach 35-50% Gray <25%

Lilac 0

Most effective role for CCOs (CCO question)

31

Note: analyst categorized qualitative answers

12

6

3

1

1

1

1

Convener

Direct investment

General aligment/collaboration

Data/analytics/technology support

APMs/VBP

Workforce

Training/infrastructure changes

Other:

Offering unique perspectives to

community: (1) “global

perspective” of CCO, and (2)

member perspective via CAC

(n=14)

Priority areas for future work in SDOH

32

12

3

73%

85%

67%

53%

60%

48%

33%

50%

44%

CCO CAC Community Partner

Housing Trauma

Food or diaper insecurity Transportation (non-medical)

Early childhood education Employment support

Language & Literacy Parenting education

Discrimination Crime & violence (including domestic)

Incarceration Other (please specify)

Other priority areas for future work

• Environmental/neighborhood conditions, including safe,

affordable recreation

• Health equity and access

• Workforce development

• Social isolation

• Community engagement

33

What are the barriers to SDOH work,

according to CCOs?

34

6.7%

13.3%

20.0%

46.7%

80.0%

Not a current organizational priority

Lack of leadership support

Don't understand role/responsibility of CCO in SDOH

Don't see impact (member health/CCO ops)

Lack of partners/challenges collaborating

Don't know how to identify the need

Billing issues

Don't know how to engage in the work

Challenges prioritizing which area(s)

Lack of funding/funding challenges

Ba

rrie

rs

(n=15)

*Other:

• Slow return on investment

• Hard to spread risk across

stakeholders

• Lack of evidence-based

strategies

• Concerns about sustainability

Top areas of SDOH CCOs would like to

address using health-related services, but

are experiencing barriers

35

27%

0%

0%

7%

7%

7%

13%

20%

20%

27%

40%

80%

Other (please specify)*

Crime & violence (including domestic)

Discrimination

Employment support

Parenting education

Incarceration

Language & literacy

Food or diaper insecurity

Transportation (non-medical)

Early childhood education

Trauma

Housing

*Other:

• Environmental/neighborhood

conditions & safety

• Coordination of services

across systems (not just

health care)

• Workforce development

• Community engagement

(n=15)

Barriers to using health-related services

to address SDOH

36

80%

7%

7%

7%

7%

20%

20%

53%

60%

Other (please specify)

Don't know how to identify member needs

Don't know how to appropriately engage in the work

Lack of leadership support

Not a current organizational priority

Billing issues

Lack of partners/challenges collaborating

Challenges prioritizing which area(s) to work on/needsto address

Lack of funding/funding issues

(n=15)

Other barriers to using health-related

services

• Other funding challenges

– Lack of consistent vision for CCO global budget

– Dueling last resort funding pools

– Demand feels endless compared to CCO budget

• Safe harbors for funding housing

• Other partnership challenges

– Sharing risk

– Knowledge among partners re: SDOH, heath-related services, how to partner

• Difficulty evaluating impact

– Linking services provided to outcomes

– Proving ROI

• Administrative complexity

• Implementing consistent & fair treatment for all members within funding

restrictions

37

Other data to inform HRS guide topic

selection: OEI Modified Policy Delphi

(2012)

OHA’s Office of Equity and

Inclusion conducted a

series of surveys to a

panel of experts on the

topic of health inequities.

Full report: Engaging Oregonians in Identifying

Health Equity Priorities

SDOH-related policy priorities ranked

by importance:

1. Affordable and safe housing and

neighborhoods

2. Employment opportunities

3. Education opportunities

4. Access to healthy foods

5. Engagement with

government/health entities

6. Transportation

Table 6, pg. 27

38

Other data to inform HRS guide topic

selection: 211 Medicaid contact reports

(July 2016-June 2017)

Oregon 211 (toll-free

community resource line)

produces reports of top

needs of Medicaid-

enrolled contacts

• 7 of the top 10 basic

needs were housing-

relatedFull resource: Medicaid Contact Needs,

Oregon and SW Washington, June 2016-July

2017

Top 10 basic needs

• Electric Service Payment Assistance

• Rent Payment Assistance

• Community Shelters

• Low Income/Subsidized Private

Rental Housing

• Child Care Provider Referrals

• Transitional Housing/Shelter

• Rental Deposit Assistance

• Food Pantries

• Food Stamps/SNAP

• Water Service Payment Assistance

39

40

Questions?

MAC Health-related Services Guide

Priority Area Selection

Community prioritization - review

SDOH area CCOs CACs Community

Partners

OEI Equity

Priorities

Report

2-1-1 report

– Medicaid

caller needs

Housing 1 1 1 1 1, 2, 3*

Trauma 2 2 2

Food or

Diaper

Insecurity

3 3 3

Employment 2

Education 3

42

*Includes electric service payment assistance (utilities), rent payment

assistance, community shelters

MAC prioritization & voting

• Rank your top three priorities 1-3

• Each member identify top 1st, 2nd, 3rd priority

• Tally and identify top 1-2

• Discuss

• Come to consensus/vote on topic for health-

related services guide

(Enter) DEPARTMENT (ALL CAPS)

(Enter) Division or Office (Mixed Case)

43

MAC Draft Framework &

Recommendations

Addressing SDOH through Oregon CCOs

Committee Discussion

Recommendations outline

• Why social determinants of health in Oregon CCOs?

• Defining Social Determinants of Health in Oregon CCOs

• MAC recommendations on the role of CCOs in

addressing the social determinants of health

– 10 roles for Oregon CCOs

– MAC recommendations

– Considerations/risks

45

Definition – SDOH in Oregon CCOs (pg.

4)

Health begins where we live, learn, work, and play. The social

determinants of health are the social, economic, political, and

environmental conditions in which people are born, grow, work, live,

and age (see figure 3). These conditions significantly impact length and

quality of life and contribute to health inequities. The social

determinants of health are not fairly distributed in communities.

Distribution is shaped by a wider set of transformation agendas and

structures, such as norms, policies and political systems, both historical

and current. The social determinants of equity are structural factors,

such as racism, that determine how different groups of people

experience social determinants of health.

46

Social Determinants of Health & Equity

Factors (pg. 4)

47

Ten roles for CCOs to Address the Social

Determinants of Health (pg. 7)CCO Role Description ExampleDirect Investment Grants or more permanent funding to fund initiatives related to

SDOH, often by funding providers and community-based

organizations.

CCO provides grant to local farmers’ market organization to

establish a farmers’ market in a food desert/food swamp (area

with limited access to healthy food)

Health-related Services Form of direct investment. Health-related services are non-state

plan, non-covered services (HRS) intended to improve care

delivery and member health. HRS include flexible services

(member-specific services) and community benefit initiatives.

CCO funds non-medical transportation for members to go to

parenting classes, food bank, job interview

Alternative Payment

Models (APM)/Value-

Based Payment (VBP)

Payment models designed to pay for value (i.e. outcomes)

rather than volume (i.e. services). Payment can be designed to

incentivize SDOH activities, allow flexibility address holistic

medical/social needs to improve health

CCO provides incentive payments to providers to support SDOH

work, e.g. incentives for SDOH screenings, for PCPCHs to adopt

standard 5.E.C. for tracking community/social service referrals

(see Spotlight on PCPCH pg____)

Workforce Contracting with or otherwise funding healthcare workers to

address social determinants of health (e.g. community health

workers)

CCO contracts with community health worker to provide social

service referrals to high utilizers or operates a care coordination

hub, such as the Pathways model (see Spotlight on Pathways,

pg. ____)

Convener Bringing together diverse, multi-sectoral partners to identify

common priorities and work toward addressing SDOH

CCO engages social service and other community partners to

integrate social determinants of health into its community health

assessment and community health improvement plan; facilitate

identification of common SDOH priorities for community

Data/analytics support Providing health care data or data resources (e.g. Health IT,

secure email system) to partners, such as social service entities

CCO supports building a social determinant of health screening

instrument into EHR for provider use

General

alignment/collaboration

Aligning CCO SDOH priorities with community-selected goals or

strategies

CCO adopts common metrics with local early learning hub

Policy/government

relations

Advocating for policies that address SDOH in communities CCO advocates for improved transportation options for residents

in service area

Internal infrastructure

changes

Staffing, policies, and training to ensure entity is well set up to

address SDOH

CCO employs culturally diverse staff to work with specific

populations

Social needs/resource

clearinghouse

Compiling and distributing social needs/resource data to

providers and other partners

CCO assembles social needs data on members and shares risk

scores with providers to inform care (see Spotlight on OPIP, pg.

___)

48

MAC recommendations (pg. 8)

• CCOs, as locally based and locally controlled entities, should select

their role(s) based on the needs and resources in a given community.

Indeed, the question of whether a CCO should play the broad role of a

“hub” or a “spoke” in addressing SDOH may depend on what is best

for its community.

• CCOs should capitalize on their strengths and role as payers,

operating under a global budget.

• CCOs should aim to support existing efforts and avoid duplication of

work.

• CCOs should capitalize on their fundamental role of care coordination

to ensure providers have the necessary information and resources to

deliver both SDOH-informed healthcare and SDOH-targeted healthcare

without duplicating services.

• CCOs should aim to address SDOH in a way that promotes person and

family-centered care.

49

P I L O T C L O S E O U T P R E S E N T A T I O NI N T E R C O M M U N I T Y H E A L T H N E T W O R K C C O

Alternative Payment Methodologies Phase II: PCPCH TransformationIHN-CCO PILOT CLOSEOUT


Project SummaryIHN CCO received $1,826,727.00 in transformation funds to support 37 PCPCH’s in transforming their delivery model (IT and clinic infrastructure) in preparation for a value-based APM. PCPCH’s had to sign an agreement to transform their payment model to an APM to receive the funds.Funds were allocated on a sliding scale considering clinic size by employed PCP’s. The larger the clinic size, the smaller the per physician amount allocated.Measured progress made in use of the funds through Access, Quality and Utilization metrics.


Project SummaryParticipating PCPCH’s:Samaritan Health Services PCPCH’s: 22 sitesBenton Community Health Centers PCPCH’s: 4 sitesLincoln Community Health Centers PCPCH’s: 4 sitesThe Corvallis Clinic PCPCH’s: 4 sitesCorvallis Family Medicine PCPCHCorvallis Internal Medicine PCPCHCoastal Health Practitioners PCPCH


Key Findings: Access

Some clinics provide care coordination internally, and some have partnered with outside Community Health Workers to provide care coordination.

Goals Metric Outcome

Access to Care

Increase the Total combined count of PCPCH office visits and

care coordination

“touches"

All clinics combined resulted in a 44% increase in visits.

65% of the clinics had a positive increase in services provided.


Key Findings: QualityGoals Metric Outcome

SBIRT: Screening, Brief Intervention, Referral to Treatment

87% Met IHNCCO Improvement Target97% Clinics increased from their individual baseline

Adolescent Well Care Visits 24% Met IHNCCO Improvement Target70% Clinics increased from their individual baseline

Colorectal Cancer Screening 27% Met IHNCCO Improvement Target89% Clinics increased from their individual baseline

Developmental Screening 44% Met IHNCCO Improvement Target57% Clinics increased from their individual baseline

Effective Contraceptive Use 15% Met IHNCCO Improvement Target73% Clinics increased from their individual baseline

Assessments for Children in DHS Custody 9% Met IHNCCO Improvement Target50% Clinics increased from their individual baseline

Emergency Room Utilization - Decrease 0% Met IHNCCO Improvement Target26% Clinics increased from their individual baseline

Prenatal Care 71% Met IHNCCO Improvement Target96% Clinics increased from their individual baseline

Developmental Screening 44% Met IHNCCO Improvement Target57% Clinics increased from their individual baseline

Quality of Care


Key Findings: Utilization

Goals Metric Outcome

Count of ALL ER Visits 5% decreased48% Clinics reported improvement

Count of Assigned patients seeking "outside PCP services (leakage)

53% decreased55% Clinics reported improvement

Count of Mental Health/Behaviorist visits

204% increased77% Clinics reported improvement

Count of Preventive Services 175% increased90% Clinics reported improvement

Utilization


Successes

• Positive results for 12 out of the 14 metrics measured.

• Members are being managed at the right place at the right time.

• Substantial progress in becoming high functioning PCPCH’s. Integrated services: mental health, and traditional health workersEMR functionality and focus on data aggregationMember assignment reconciliation and managementPCPCH workflows in place to manage whole person care APM payments based on quality

Goal Outcome80% of members assigned to

PCPCH’s are paid an APM based on quality by 12/31/2016.

94%


Remaining ChallengesReporting Tools: More robust, real-time and aligned metric availability

Case Management Tools: Communication and referral solutions across the community.

PCP assignment management: Difficult to be measured on patient engagement when patient cannot be reached.


Remaining Challenges

Total Cost of Care – Are we lowering costs?

Goal Results To Date

Pharmacy costs increased = 23%

Medical costs increased = 6%

Inpatient costs decreased = 3%

Combined Total increase = 9%

Did Total Cost of Care Decrease?


Post Pilot SustainabilityAPM Contracting: The APM models that continue

to be enhanced, factor in incentive money to help continue to support medical home development.


Thank you

Carla JonesReimbursement Manager – IHN CCO

[email protected]

mailto:[email protected]

mac social determinants of health survey january …...–ducation (e.g., elhub partner) e –dverse...

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