1. Columbia Pacific Coordinated Care Organization (CCO) – Data Summary Reedsport

3. Changes in Oregon Health Plan Federal Accountable Act Healthcare Coordination & Integration Coordinated Care Organizations Dual Eligibility Global Budgets For All Primary Care Health Homes Metrics / Performance Measures Community Advisory Councils

4. OREGON INTEGRATED & COORDINATED HEALTH CARE DELIVERY SYSTEM

5. Physical HealthMental HealthAddictions TX Assessment Diagnosis Treatment Plan (EBP) Pre-set rate per service Monitor / Update OHP Client Assessment Diagnosis Treatment Plan (EBP) Pre-set rate per service Monitor / Update Assessment Diagnosis Treatment Plan (EBP) Pre-set rate per service Monitor / Update Oral Health Assessment Diagnosis Treatment Plan (EBP) Pre-set rate per service Monitor / Update

6. Primary Care Health Homes – Center of patients’ coordinated care. Includes a team that works on keeping patients at their healthiest. Local Control (different CCO models) Coordination – Integrate Physical health, mental health, dental health– single point of accountability Community Advisory Council – Each CCO convenes a CAC to ensure that the health care needs of consumers are being addressed Metrics / Performance Measures – Operate under contracted performance standards with clinical, financial and operational metrics Global Budget And Shared Saving – More flexibility to manage dollars Coordinated Care Organizations

7. Why This Why Now? CCO created a culture which allowed providers to bring these local activities into the next generation of integration

8. Better Health Care System Better Health Outcomes Cost Savings

9. All OHP Clients At High Risk - Chronic Disease Chronic Disease Coordinated case management – Reduce high end costs Coordinated case management – Reduce likelihood become chronic Early Assessment & Identification of High Risk For Chronic Disease Improve Health System, Improve Health Outcomes, Lower Costs

10. All OHP Clients At High Risk - Chronic Disease Chronic Disease Coordinated case management – Reduce high end costs Coordinated case management – reduce likelihood become chronic Early Assessment & Identification of High Risk For Chronic Disease

11. All OHP Clients At High Risk - Chronic Disease Chronic Disease Coordinated case management – Reduce high end costs Coordinated case management – reduce likelihood become chronic Early Assessment & Identification of High Risk For Chronic Disease

12. All OHP Clients At High Risk - Chronic Disease Chronic Disease Coordinated case management – Reduce high end costs Coordinated case management – reduce likelihood become chronic Early Assessment & Identification of High Risk For Chronic Disease Savings = reinvestment into system – incentive, etc. REALLY?

13. Cost Impact Sample – Using Diabetes for A Single Oregon County: Number of Persons: Number of Deaths: Costs: 9,300 531 $42.6M If you can prevent 4.67% of people from getting Diabetes: Number Prevented: 437 Lives Saved: 32 Financial Cost Savings: $2 M If you can prevent 20% of people from getting Diabetes: 1,860 121 $8.52 M

14. Cost Impact Sample – Using Diabetes for Douglas County: If you can prevent 4.67% of people from getting Diabetes: Number Prevented: 437 Lives Saved:32 Financial Cost Savings:$2 M If you can prevent 20% of people from getting Diabetes: 1,860 121 $8.52 M $8.52 Million Question: What is the likelihood of preventing 5%, 10%, 20% of population from getting Diabetes? The risk of Type 2 Diabetes can be reduced by 50-70% by control of obesity And by 30-50% by increasing physical activity

15. Personal impact cannot be quantified Can apply model to other chronic diseases – Each has risk factors which increase the likelihood of illness: Heart Disease and Stroke Prevention: No tobacco Physically active Healthy weight Healthy food choices Preventing / controlling high blood pressure 12 – 13 point reduction in average systolic blood pressure over 4 years reduces heart disease risk by 21%, stroke risk by 37% Cancer Prevention: No tobacco Limiting alcohol Limited exposure to ultraviolet rays Diet rich in fruits and vegetables Maintaining a health weight Being physically active Seeking regular medical care

16. PCP Oral Health Mental HealthAddictions

17. Health Integration System Behavioral Health Mental Health Dental Health Patients Physical Health Neighborhood Health Family Spiritual Community Providers Peers

18. 15 CCO management areas 18 Community Advisory Councils – Ensure health care needs of consumers are being met. Community / consumer focus within CCO’s work to accomplish vision – Improve Health Care System, Improve Health Outcomes, Lower Costs Current Goal – Identify 3 priority areas to improve health then identify strategies to reach that goal

19. Summary of Findings National / State Studies: Higher death rates related to: Cancer Heart disease Stroke Chronic Lower Respiratory Disease Diabetes Suicide Alcohol-Induced Deaths Higher Rates of Inadequate Prenatal Care Higher percentage of reporting of depression/anxiety and high blood pressure (CP CCO Medicaid data) Community Responses: Conditions create a healthy community: Jobs Education / Schools Environment Health problems in community: Alcohol / drug addiction Not enough doctors Obesity Diabetes Cancer High Blood Pressure 3 things to improve community health: More doctors Doctor appointments after five o’clock Expand OHP

20. Chronic Health Conditions Percent told they have it by a physician (N= 1,486) Of those percent currently taking RX for it Diabetes9.762.4 High cholesterol19.145 High blood pressure29.657.8 Depression / anxiety44.251.8 Asthma18.251.9 Emphysema / COPD8.250.4 Heart attack / Angina6.650 Congestive heart failure269 Kidney problem5.133.3 Cancer3.750 Chronic Condition Diagnoses – Medicaid-eligible Population (CPCCO Service Area

21. Leading Cause Of Death….

32. In Douglas County, this includes the following: 4,553 individuals with 7,632 conditions 60% (2,760) with one condition – either a physical or mental illness 39.4% (1,793) with more than one condition Of those with more than one condition, 16.5% (751 of the total 4,553) had both a physical and mental health condition

33. Health Behaviors

34. Adult Smoking

35. Adult Obesity

36. Inadequate Prenatal Care Rate (2007-2011 Avg. Rate : 1,000 Births)

37. Low Birthweight Rate (2007-2011 Avg. Rate : 1,000 Births)

38. A Look At Who We Are…

39. Reedsport

40. Percent White / Caucasian

41. Percent Hispanic (all races)

42. Under Age 18

43. Percent Male

47. Community Survey N = 131

48. 1.In the past year, have you or anyone living in your home used health services at any of the following locations? Please select all that apply: PercentNumber Hospital64.1%84 Urgent care19.1%25 Doctor’s office or other outpatient medical clinic82.4%108 Veterans health Administration hospital or clinic6.1%8 Addictions treatment center2.3%3 Dental services46.6%61 Public health department11.5%15 Mental health / behavioral health or other counseling7.6%19 9119.9%13

49. 2. We have good doctors (They care about patients, provide good health care, etc.) 75.6%99 We have local access to specialty services (A focus on specific area of care like a heart doctor) 31.3%41 There are good prevention services that help reduce health problems (Services that help people quit smoking or to eat healthy) 50.4%66 Citizens make use of recreational activities (Helps with exercising and stress reduction, etc.) 42%55 What conditions exist now in your community to help create or foster good health? Please select all that apply:

50. 3. What do you think are the three (3) most important ways to create a healthier community? Please select only 3 A clean environment34.4%45Mental health treatment16.8%22 Access to healthy foods 24.4%32Food banks/hunger programs21.3%28 Affordable housing29%38Low crime/safe neighborhoods17.6%23 Cultural acceptance2.3%3Sports and recreation activities6.9%9 Education / Schools36.648Tobacco prevention / treatment services 6.9%9 Drug/alcohol prevention and treatment 19.1%25Job opportunities and a healthy economy 55.7%73 Health prevention and wellness education 21.4%28Better access to health care services 26%34

51. 4. What do you think are the three (3) most critical health problems in your community? (those problems which have the greatest impact on overall community health) Cancer21.4%28Lack of mental health treatment facilities 7.6%10 Respiratory/lung disease10.7%14High crime rates0.8%1 HIV/AIDS1.5%2High cost of mental health services3.1%4 Diabetes25.2%33Not enough doctors and clinics32.1%42 Heart disease / stroke15.3%20High cost of health care / lack of health insurance 16.8%22 High blood pressure19.8%26Too few recreational and exercise facilities 3.8%5 Tobacco use9.2%12Poor eating habits15.3%20 Obesity32.1%42Lack of access to healthy foods3.1%4 Mental Illness6.9%9Domestic violence6.1%8 Alcohol/drug addiction32.1%42Lack of transportation to medical facilities 8.4%11 Dental problems5.3%7Too little affordable housing9.9%13 Sexually transmitted diseases 0.8%1Child abuse5.3%7 Suicide3.1%4Too few educational opportunities after high school (college, trade schools, et.) 13.7%18

52. 5. More health education services 26.7%35 More doctors 60.3%79 More illness prevention services / Screening 20.6%27 More alcohol and drug treatment 16%21 More dentists 10.7%14 Doctor appointments after 5 pm or on weekends 38.9%51 More culturally sensitive care 2.1%4 Transportation assistance 16.6%22 More mental health services18.3%24 Alternative health care28.2%37 Expand the OHP (Medicaid)35.1%46 More tobacco cessation programs4.6%6 If you could pick just three (3) things to improve your community's access to health care, what would they be? Please pick only 3 boxes:

53. It costs too much 45%59 Don’t know where to go to get care 3.8%5 Don’t have insurance 36.6%48Afraid of what they might find wrong with me 7.6%5 Childcare issues 1.5%2Do not have a regular doctor13%17 Transportation problems 16.8%22Couldn’t get appointment quickly enough 25.2%33 Don’t like doctors 7.6%10Have OHP but no doctor4.6%6 Waited for the health problem to go away 26%34Doctor’s office not open not open when needed 13%17 6. Think about the most recent time when you or a family member living in your home went without needed health care. What were the reasons why? Please check all that apply

54. 7. Age

55. 8. Gender

56. IncomeRace / Ethnicity: Less than $5,000 11.5%15 American Indian or Alaska Native 4.6%6 $5,000 - $15,000 19.8%26 Asian 0%0 $16,000 - $25,000 25.2%33 Black or African American 0%0 $26,000 - $40,000 15.3%20 Latino / Hispanic 2.3%3 $41,000 - $70,000 16%21 Native Hawaiian or Other Pacific Islander.8%1 $71,000 - $100,000 3.8%5 White 77.1%101 More than $100,000 3.1%4

57. Summary of Findings National / State Studies: Higher death rates related to: Cancer Heart disease Stroke Chronic Lower Respiratory Disease Diabetes Suicide Alcohol-Induced Deaths Higher Rates of Inadequate Prenatal Care Higher percentage of reporting of depression/anxiety and high blood pressure (CP CCO Medicaid data) Community Responses: Conditions create a healthy community: Jobs Education / Schools Environment Health problems in community: Alcohol / drug addiction Not enough doctors Obesity Diabetes Cancer High Blood Pressure 3 things to improve community health: More doctors Doctor appointments after five o’clock Expand OHP

58. “City-Data.com: Reedsport, OR. 2013. “Community Health Needs Survey, - Reedsport” 2013. Columbia Pacific Coordinated Care Organization : Community Advisory Council. Oregon. “County Health Rankings and Roadmaps – a Healthier Nation County by County,” 2013. Robert Wood Johnson Foundation and University of Wisconsin – Population Health Institute.” “County Health Calculator,” 2013. Robert Wood Johnson Foundation and the Virginia Commonwealth University Center on Human Needs. “Data Elements for CCOs Reports,” 2013. Oregon Health and Science University. Office of Rural Health. “Prevention Chronic Diseases and Reducing Health Risk Factors,” 2013. Centers for Disease Control and Prevention. CDC 24/7 : Saving Lives. Protecting People.