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

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 Current Goal – Identify 3 priority areas to improve health then identify strategies to reach that goal 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

19. Summary of Findings National / State Studies: Higher death rates related to: Heart disease Slightly higher rates of: Smoking Heavy drinking - female Higher percentage of reporting of depression/anxiety and high blood pressure (CP CCO Medicaid data) Community Responses (Not in specific Order) Conditions create a healthy community: Jobs Education / schools Drug / alcohol prevention Health problems in community: Alcohol and drug addiction Obesity Tobacco use 3 things to improve community health: Later in day doctor appointments More doctors More health education services

20. Poor Or Fair Health

22. Poor Physical Health Days

23. 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

24. Poor Mental Health Days

25. Low Birthweight

26. Leading Cause of Death - Rate Per 100,000 (5 year average) 2007 – 2011 CauseColumbia CountyOregon Heart Disease 175.0163.1 Stroke Unintentional Injuries Suicide 40 49.2 15.2 47.9 41.9 16.2

27. Health Behaviors

28. Adult Smoking

29. Tobacco Use Smokeless (By Males)

30. Excessive Drinking

31. Binge Drinking

32. Heavy Drinking

33. DUI Rates Per 100,000

34. Percent Motor Vehicle Fatalities Involving Alcohol

35. Death Rate from Alcohol-Induced Diseases per 100,000

36. Percent of Youth Who Had Drank Alcohol Past 30 Days (11 th Grade)

37. Percent of Youth Who Binge Drink in the Past 30 Days (11 th Grade)

38. Percent of Youth Who Drove When Drinking Alcohol (11 th Grade)

39. Death Rate from Drug-Induced Causes per 100,000

40. Percent Who Used Illicit Drug(s) Other Than Marijuana in Past 30 Days

41. Percent of Youth Who Used Marijuana In Past 30 Days (11 th Grade)

42. Death Rate from Suicide per 100,000

43. Percent of Youth Who Attempted Suicide in the Past Year (11 th Grade)

44. Percent of Youth Who Had Depressive Episode in the Past Year (11 th Grade)

45. Obesity and Access to Recreation

46. Obesity

47. Physical Inactivity

48. Access To Recreational Facilities

49. Limited Access To Healthy Foods

50. Fast Food Restaurants

51. Clinical Care

52. Uninsured

53. Preventable Hospital Stays

54. Diabetic Screening

55. Mammography Screening

56. Up-to-date Immunizations Among Two-year Olds

57. Mothers Receiving Inadequate Prenatal Care

58. Percent Age 20+ with Diabetes

59. Social, Economic, and Physical Environment

60. High School Graduation

61. Some College

62. Unemployment

63. Children In Poverty

64. Inadequate Social Support

65. Children in Single-parent households

66. Teen Birth Rate

67. Violent Crime Rate

68. A Look At Who We Are…

69. Average Age? Oregon = 38.1 Columbia County = 40.8

70. Age 60 +

71. Under Age 18

72. Percent White / Caucasian

73. Percent African American

74. Percent Indian or Alaskan Native

75. Percent Asian or Pacific Islander

76. Percent Other Race

77. Percent Two or More Races

78. Percent Male

79. Percent Who Speak Language Other than English At Home

80. Housing Vacancy Rate

81. Percent Households With Retirement Income

82. Percent Households with Social Security Income

83. Community Survey Preliminary Data: 350 Community Surveys

84. 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 Hospital24.3%85 Urgent care50.3%176 Doctor’s office or other outpatient medical clinic79.7%279 Veterans health Administration hospital or clinic6.3%22 Addictions treatment center5.1%18 Dental services68.3%239 Public health department20.6%72 Mental health / behavioral health or other counseling23.1%81 91113.4%47

85. 2. We have good doctors (They care about patients, provide good health care, etc.) 63.7% 223 We have local access to specialty services (A focus on specific area of care like a heart doctor) 15.4% 54 There are good prevention services that help reduce health problems (Services that help people quit smoking or to eat healthy) 38% 133 Citizens make use of recreational activities (Helps with exercising and stress reduction, etc.) 34% 119 What conditions exist now in your community to help create or foster good health? Please select all that apply:

86. 3. What do you think are the three (3) most important ways to create a healthier community? Please select only 3 A clean environment23.7%83Mental health treatment20.3%71 Access to healthy foods 25.1%88Food banks/hunger programs12.6%44 Affordable housing22.6%79Low crime/safe neighborhoods18.3%64 Cultural acceptance4.3%15Sports and recreation activities21.1%74 Education / Schools34.3%120Tobacco prevention / treatment services 7.7%27 Drug/alcohol prevention and treatment 28.6%100Job opportunities and a healthy economy 42.9%150 Health prevention and wellness education 23.7%83Better access to health care services 23.7%83

87. 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) Cancer17.4%61Lack of mental health treatment facilities 10.3%36 Respiratory/lung disease6%21High crime rates4.9%17 HIV/AIDS1.4%5High cost of mental health services2.9%10 Diabetes24%84Not enough doctors and clinics8.9%31 Heart disease / stroke14.9%52High cost of health care / lack of health insurance 18%63 High blood pressure15.1%53Too few recreational and exercise facilities 7.1%25 Tobacco use23.4%82Poor eating habits14.6%51 Obesity33.7%118Lack of access to healthy foods4.9%17 Mental Illness20.6%72Domestic violence3.1%11 Alcohol/drug addiction45.1%158Lack of transportation to medical facilities 5.1%18 Dental problems14.3%50Too little affordable housing11.1%39 Sexually transmitted diseases 5.1%18Child abuse5.1%18 Suicide3.7%13Too few educational opportunities after high school (college, trade schools, et.) 11.4%40

88. 5. More health education services 34.4%120 More doctors 40.3%141 More illness prevention services 17.1%60 More alcohol and drug treatment 21.4%75 More dentists 14%49 Doctor appointments after 5 pm or on weekends 49.1%172 More culturally sensitive care 3.1%11 Transportation assistance 15.7%55 More mental health services19.769 Alternative health care17.7%62 Expand the OHP (Medicaid)30.9%108 More tobacco cessation programs6.9%24 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:

89. It costs too much 53.7%188 Don’t know where to go to get care 5.4%19 Don’t have insurance 36.3%127Afraid of what they might find wrong with me 8%28 Childcare issues 3.1%11Do not have a regular doctor8.9%31 Transportation problems 12%42Couldn’t get appointment quickly enough 17.7%62 Don’t like doctors 5.1%18On the Oregon Health Plan, but do not have a doctor 3.1%11 Waited for the health problem to go away 19.1%67Doctor’s office not open not open when needed 19.4%68 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

90. 7. Age

91. 8. Gender

92. IncomeRace / Ethnicity: Less than $5,000 16.6%58 American Indian or Alaska Native 2.6%9 $5,000 - $15,000 20.6%72 Asian.6%2 $16,000 - $25,000 25.7%90 Black or African American.3%1 $26,000 - $40,000 26%91 Latino / Hispanic 3.1%11 $41,000 - $70,000 29.4%103 Native Hawaiian or Other Pacific Islander.6%2 $71,000 - $100,000 8.6%30 White 80.9%283 More than $100,000 7.7%27 Other:.3%1

93. Summary of Findings National / State Studies: Higher death rates related to: Heart disease Slightly higher rates of: Smoking Heavy drinking - female Higher percentage of reporting of depression/anxiety and high blood pressure (CP CCO Medicaid data) Community Responses (Not in specific Order) Conditions create a healthy community: Jobs Education / schools Drug / alcohol prevention Health problems in community: Alcohol and drug addiction Obesity Tobacco use 3 things to improve community health: Later in day doctor appointments More doctors More health education services

94. “Community Health Needs Survey, - Columbia County” 2013. Columbia Pacific Coordinated Care Organization : Community Advisory Council. Oregon. “County Health Calculator,” 2013. Robert Wood Johnson Foundation and the Virginia Commonwealth University Center on Human Needs. “County Health Rankings and Roadmaps – a Healthier Nation County by County,” 2013. Robert Wood Johnson Foundation and University of Wisconsin – Population Health Institute. “Data Elements for CCOs Reports,” 2013. Oregon Health and Science University. Office of Rural Health. “Columbia County’s Epidemiological Data on Alcohol, Drugs and Mental Health. 2000 to 2012. Oregon Health Authority. Office of Health Analytics and Addictions and Mental health Division. “Columbia Pacific CCO Service Area. Health & Care Profile for Newly Eligible Oregonians Under the ACA” “Prevention Chronic Diseases and Reducing Health Risk Factors,” 2013. Centers for Disease Control and Prevention. CDC 24/7 : Saving Lives. Protecting People. “Quick Facts,” January 2013. Oregon Department of Human Services; Children, Adults and Families Division. Office of Business Intelligence and the Office of Forecasting, Research and Analysis.