1. Oregon’s Health System Transformation
Cathy Kaufmann, MSW Transformation Center Director
Kelly Ballas
OHA Chief Financial Officer
Bill Bouska
Innovator Agent
Welcome
Introduce all presenters and roles
(Cathy) What we’ll be talking about today:
Oregon’s triple aim, why a change is needed, Oregon’s CCOs and the coordinated care model
What coordinated care means for the patient (Malik)
Alternative payment methodologies
The Transformation Center’s work
Innovation (stories: community health workers, Ted Hanberg)
The IA and work in the CCOs/ Innovation and the local level

2. Triple Aim: A new vision for Oregon
(Cathy)

3. Better health, better care, lower costs
Why do we need to transform the health system?
The old way wasn’t working:
Costs too high
Health outcomes too low
Too much money spent on fragmented care
(Cathy and Kelly)

4. No child should go to the ED with asthma
Oregon’s vision
(Cathy)
Malik Wilkerson is an 8-year-old third-grader who has asthma.
Asthma attacks used to send Malik to the emergency room once or twice a month, says his mother, Maydean Wilkerson. "He'd get to the point where he couldn't breathe."
Today, that almost never happens. His primary care team has helped Malik bring his asthma under control and drastically reduce his trips to the hospital.
The new, coordinated approach involves reduced exposure to household asthma "triggers"; a home nebulizer to convert his medication into a quicker-acting mist; and a portable mini-inhaler to help him overcome wheezing attacks at school or on the playground.
Asthma is the most common chronic disease among children — and especially prevalent in low-income households. Although asthma can be well controlled by medication and preventive measures, Oregon children went to hospital emergency rooms 550 times for asthma attacks in 2006, according to the state Asthma Program.
The average cost of a hospital visit for asthma was $12,000. The Oregon Health Plan paid more than $5.5 million in 2007 for hospital care of asthma.
Malik is an example of how coordinated care can reduce that expense while improving health.
His mom enrolled in Multnomah County's Healthy Homes program, which helps children with asthma get control over their disease through careful choice of medications and reduction of environmental hazards in the home.
Healthy Homes visited the Wilkerson home to search for asthma triggers and recommend preventive steps: Natural cleaning agents. Mold prevention. Non-allergenic bedding and pillow cases. A special vacuum cleaner that captures dust without releasing any into the air.
Since Malik started using the nebulizer and special bedding and since his mom substituted vinegar-based cleaners for scented detergents, he has made only two visits to the hospital for asthma.
These lower-cost interventions are a good deal for everyone, his mother says, including taxpayers.
"In the long run it saves money by keeping Malik out of the hospital."
No child should go to the ED with asthma
Malik, 8, used to go to the Emergency Department with asthma attacks as much as twice a month. Thanks to a coordinated care pilot project and a community health worker, he is avoiding the hospital.

5. Coordinated Care Model
Best practices to manage and coordinate care
Sharing responsibility for health
Measuring performance
Paying for outcomes and health
Providing information
A sustainable rate of growth
Cathy/ Kelly

6. 50% of babies born in Oregon
Oregon Health Plan (2013)
50% of babies born in Oregon
16% of Oregonians
85% of Oregon providers
11% percent of total state budget
Fastest growing portion of state budget
Cathy
(2013 data)
In 2014, OHP will open up to approximately 200,000 more Oregonians
Why implement the coordinated care model in OHP?
Oregon Health Plan is incredibly important to the people of our state – it’s also incredibly expensive

7. Coordinated Care Organizations
A local network of all types of health care providers working together to deliver care for Oregon Health Plan clients.
Goal: Care will be coordinated at every point, from where the services
Are delivered to how the bills are paid.
The model:
Better coordinate care at patient and financing level
Integrate public, physical, mental and dental health
Leverage public health strategies - recognizes that 10% of health happens in medical system
Measure performance
Engage people in their own health
Pay for outcomes, not activities
Provide clear and transparent information
Cathy
First implementation of the model, Oregon Health Plan = CCOs
(Then, transition to Kelly  paying for value/improved health outcomes with CCOs/ the coordinated care model, not the volume of service)

8. Paying for value, not volume
Changing the landscape in Oregon
Kelly introduces self, introduces his section of the presentation

9. Leveraging the state’s purchasing power in transitioning to value-based health care
Medicaid
Public Employees Benefits Board
Oregon Educators Benefits Board
Other Entities
Kelly

10. Payment reform work outside of state paid programs
PCPCH Multi-Payer Workgroup
OHA and OHLC
Rural Hospital Reimbursement Initiative
OHA and OAHHS
Transformation Center: Technical Assistance on Alternative Payment Methodologies
Payment reform initiative in 2014
Kelly

11. CCO Model Encourages Payment for Value
Global Budget with Fixed Rate of Growth
Quality Incentive Pool
Patient Centered Primary Care Homes
Transformation Plans
Flexible Services to Deter Higher Cost Care
Non-Traditional Healthcare Workers
Kelly

12. Global Budget Excerpt from the OHPB CCO Implementation Proposal:
CCO global budgets are designed to cover the broadest range of funded services for the most beneficiaries possible.
The construction of global budgets start with the assumption that all Medicaid funding associated with a CCO’s enrolled population is included. Global budgets include services historically provided under Medicaid managed care in addition to Medicaid programs and services that have been provided outside of the managed care system. This inclusive approach enables CCOs to fully integrate and coordinate services and achieve economies of scale and scope. The global budget approach also allows CCOs maximum flexibility to dedicate resources toward the most efficient forms of care.
Kelly

13. Quality Incentive Pool
OHA is using a payment for value approach in which 2% of the CCOs’ global budget is withheld and placed in a quality incentive pool.
Money is distributed to CCOs based on CCO incentives measures it achieves either on an absolute benchmark or a demonstrated improvement from its own baseline (the “improvement target”).
Each CCO is eligible to earn at least $1 million dollars from the quality pool, if they meet improvement targets or achieve benchmark values on at least 75% of incentive measures and meet or exceed Electronic Health Record (EHR) measures.
Quality pool incentives will be distributed mid-year 2014 for year one of CCO contracts.
(Kelly) 13 13

14. Quality Pool: Metrics Addressing chronic conditions
Reducing preventable and costly utilization
Integrating physical and behavioral health care
Improving access to effective and timely care
Improving perinatal and maternity care
Reducing preventable hospitalizations
Improving primary care for all populations

15. Patient-centered primary care homes
Kelly

16. Patient-Centered Primacy Care Home Payments
Patient-centered primary care home (PCPCH) :
A team-based approach that involves physicians, nurses and medical assistants as well as pharmacists, nutritionists, social workers and care coordinators.
The FFS payment model fails to recognize the complexity of primary care, does not reward quality care, and decreases opportunities for communication between patients and their health care teams.
Four types of patient-centered primary care home payment models exist:
Enhanced FFS evaluation and management payments
Additional codes for medical home activities within FFS payments
PMPM medical home payments to supplement evaluation and management FFS payments
Risk-adjusted, comprehensive PMPM payment
Source: Merrell K, Berenson RA. Structuring Payment for Medical Homes. Health Affairs, 29, no.5 (2010): 16 16 16

17. Transformation Plans: Implementing Alternative Payment Methodologies
Patient Centered Primary Care Homes
Incentives to reduce ER visits
Incentives for quality outcomes
Increase access to PCPCH
Capitation with quality metrics
Bundled payment pilots
Shared savings pilots
Pay for Performance
Kelly

18. Flexible Services
Health related non-State Plan services intended to improve care delivery and enrollee health.
Cost effective alternatives to traditional services.
Non-encounterable and delivered in lieu of higher cost medical care.
Broad categories of services and equipment.
Kelly

19. (Non)Traditional Health Care Workers
Community Health Workers
Promote health or nutrition within their community by serving as a liaison between communities, individuals and CCOs.
Peer Wellness Specialists
Provide peer services in behavioral health and addictions recovery to people with similar life experiences.
Personal Health Navigators
Provide information, assistance, tools and support to enable patients to make the best health care decisions.
Kelly
Note: formally called non-traditional health workers, now being referenced as “Traditional health care workers”

20. Alternative Payment Methodologies
Donald Berwick, MD on transitioning to value-based health care:
“Finance leaders are key to the mission at hand. They provide the information, and they will figure out the transition models. But they will only be able to help if they are part of a larger whole where everyone is headed in the same direction.”
Interview with hfm, May 2013
Kelly
Broad range of payment reform concepts

21. Challenges to Payment Reform
Continued use of FFS payment in payment reforms
Holding providers accountable for costs they cannot control
Physician compensation based on volume, not value
Lack of data for setting payment amounts
Lack of patient engagement
Inadequate measures of the quality of care
Lack of alignment among payers
Negative impacts on hospitals
Policies favoring large provider organizations
Lack of neutral convening and coordination mechanisms
(Kelly)
We are addressing all of these challenges and working towards solutions.
Source: Miller HD. Ten Barriers to Healthcare Payment Reform and How to Overcome Them. Center for Healthcare Quality and Payment Reform. December 21 21 21

22. Oregon’s Opportunities
Large scale changes are necessary to implement payment reform and there are areas in which Oregon can build from more quickly:
Access to Timely Data – Office of Health Analytics, Quality Corporation, and Oregon HIE efforts
Determining Appropriate Financial Risk – Various risk adjustment methods exist, CCO risk corridors
Aligning Incentives with Quality Measures – Numerous measures exist, outcomes-based measures and effective incentives
Solving Contractual Issues – Long-term contracting with allowable adjustments, gainsharing agreements and anti-trust issues
Creating Collaboratives – Regional Health Improvement Collaborative, Transformation Center
(Kelly)
Risk adjustment methods to limit risk include:
Condition/Severity Adjustments;
Outlier Payments and Adjustments when certain conditions are met;
Risk Corridors
Exclusions and Risk-Sharing arrangements that exclude the costs of services provided by certain outside providers from payments or having two providers accept accountability (and the associated payment) for different portions of the total costs of caring for a group of patients.
To align incentives with quality measure, measurements should be outcomes-based and be tied to effective incentives. We should also work to ensure that measures are consistent across payers. 22 22 22

23. Alternative Payment Methodologies
Many promising alternative payment methodologies (APMs) exist and are increasingly being used by payers.
Bundled Payments - Providers are paid a set amount for all services rendered during a defined “episode” of care, including follow-up care.
Shared Savings - If providers meet or exceed cost-saving targets and quality measures, they can then share in a portion of the savings.
Pay-For-Performance - Providers are paid incentive payments based on quality indicators that are calculated as a percentage of the underlying fee-for service payment or a portion of claims paid withheld and then redistributed to providers.
Patient Centered Medical Home Payments - Additional activities and functions related to care management and population health are reimbursed by an extra fee that may be capitation or FFS based. 23

24. Bundled Payments
Bundled payments combine the services of various partners and build case rates for episodes of care based on historical claims data, allowing for only a portion of the costs associated with potentially avoidable complications.
Payments can be developed prospectively by providing a predetermined payment up front or retrospectively by developing a budgeted amount for an episode of care and either sharing the savings when there is a surplus, or sharing the losses services.
Bundled payments act as an incentive for providers to work together to better coordinate their activities in a value-maximizing way. 24

25. Bundled Payment Initiatives - Examples
ProvenCare (Geisinger Health System)
Episode of care payments for coronary artery bypass graft (CABG) where surgeons explicitly ensure that surgery is appropriate, document a shared decision-making process with the patient, and initiate post discharge follow-up to ensure compliance with medication and rehabilitation recommendations:
Involves 40 benchmark steps for CABG surgery
Uses flat rate for surgery and related care 90 days after discharge
Assumes historical complication rate is reduced by half
Results: First year evaluation showed a 10% reduction in readmissions, shorter average length of stay, reduced hospital charges, and a 44% decrease in hospital admissions over an 18 month period.
(Kelly)
Source: Lee TH. “Pay for Performance, Version 2.0?” New England Journal of Medicine 357, no.6 (2007): 531–533. 25 25

26. Bundled Payment Initiative, Continued…
Medicare Acute Care Episode (ACE) Demonstration
Bundled payments for both hospital (Medicare Part A) and physician services (Medicare Part B) for a select set of inpatient episodes of care limited to orthopedic and cardiovascular procedures. Savings are shared with physicians and patients (up to 50% of Medicare’s savings, not to exceed one year of Part B premiums ranging $200 - $1,100).
Baptist Health System Results:
Hospital savings of $4.3 million from June December 2010
$558,000 in gain sharing payments to physicians and
$646,000 in shared savings to Medicare patients
Significant improvements in orthopedic quality metrics,
Increased utilization of standardized order sets. Baptist Health System.
(Kelly)
Source: Lessons Learned from the Acute Care Episode Demonstration Program. Presented at the Health Industry Forum - Episode Payment: Private Innovation and Opportunities for Medicare. May 17, Available: 26 26

27. Bundled Payment Challenges
Factors making the implementation of bundled payment systems challenging include:
Fragmented provider networks
Challenges in clearly defining episodes of care
Administrative burdens associated with bundle packaging and payment distribution
Concerns about complications of chronic disease not being reflected in compensation
No prevention of episode from happening other than readmissions 27

28. Shared Savings
Evaluates payments made over a period of time and sets cost-saving targets for the ensuing period (most often a year). The desired outcome is that the payer spends less on unnecessary services and test and the provider get gets more for providing quality care.
Savings are shared with providers that meet targets - “upside risk.”
Losses may be spread across the providers when targets are not achieved - “downside risk.”
Distribution of savings across multiple providers is typically tied to quality measures and outcomes. 28

29. Shared Savings Initiatives
Medicare Shared Savings Program (ACOs)
Establishes rewards for hospitals, providers, and suppliers who lower their growth in health care costs for Medicare Fee-For-Service (FFS) beneficiaries while meeting quality performance standards. Goals are to improve beneficiary outcomes and increase care value through:
Promoting accountability via 33 quality measures,
Requiring coordinated care for all Medicare FFS services, and
Encouraging redesigned care processes and infrastructure investment.
NewHealth Collaborative (Summa Health System) Results:
Lowered MA costs by 8.4% with 10% reduction in readmissions
Increased physician engagement resulting from financial incentives, education, support, and understanding infrastructure investments (EHRs)
Source: Silow-Carroll S, Edward JN (Health Management Associates). Early Adopters of the Accountable Care Model: A Field Report on Improvements in Health Care Delivery. The Commonwealth Fund. March 2013. 29

30. Shared Savings Initiatives, Continued…
BCBS of Massachusetts Alternative Quality Contract (AQC)
Population-based global payment system where hospitals and physicians (called provider groups) take responsibility for the full continuum of care. Participants bear financial risk (downside risk) and share in savings (upside risk). Financial incentives based upon performance on a broad set of quality measures.
Results:
Significant quality improvement and 1.9% slower growth in medical spending in 2009 relative to rest of network; includes 3% average incentives.
Second year (2010) found a 3.3% slower growth in spending.
Groups previously FFS had greater savings; 6.3% (2009), 10% (2010).
Savings largely from referring patients to lower-cost facilities for services and reducing utilization. 30

31. Shared Savings Challenges
Despite the positive results, concerns about shared savings include:
Does not change the underlying payment system,
Can reward high spenders rather than high performers, and
Can result in a reduction in revenues for some providers and hospitals. 31

32. Pay-For-Performance (P4P)
Method of reimbursing providers based on the achievement of pre-determined measures of quality.
Quality can be measured in terms of benchmarking (outcome-based), or quality can be measured in terms of improvement (process-based).
Interest in P4P is due to variation in quality across providers, difficulty within the current payment system to reward high-quality, cost-effective care, and the lack of incentive within the current system to encourage providing services with long-term health or cost savings payoffs.
Proponents of P4P also argue that consumer choice alone does not provide sufficient incentive for providers to improve their quality of care and that consumers do not consistently use available information on quality to aid in their healthcare decision-making. 32 32

33. P4P Initiatives Hospital Quality Incentive Demonstration (HQID)
The largest hospital value-based purchasing demonstration, led by CMS and the Premier healthcare alliance. Data was collected data on more than 30 evidence-based clinical quality measures from more than 200 participating hospitals. The HQID helped to inform regulations for value-based purchasing (VBP) under the ACA.
HQID Participant Results:
Raised overall quality by an average of 18.6% based 30+ quality measures
Administered approximately 962,540 additional evidence-based clinical measures to 2.7 million patients treated in six clinical areas
Saved the lives of 8,500 heart attack patients (Premier mortality analysis)
Received incentive payments of more than $60 million from CMS for performance, improvement, and attainment of quality goals.
(Kelly)
Six clinical areas included Acute Myocardial Infarction, Heart Failure, Isolated Coronary Artery Bypass, Pneumonia and Hip or Knee Total Replacement.
In addition, 18 hospitals moved from the bottom to the top 20% of hospitals in one or more clinical areas, improving quality scores by an average of 29.2%. It is estimated that an expansion of this project to all acute care hospitals that are paid under the Medicare PPS would result in an estimated net savings of $34.0 billion over 10 years. The impact to state and local governments would be a savings of $0.8 billion over 10 years. The estimated savings is predominately due to an expected decrease in readmissions for Medicare beneficiaries. It should be noted that these estimates are only based on P4P programs for inpatient services. If the program was expanded to all providers and all services, additional savings could be expected. 33 33

34. P4P Initiatives, Continued…
BCBS of Michigan Value Partnership
The Hospital P4P program rewards hospitals an additional 5% (on average) for performance on quality indicators and participation in 12 hospital-based Collaborative Quality Initiatives (CQIs). CQIs include readmissions reporting, timing of acute myocardial infarction, percutaneous coronary intervention, initial antibiotic selection for pneumonia, surgical care infection prevention for four surgery types (i.e., CABGs and cardiovascular, hip and knee replacements, colon, and hysterectomies), and minimizing elective induction between weeks.
Results:
Participation in the first QCI designed to improve care for patients who undergo angioplasty resulted in decreases in hospital deaths (20%), Emergent coronary artery bypass grafts (92%), Myocardial infarctions (64%), strokes (18%) since 2002.
(Kelly)
Source: Blue Cross Blue Shield of Michigan's Value Partnerships program. Information available at: 34 34

35. P4P Challenges
Several limitations that must be addressed when considering P4P implementation:
Measures of care coordination and integration, quality outcomes measures need further development and validation.
Measures used across a number of initiatives and payers should be harmonized in order to provide consistent incentives and to simplify reporting strategies.
P4P programs are process-oriented and may encourage more services.
It is unknown whether the potential bonuses will be sufficient to compensate for the collection of data or to motivate change in the way providers care for patients.
Kelly
Last Bullet – There is very little guidance that indicates what size bonus truly motivates providers to make changes. 35 35

36. Medical Home Initiatives
Horizon Healthcare Services (New Jersey)
Horizon works with providers and practice associations to transform practices into NCQA-recognized medical homes. The pilot program included 8 practices that were paid a care coordination fee ($2.00-$3.50 PMPM) in addition to FFS reimbursement to support practice transformation and additional services. Practices also received:
Additional payments based on quality and utilization outcomes
Data/reports identifying patients who might benefit from outreach
Help from Horizon care coordinators with outreach and other work
Results:
Improved quality measures (more screenings, better diabetes control)
Improved utilization measures (lower cost of care, lower rate of ER visits, hospital readmissions, patient admissions, higher use rate of use for generics)
An expanded version of this program is being implemented that includes 48 practices serving 154,000 Horizon members. The practices receive a care coordination fee of $3.00-$5.00 PMPM. Practices are eligible for additional payments based on quality, utilization and patient experience measures at two levels. At the basic level, practices can receive between $0.50-$9.00 PMPM by showing improvement on quality, utilization and patient experience measures. At the advanced level, practices can directly participate in a shared savings model and receive a portion of the savings that Horizon achieves. In addition to these payments, practices receive a $2.00-$5.00 PMPM payment to fund the care coordinator position. Results from the expanded version of the model are not yet available.
Source: Urvashi B. Patel, Carl Rathjen and Elizabeth Rubin. Horizon's Patient-Centered Medical Home Program Shows Practices Need Much More Than Payment Changes To Transform Health Affairs, 31, no.9 (2012): 36 36

37. Medical Home Initiatives, Continued…
Wellpoint Medical Home Pilot
As part of the Colorado Multipayer Patient-Centered Medical Home program that targeted 6,200 Wellpoint patients, Wellpoint paid practices a care coordination fee and payments of up to 7.50 PMPM based on quality and utilization measures. Payments dependent on level of recognition received through NCQA.
Results:
Patients showed an 18% decrease in the rate of acute inpatient admissions over the study period compared to the control population
15% decrease in total ER visits and improvement in diabetes control
Practices achieving the highest level of recognition could receive $7.50 PMPM while practices with level 2 recognition received $6.00 PMPM.
Source: Raskas R, et. al. Early Results Show Wellpoint’s Patient-Centered Medical Home Pilots Have Met Some Goals for Costs, Utilization and Quality. Health Affairs, 31, no.9 (2012): 37 37

38. Medical Home Challenges
Moving the primary care delivery system towards functioning as “advanced” primary care homes regardless of payer, size, or location can be a challenging:
Many smaller, independent practices do not have health system support
Investments and education are needed to help manage practice changes
Requiring primary care clinics to meet advanced primary care home measures without additional resources or an adequate workforce will exacerbate existing workforce shortages and could worsen health disparities in underserved populations. 38 38

39. Understanding Payment Logistics
Payers must determine the total cost of care to decide which payment methodology would be the most effective at delivery quality results at a reduced cost. Each methodology then comes with an associated level of risk that will also need to be considered. 39 39

40. Total Cost of Care
According to Harold Miller, Executive Director of the Center for Healthcare Quality and Payment Reform, total per capita health care costs are driven by:
The prevalence of health conditions in the population;
The number of “episodes of care” they require per condition;
The number and types of health care services in each episode;
The number and types of processes, devices and drugs; and
The cost of each individual process, device, and drug.
There are also short-run and long-run costs.
Charges that are incurred at the time of service are the short-run cost, but also include indirect costs due to the patient’s lost productivity.
Long-run costs are the future expenditures attributed to current care (or lack thereof).
Putting it into context, If a provider overlooks giving a patient a routine measles vaccine during an exam, the patient may contract measles at some point in the future. The total cost of care that can be associated with the initial exam visit is the cost for services provided at the visit plus the cost of all services relating to the measles treatment plus the cost of lost productivity (i.e. time off of work, etc.) during the patient’s recovery from measles.
Source: Miller HD. From Volume To Value: Better Ways To Pay For Health Care. Health Affairs, 28, no.5 (2009): 40 40

41. Financial Risk
Financial risk assumed by the provider can serve as the basis for encouraging more efficient care. Each payment methodology carries a set of risks assumed either by the payer, the provider, or both.
This chart illustrates that as a payment system moves down the continuum of healthcare payment methods from FFS toward full capitation, the risk shifts from payer to provider
Source: Miller HD. Creating Payment Systems to Accelerate Value-Driven Health Care: Issues and Options for Policy Reform. The Commonwealth Fund. September 2007. 41 41

42. Transitional Approach
(Kelly)
Some payers and providers may be prepared to implement APMs immediately while others may need a flexible approach in order to transition to a truly value-based payment system. Payers and Providers could initially shift from FFS to shared savings and then work towards episode payments and more complicated risk arrangements. This chart shows how shifts can be made by three major provider types: Primary Care Providers, Specialty Care Providers, and Hospitals. 42 42

43. In Summary
Re-aligning the priorities of Oregon’s health care system using alternative payment methodologies will allow for provider incentives to include quality and efficiency in health care services and will eventually result in:
A higher level of illness prevention
More accurate diagnoses/prognoses of conditions
More appropriate care reflecting patient preferences and engagement
An Avoidance of adverse events
Improvements in follow-up to care
Kelly - Transition to Cathy at end – The Transformation Center is involved in finding solutions to the challenges presented, providing support to the CCOs 43 43

44. Why a Transformation Center?
To support Health System Transformation, OHA needs to transform itself, too.
Move beyond just regulating CCOs. Be a supportive partner in transformation and the spread of innovation.
Transformation Center will operate as OHA’s hub for innovation and improvement, but will also help the agency see where it needs to transform internally.
There is a need for a central organizing office to help CCOs increase the rate and spread of innovation needed to achieve better care, better health, and lower costs.
Our role is not to be the experts but to help good ideas travel faster.
The implementation of any innovation is the result of a social process: people talking to people
Cathy begins

45. Our goals:
Champion and promote health systems transformation in partnership with CCOs, providers and communities.
Build an effective learning network for CCOs.
Foster the spread of transformation beyond Medicaid.
Ensure state agency operations, policies and procedures support transformation.
Cathy, Bill

46. What will the Center do? Help good ideas travel faster!
Improve OHA operations and policies to better support the goals of transformation
Innovator Agents
Transformation Fund grants
Learning collaboratives
Innovation Bank
Technical assistance
Conferences and workshops
Communications, outreach and networking
Council of Clinical Innovators
Help disseminate clinical guidelines
Support efforts aimed at CCO and Early Learning Hub alignment
Cathy
- Help good ideas travel faster

47. Innovation

48. Central Oregon Pilot: Community workers make the difference
Cathy or Bill
Support innovation, rapid learning of what works
E.g., Community workers that can help reduce emergency department visits, such as in this Central Oregon Pilo
Central Oregon Pilot: Community workers make the difference
Addressing behavioral health: Reduced ED visits by 49% and reduced net costs net costs more than $600,000 in first six months.
Photo: Oregonian

49. Learning Collaboratives
The learning collaboratives enable CCOs to share best and emerging practices as well as do shared problem solving:
Participation in one statewide learning collaborative is required in contract and our waiver – others are voluntary.
Initial learning collaboratives for:
CEOs
Medical Directors and Quality Improvement Coordinators
Community Advisory Council members
Also convening a collaborative focused on high risk, high utilizers.
Cathy

50. Ted Hanberg, 83, frequent hospitalization
(Cathy or Bill)
Sharing and spreading innovations, such as how a coordinated approach to health care is helping patients such as Ted Hanberg manage several chronic illnesses at once without landing in the hospital every few weeks.
Mr. Hanberg's new health team, which uses the coordinated care model to help patients manage chronic conditions. With a focus on managing high-maintenance illnesses such as congestive heart failure, this approach helps keep patients healthier while at the same time avoiding higher-cost hospital admissions. The team includes doctors, nurses and medical assistants. A nurse acts as case manager, keeping Hanberg's primary care doctor in the loop.
Malik Wilkerson is an 8-year-old third-grader who has asthma.
Asthma attacks used to send Malik to the emergency room once or twice a month, says his mother, Maydean Wilkerson. "He'd get to the point where he couldn't breathe."
Today, that almost never happens. His primary care team has helped Malik bring his asthma under control and drastically reduce his trips to the hospital.
The new, coordinated approach involves reduced exposure to household asthma "triggers"; a home nebulizer to convert his medication into a quicker-acting mist; and a portable mini-inhaler to help him overcome wheezing attacks at school or on the playground.
Asthma is the most common chronic disease among children — and especially prevalent in low-income households. Although asthma can be well controlled by medication and preventive measures, Oregon children went to hospital emergency rooms 550 times for asthma attacks in 2006, according to the state Asthma Program.
The average cost of a hospital visit for asthma was $12,000. The Oregon Health Plan paid more than $5.5 million in 2007 for hospital care of asthma.
Malik is an example of how coordinated care can reduce that expense while improving health.
His mom enrolled in Multnomah County's Healthy Homes program, which helps children with asthma get control over their disease through careful choice of medications and reduction of environmental hazards in the home.
Healthy Homes visited the Wilkerson home to search for asthma triggers and recommend preventive steps: Natural cleaning agents. Mold prevention. Non-allergenic bedding and pillow cases. A special vacuum cleaner that captures dust without releasing any into the air.
Since Malik started using the nebulizer and special bedding and since his mom substituted vinegar-based cleaners for scented detergents, he has made only two visits to the hospital for asthma.
These lower-cost interventions are a good deal for everyone, his mother says, including taxpayers.
"In the long run it saves money by keeping Malik out of the hospital."
Ted Hanberg, 83, frequent hospitalization
Coordinated Care team helped him get his heart disease under control.
It’s been more than one year since he’s been to the hospital and he is living independently with his wife and daughter in Happy Valley.

51. Council of Clinical Innovators
The Center will develop a Council of Clinical Innovators:
10-12 providers who can serve as advisors and champions for the implementation of key innovations in the delivery and coordination of care.
Will build upon strong partnerships created during the development of the coordinated model of care with Oregon’s physician, specialty and other provider associations to spread transformation.
Cathy

52. Innovator Agents
High-level OHA positions that are embedded in the CCO community.
Serves as a single point of contact for the CCOs with the agency and helps bust bureaucracy within OHA.
Support the CCO as it implements its transformation plan
Act as champions of change, not regulators.
Connect regularly with other Innovator Agents to shared best and emerging practice and for shared problem solving.
Bill – describe IA role

53. Innovator Agents
Supporting CCOs by understanding their needs, finding solutions to challenges and promoting innovation.
Metrics, community health assessments, delivery system integration, CACs, and more
(Bill)
1. Support the CCOs from where they are at and where they identify the need for help.
2. Support the CCOs as the benefit package continues to expand, for example; A&D residential, NEMT, Dental, OHP 2014, Adult MH residential, TCM.
3. Incentive metrics and transformation plan.
4. Delivery system integration.
5. Community Advisory Councils
6.  Community Health Assessment and Improvement Plan
7.  Work across other government agencies and providers
8.  Work internally with OHA departments
Describe examples of

54. Questions?
All

55. More information at:
Transformationcenter.org Contact us at: