THE HEALTH COUNCIL MODEL MANAGING HOSPITALS & HEALTH SYSTEMS THROUGH REFORM.

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Presentation transcript:

THE HEALTH COUNCIL MODEL MANAGING HOSPITALS & HEALTH SYSTEMS THROUGH REFORM

CAP Co-chairs Columbia Gorge Health Council The Board Activities: Directs CCO activities for the region, reviews financials, provides strategic direction to the CCO Clinical Advisory Panel Activities: Provides clinical direction to the CCO by structuring review of high spend clinical areas, originates some initiatives, provides guidance for QI review and transformation fund spending.. Community Advisory Council Activities: Informs the CCO about member-relevant issues, directs coordination of the Community Health Assessment. CAC Chair CAC liaison STRUCTURE: PACIFICSOURCE COMMUNITY SOLUTIONS CCO ONE CONTRACT, TWO REGIONS

AIM I: LOWERING COST Tactic: Communicate Health Council Target Areas to the Medical Staff of both hospitals, and individually via the CAP members. Example: Focus Areas Super-users 161 people (2.2%) use 40% of the funding ($7M) 273 people (3.7%) use the next 20% chunk of funding  Proposed Solutions: The “hot-spotter strategy”: Community Health Worker Hub and Primary Care PCPCH Case Management Education Emergency Department Usage Wasco County ER use rate is 2x Hood River County, even though the population is divided 55% Wasco and 45% Hood River  Proposed Solution: ED Diversion Program (like the Central Oregon Model)

AIM I: LOWER COST CGHC Focus Areas (cont.) Behavioral Health Integration Poorly managed mental health conditions magnify costs of treating chronic physical conditions  Proposed Solution: Integrate care, (like the MCOC model) Specialty Drug Use Our CCO is 30% lower in occurrences of chronic disease but we are 4.3X higher in specialty drug use cost Pharmacy costs are a large piece of the spend  Proposed Solution: Investigate 340B cost savings and review prescribing practices at a peer to peer level

AIM II: IMPROVE QUALITY THROUGH INCENTIVE MEASURES Wellness and Prevention Health ScreeningAppropriate Use of the system Adolescent CheckupsChild development screening PCPCH Enrollment *tier level matters Follow up after Mental Illness hospitalization Colorectal Cancer Screening Follow up after ADHD medication start Physical & Mental health eval for children entering DHS custody Alcohol/ Drug Misuse Screening CAHPS: 1. Access to care 2. satisfaction with care Controlling DiabetesEarly prenatal careED Utilization Controlling Hypertension Screening for Depression Avoiding elective preterm delivery Using an Electronic Health Record System

AIM III: IMPROVING THE EXPERIENCE OF CARE WITH TRANSFORMATION PROJECTS Transformation funding - Model for distribution

AIM III: IMPROVING THE EXPERIENCE OF CARE WITH TRANSFORMATION PROJECTS Transformation funding - Model for distribution  Clinical Advisory Panel : Does the project have ethical merit?  Community Advisory Council : Is it right for our community?  Board : is it financially viable and is there sufficient ROI?