How do CCOs work? Where are we in the transformation process? How it will affect you and your clients? How can you play a role?

LEGACY HEALTH

Why Transform? Why Now? Fragmented, siloed systems Unsustainable health care costs Not great health outcomes State budget woes

System Challenges: Influence Factors on Health Status Social 15% Environmental 5% Human Biology 30% Lifestyle & Behavior 40% Medical Care 10% Source: McGinnis J.M., Williams-Russo, P., Knickman, J.R. (2002). Health Affairs, 21(2), 83

Eight year old, Malik, lives with asthma. Thanks to a Coordinated Care pilot project and his Community Health Worker, Malik learned how to manage his asthma daily. Now he spends more time playing with his friends and less time in the hospital.

Vision of CCO Implementation Integration & coordination of benefits & services Local accountability for health & resource allocation Standards for safe & effective care Global budget indexed to sustainable growth Redesigned Delivery System Healthier population Improved Outcomes Reduced Costs [The Triple Aim] [A CCO]

“I think you should be more explicit here in Step two.”

… And dentists

[Insane] CCO Development Timeline July ‘11 January ‘12 March ‘12 April ‘12 May/Jun ‘12 July ‘12 August ‘12 Nov ‘12 Jan ‘13 Feb ’13 January ’14 HB 3650 signed into law OHPB’s Implementation Plan published, SB 1580 signed into law CCO Letters of Intent submitted, RFA published Application for CCO Certification due Readiness Review Execute CCO Contract with OHA- Go Live! FFS enrolled into CCOs Transformation Plan draft due Transformation Plan implementation begins Medicaid population expansion

Key Components of CCO Development Geographic/Demographic Scope Business & Operations Information Systems Utilization Management Administration Claims Processing Customer Relations Workforce Development Local Governance Board of Directors Community Advisory Council Clinical Advisory Panel Model of Care Physical, mental, oral health integration Social service networking/integration Delivery system transformation Keeping people healthy Financing Global Budget Capitalization Risk Revenue Alternative Payment Methodologies

Why would Oregon’s health systems agree to do all this (just for Medicaid)? ~18% of Oregonians are enrolled in Medicaid today Will jump to 25% after ACA Medicaid expansion in 2014 The Governor is working to fold all publicly funded health coverage into the CCO model PEBB & OEBB If that happened, ~40% of Oregonians would have care paid for and coordinated through CCOs $1.9 Billion in federal investment  accounts for 19% of the state’s Medicaid budget this biennium

Community Advisory Council Majority consumers CAC member sits on Governing Board Duties include: Community Needs Assesment Community Health Improvement Plan We are looking for community members NOW! Contact your local CCO to join or attend meetings.

What does Transformation look like? The fundamental questions for stakeholders: Can we do more with less? Can we do more of what works? Can we let go of what doesn’t? How do we together foster communities that support the best possible lives for everyone in Oregon?

Rose Englert Sr. Manager, Regulatory Affairs CareOregon 14

15 List of CCO Maps and Governing Boards: health-reform/certification/index.aspx

CareOregon Affiliated CCOs Health Share of Oregon Columbia Pacific CCO Jackson Care Connect Yamhill County Care Organization PrimaryHealth of Josephine County

What Does It Take To Be A CCO?  Corporate Structure/Governance  Community Advisory Council  Coordinate physical, behavioral, & oral health  Experience managing financial risk  Minimum financial reserves  Primary care medical homes  HIT strategy  Written agreements with counties, public health & Area Agency on Aging

CCO Possibilities  Ability to reduce preventable conditions  Widespread use of primary care health homes  Improved outcomes due to enhanced care coordination and care delivered in most appropriate setting  Reducing errors and waste  Innovative payment strategies  Use of best practices and centers of excellence  Single point of accountability for achieving results 18

Minimum Standards to Evaluate CCO Transformation Integration, Primary Care, Payments 1.Implement a health care delivery model that integrates mental health and physical health care and addictions. 2.Implement Patient-Centered Primary Care Homes. 3.Implement consistent alternative payment methodologies that align payment with health outcomes.

Minimum Standards to Evaluate CCO Transformation Assessments, Improvement, & IT 4. Prepare a strategy for developing a Community Health Assessment and adopt an annual Community Heath Improvement Plan. 5. Develop a plan for encouraging electronic health records; health information exchange; and meaningful use.

6. Assure communications, outreach, Member engagement, and services are tailored to cultural, health literacy and linguistic needs. 7. Assure that the culturally diverse needs of Members are met; provider and new health care workers reflect member diversity. 8. Develop a quality improvement plan focused on eliminating disparities in access, quality of care, experience of care, and outcomes. Minimum Standards to Evaluate CCO Transformation Reflecting Diversity, Addressing Disparities