Transcript Slide 1

Health Care Transformation &
Coordinated Care Organizations
Presented by Senator Dr. Alan Bates
& Paul Phillips, Pac/West
Tuesday, July 26, 2011
Hosted by
2011 Session Overview
• 3rd Term for Governor John Kitzhaber
• Senate Democrats hold a small
advantage 16-14
• First time: Oregon House was evenly
divided 30-30
– Co-Speakers
– Co-Chairs (One Democrat/One
Republican) for every Committee
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Health Care Legislation Passed
• Major health care legislation still manages to
pass:
– Oregon Health Insurance Exchange
– Parity of in-patient/out-patient methodologies
payments
– Elimination of payments for adverse and/or never
events
– Recruitment and retention of physicians
– Health Care Transformation
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Why the Need for Health Transformation?
• The cost of health care rises every year
• Oregon has a 3 billion dollar budget hole
• Bad economy = more Medicaid clients
IN SHORT:
Oregon must help more people
with less money
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Health Transformation: Process
• Goal: Integration and reduce costs in order to
build a sustainable system
– The Governor established a work group process
– Input was gathered from throughout the State
– Turf protection became the focus
– A smaller work group established a baseline
– The legislature worked on a bill
– Eventually leadership took over (Bates, Freeman,
Kotek, Roblan, Hanna, Thompson)
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House Bill 3650: Health Transformation
• Goal: Provide better care and reduce costs
and focus on unique community needs
– Break down the delivery silos
– Operate inside a global budget
– Find cost savings (reduce redundant care, stop
payment for never events, med/mal reform)
– Integrate services with Coordinated Care
Organizations (CCOs)
– Build on the successes of MCOs like WVP
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Old Way of Delivering Care
• Each silo has their
own pot of money
• Services often don’t
work together
• Patients and systems
can get lost in the
shuffle
(See pg. 2 of handout)
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New Model
• Work from one global budget
for all a patient’s needs
• CCO is one point of contact for
the patient to get care they
need
• Funding more clear
• Flexibility to fund the
programs and care that get
(See pg. 2 of handout)
results
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What is a CCO?
• Similar to a locally based Managed Care
Organization, except will integrate:
– Physical health (including prevention)
– Mental health
– Dental health
– Behavioral health
• Provides all health services for Medicaid
clients and acute care for dual eligibles
• Organization can be set up through contracts
or partnerships
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CCO Structure
(See pg. 3 of handout)
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How a CCO Works
• CCO will be made up of primary care providers, clinics,
mental health providers, hospitals, specialists &
preventative care programs, etc…
• Services for client will be coordinated by the CCO
• Governance: Locally controlled board made up of those
taking financial risk in the CCO
• Public Input: Community Advisory Council made up of
community leaders will give feedback to the CCO
• No entity has a “veto” power over another (Plan,
County, Hospital, major provider)
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What’s Next?
• OHA is forming the Transformation process:
– Workgroups: CCO Criteria, Global Budgets, Quality
Metrics and Dual Eligibles
– Analysis of defensive medicine
• MCOs need to lead the transition to CCOs:
• Legislative approval still needed specific to:
• Global budgets
• CCO organizationally
• Defensive medicine analysis
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Timeline
(See pg. 4 of handout)
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Timeline
• The transition time is very short (July 2012)
• In less than a year, CCOs will have to be up
and running with a community focus
• Work with OHA during the interim will be vital
• Oregon will be looking for a leader
• WVP and other plans are positioned to be
leaders right along with their community
partners and healthcare delivery systems
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WVP Well Positioned
• WVP has delivered GREAT results
– Executive staff and organizational excellence
• WVP offers a unique set of credentials:
– We have the physician community thus the professional
expertise and the primary care provider networks to serve
our community
– We offer population based management with a proven
record of innovation and cost containment
– We are the bridge between facility based management
and a healthier community
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Summary
• Transformation has worked in Oregon
– SB 27: 1989 The Oregon Health Plan
– SB 44: 1991 Expansion of OHP Coverage
• Transformation will work again
– HB 3650: 2011 OHP Phase Three
• Transformational success will be based off:
– Cooperation
– Vision
– Removing impediments within regulatory existing system
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Summary
• Transformation will result in Medicaid clients
getting the right care at the right time
• Professionals providing care will have more
tools to help their patients get healthy
• CCOs will save the system money though
better coordination and care
• Community-based care will continue to be the
cornerstone of OHP as MCOs lead transition
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Summary
• Don’t wait: Become a CCO now
• Start building partnerships with
local providers
• Share your vision of a CCO with
everyone
• Identify new cost savings in a
coordinated care model
• Be a leader: this isn’t a
competition it is a coordination
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Questions
Thank you!
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