Transcript Tri-County Medicaid Collaborative

A collaborative of organizations and individuals
devoted to the health of the community
November 14, 2012
David Labby MD, Chief Medical Officer
Sandra Clark, Project Director – Community Health Strategies
Why CCOs are needed
• $860 million state shortfall for Medicaid care
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for 2011-2013.
Medicaid/Oregon Health Plan grew by 200,000
members in past 5 years.
Anticipate over 1 million members by 2019.
Affects 212,000+ Tri-County residents.
Tri-County share of the shortfall is $258
million.
U.S. ranks far down on the list of developed
nations in terms of health outcomes.
Change is Good!
…..You Go First!
Health Transformation in Oregon
47/21/2015
LEGACY HEALTH
Coordinated Care Organizations
• Community-based organizations with strong consumer
and provider involvement in governance
• Responsible for full integration of physical, behavioral and
oral health, minimize fragmented care
• Global budget
• Revenue flexibility to allow innovative solutions
• Agreed upon rate of growth
CCO Criteria
Operate within a global budget
Manage financial risk, establish financial
reserves, meet minimum financial requirements
Coordinate physical, mental health and chemical
dependency services, oral health care
Encourage prevention and health through
alternative payments to providers
Engage community member/health care
providers in improving health of community
Address regional, cultural, socioeconomic and
racial disparities in health care www.health.oregon.gov
Health Share of Oregon
Board of Directors
Elected Board
Members
Founding Members
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Adventist Health
CareOregon
Central City Concern
Clackamas County
Kaiser Permanente
Legacy Health
Multnomah County
OHSU
Providence Health & Services
Tuality Healthcare Alliance
Washington County
• Primary Care Provider physician: Jill
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Ginsberg
Specialist physician: W. Gary
Hoffman
Nurse Practitioner: Jean-Claude
Provost
Mental Health Treatment Provider:
Mary Monnat
Addiction Treatment Provider: Jackie
Mercer
Dentist: Michael Biermann
Community-at-Large: Mel Rader
Community-at-Large: Ramsey Weit
Chair of Community Advisory
Council: Steve Weiss
Goals
1. Deliver coordinated, high quality services at the
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right place at the right time. (No Wrong Door)
Engage OHP members, the high-risk
uninsured, providers, and community resources
in meaningful partnerships.
Work to eliminate health disparities.
Focus on excellent customer service and
satisfaction.
Spend health dollars wisely to create a
sustainable system.
The Work So Far
(and what we are doing now)
• Months of delicate and often difficult discussions among
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diverse and historically competitive organizations;
Awarded $17 million grant from the Centers for Medicare and
Medicaid Innovation to fuel transformation of clinical care for
high utilizing OHP enrollees;
Certified as Coordinated Care Organization Effective
September 1; the largest CCO in the State;
Launched our Community Advisory Council and Seated Full 20
Member Board of Directors;
Recruiting permanent leadership;
Convening meetings with stakeholders, community members,
and creating systems for transformation
Preparing Three Transformation Plans
• Model of Care (Includes Flexible Benefits, NTHW, Etc.)
• Administrative Consolidation (Seven Health Plans)
• Risk and Payment Methodology
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Health Share of Oregon
Community Advisory Council Members
Steve Weiss, Chair (Consumer Member – Multnomah County)
Dalila Sarabia, Vice Chair (Community Member - Hillsboro Family Resource Center)
Amy Anderson (Consumer Member – Multnomah County)
Dan Peccia (Community Member – Self Determination Resources)
Faith Gilstrap (Community Member – Oregon Family Support Network)
Gary Cobb (Consumer Member – Multnomah County)
Glendora Claybrooks (Consumer Member – Washington County)
Joseph Lowe (Consumer Member – Clackamas County)
Kate O’Leary (Community Member – Washington County Health & Human Services)
Lyla Swafford (Consumer Member – Washington County)
Ronda Harrison (Consumer Member – Washington County)
Sam Chase (Community Member – Coalition of Community Health Clinics)
Sonja Ervin (Community Member – Alliance of Culturally Specific Behavioral Health
Providers)
Susan Myers (Community Member – Multnomah County DHS)
Tab Dansby (Consumer Member – Multnomah County)
Trell Anderson (Community Member – Housing Authority of Clackamas County)
OPEN (Consumer Member – Clackamas County)
What does transformation look like?
• Current health system is
fragmented
• We have duplicated services in
some places, and lack of capacity
for basic services elsewhere
• Asking the Questions:
• Can we do more with less?
• Can we do more of what works?
• Can we let go of what doesn’t?
• How do we create best possible
lives for everyone in Oregon?
Changing the delivery system
Changing health care’s relationship with
community resources
Q&A
http://healthshareoregon.org
[email protected]