Care Coordination: An Opportunity to Help Drive Change S ept ember - PowerPoint PPT Presentation

Care Coordination: An Opportunity to Help Drive Change S ept ember 18, 2014 1

Healthy Counties Initiative S ponsors 2

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Today’s S peakers Cherryl Ramirez Executive Director Association of Oregon Community Mental Health Programs Larry Seltzer General Manager, CareManager Business Unit Netsmart Technologies 5

How many people are attending this webinar from your computer? a. 1 b. 2 c. 3 d. 4 e. 5 or more 6

Are you a(n)… a. Elected county official b. Behavioral health care official/ staff c. Health and/ or human services official/ staff d. Law enforcement official/ staff e. Other 7

Does your county currently have a care coordination plan for individuals living with behavioral health conditions? a. Y es b. No c. Not sure 8

Care Coordination: An Opportunity to Help Drive Change OREGON’S MODEL

Oregon has a multitude of landscapes: Coast

Waterfalls

Mountains

Forests

Urban Areas

Rural

Frontier

Oregon Healthcare Reform The “Coordinated Care Organization”  A community-based and governed organization  Hybrid of a Health Plan and an ACO  Includes medical, behavioral health, Health Plans dental, public health, social services, Other Funders Employers housing, and more Coordinated Care Organization Clinic Food Mart Specialty Medical Clinics Clinic Food Mart Patient Patient Centered Centered Hospitals Primary Primary Hospitals Specialty Behavioral Care Care Health Clinics Home Home Social Service Employment/Education Child Welfare, Housing Public Health, Oral Agencies Health, Etc.

Core Elements of a CCO 1. Network of all types of health care providers who have agreed to work together in their local communities 2. Have the flexibility to support new models of care that are patient- centered, team-focused, and reduce health disparities 3. Coordinate services and also focus on prevention, chronic illness management and person-centered care 4. Have flexibility within a predictable global budget to provide community based services in addition to the traditional Medicaid benefits

1115 CMS Waiver – Vehicle for Medicaid Reform Effective July 5, 2012 Establishment of CCOs as Oregon’s Medicaid delivery system in order to improve health and healthcare, and to lower per capita costs Flexibility to use federal funds for improving health Federal investment: $1.9 billion over five years

Oregon is accountable to CMS for: Savings • 2% reduction in per capita Medicaid trend of 5.4% • State to achieve 4.4% by end of year 2 and 3.4% there after • No reductions to benefits and eligibility in order to meet targets • Financial penalties for not meeting targets Quality • Measurement and benchmarks • Financial incentives for CCOs Transparency (See www.oregon.gov/oha/metrics) Workforce development • $2 million per year for primary care loan repayment • Training of minimum 300 additional community health workers by end of 2015

ABHA (Pink) Ment ntal H Health Or Organiz izations ( (MHO HOs) Benton Deschutes Crook Jefferson Servic vice Areas Lincoln Clackamas ( Blue) Clackamas Family Care (Blue, Orange, Gold) Clackamas Clatsop Multnomah Columbia Washington Umatilla GOBHI (Green) Hoo Tillamook Wallowa d Multnomah Gilliam Baker Washingto n Lake Clatsop Rive Morrow Union Gilli Malheur Columbia r Clackamas am Umatilla Grant Sherma Wasco Yamhill n Harney Wallowa Polk Wheeler Douglas Mari Morrow Union on Wheeler Baker Hood River Wasco Jefferson Sherman Lincoln Linn Grant Bent JBH (Tan) on Coos Jackson Crook Curry Josephine Klamath Lane Deschutes Malheur LaneCare (Yellow) Lane MVBCN (Aqua) Linn Douglas Harney Polk Coos Lake Marion Tillamook Yamhill Washington (Orange) Washington Joseph Klamath Jackson THA (Orange) ine Curry Washington Verity (Gold) Multnomah January 2012

Oregon Coordinated Care Organizations

100% Integrated Care CCOs will be required to have 100% of their members enrolled in Person Centered Medical Homes with fully integrated behavioral health services. Will be responsible for tracking and assisting with elements of a person’s well-being and health-related quality of life including: ◦ Transportation ◦ Housing ◦ Employment and Financial Security ◦ Nutrition ◦ Education

Oregon Health Authority 2013 Benchmarks CCO Incentive Measures Statewide Benchmark Baseline (CY 2011) Access to Care: Getting Care 83% 87% Quickly (CAHPS survey composites for Average of the 2012 Medicaid 75 th adult and child) Percentile for adult and child rates. Adolescent well-care visits 27.1% 53.2% (NCQA) 2011 National Medicaid 75 th percentile, administrative data only. Alcohol and drug misuse: 0.02% 13% screening, brief intervention and referral for treatment Determined by Metrics & Scoring (SBIRT) Committee, based on prevalence of risky drinking behaviors and screening rate from the highest

CCO Incentive Measures Statewide Benchmark Baseline (CY 2011) Ambulatory care: outpatient ED Utilization: ED Utilization: 44.4/1,000mm and emergency department 61.0/1,000mm utilization Outpatient Utilization: Outpatient 439/1,000mm *Emergency department Utilization: utilization rate will be used to 364.2/1,000mm 2011 National Medicaid 90 th determine quality pool percentile payment. Colorectal cancer screening 15.8 / 1,000 No benchmark. (HEDIS) member months 3 percent improvement only. Baseline and benchmark are final. Developmental screening in 20.9% 50.0% the first 36 months of life (NQF 1448) Determined by Metrics & Scoring Committee, based on results from Baseline and benchmark are 2007 National Survey of Children’s final. Health.

CCO Incentive Measures Statewide Benchmark Baseline (CY 2011) Follow up after hospitalization 65.2% 68.0% for mental illness (NQF 0576) 2012 National Medicaid 90 th percentile Follow-up care for children Initiation: 52.3% Initiation: 51.0% C&M: 61.0% C&M: 63.0% prescribed ADHD medications (NQF 0108) National Medicaid 90 th percentile *Initiation component will be used to determine the quality pool payment Mental and Physical Health 53.6% 90% Assessments within 60 days for Children in DHS Custody Determined by Metrics & Scoring Committee

CCO Incentive Measures Statewide Benchmark Baseline (CY 2011) Patient-Centered Primary Care 51.8% Goal: 100% of members enrolled Home (PCPCH) Enrollment in Tier 3 PCPCHs Calculated by: The percentage of dollars available [(# of members in Tier 1)*1 + to each CCO for this measure will (# of members in Tier 2)*2 + (# be tied to the percentage of enrollees in PCPCHs, based on the of members in Tier 3)*3 ] / (The total number of members measure formula. enrolled in the CCO*3) Prenatal and postpartum care: 65.3% 69.4% timeliness of prenatal care 2012 National Medicaid 75 th (NQF 1517) percentile, administrative data only

CCO Incentive Measures Statewide Benchmark Baseline (CY 2011) Satisfaction with Care: Health 78% 84% Plan Information and Customer Average of the 2012 Medicaid 75 th Service (CAHPS survey composites for adult and child) Percentile for adult and child rates. EHR adoption 28.0% 49.2% Baseline and benchmark is final. 2014 Federal benchmark for Baseline reflects final measure Medicaid. specifications using local providers only. Elective Delivery Preliminary: 5% or below 10.1% Determined by Metrics & Scoring Committee. Incentive Pool was $46 M in first year.

CCOs making progress -- Decreased emergency department visits. Emergency department visits by people served by CCOs has decreased 17 percent since baseline data were collected in 2011. The corresponding cost of providing services in emergency departments decreased by 19 percent over the same time period. -- Developmental screening during the first 36 months of life. The percentage of children who were screened for the risk of developmental, behavioral and social delays increased from a 2011 baseline of 21 percent to 33 percent in 2013, an increase of 58 percent. -- Increased primary care. Outpatient primary care visits for CCO members increased by 11 percent and spending for primary care and preventive services are up over 20 percent. Enrollment in patient-centered primary care homes has also increased by 52 percent since 2012, the baseline year for that program. -- Decreased hospitalization for chronic conditions . Hospital admissions for congestive heart failure have been reduced by 27 percent, chronic obstructive pulmonary disease by 32 percent and adult asthma by 18 percent.