Appendix H Imagine Better health outcomes and quality of life for Oregonians, supported by: A sustainable model for Community Self Management Programs that promotes equity, access, quality, and cost savings through a flexible and evolving statewide network.
Appendix H Self-Management Programs Are… • Innovative, evidence-based interventions • Help people take care of themselves, stay healthy, and live better with existing mental & physical conditions • Span community and health system settings • Patient-centered (often peer-led) • Meet needs of those with multiple conditions Oregon Tobacco Quit Line Living Well, Tomando Control de Su Salud, Positive Self-Management ���������������� ���������������� ���������������� ���������������� ������������������ ������������������ ������������������ ������������������ 2
Appendix H Self-Management Programs and the Triple Aim * (Example: Living Well with Chronic Conditions) Better Better Care Lower Costs Health • Improved • Provider-patient • $714 / person symptoms communication savings in (fatigue, pain, sleep emergency room • Medication problems) and hospital compliance • Better quality of utilization • Confidence in life • $364 / person net filling out forms • More active lives savings (after (health literacy) (13% more $350 per person moderately active program cost) days/week) * Ory MG, Ahn S, Jiang L, Smith ML, Ritter P, Whitelaw N & Lorig, K. (2013). Medical Care 51(11), 992-998 . 3
Appendix H Our Shared Journey 2013 2015 • Stakeholder •We’ve taken a fresh interviews informed look at how to most • We’ll build a the Hub strategy •Further research efficiently use community resources & outlined in the refined the strategy, sustainable including desired align with health system statewide model that Business Plan. transformation services and partner honors community characteristics. needs and strengths. 2012 2014 4
Appendix H Community Self-Management Programs Strategic Opportunity • A vision that works for Oregon • Aligns with Triple Aim goals: better health, better care, lower costs • Aligned with federal priorities & opportunities • Promotes equity • A statewide system • Streamlines self-management program – Flexible operations and technical assistance – Collaborative • Furthers cross-sector and community linkages – Innovative • Community-level interventions • Demonstrates the business case for SMPs • Develops SMP financing structure 5
Appendix H Objectives Patient Centered Patient Centered Community Based Community Based Engage, activate and empower Statewide Access Statewide Access patients Promote clinical- community Equity Equity linkages Invest health care funding to Triple Aim Triple Aim expand access Provide culturally & linguistically Support better proficient care and better services health at lower cost Working Assumptions • Expanded access to self-management programs supports OHA priorities • Coordinated support and investment build sustainability 6
Appendix H Leading Options 2. Centralized 1. Regional 3. All Regional Hub Infrastructure Partnerships with Central Payment / Data System • Statewide • Regional entities • Regional self- umbrella entity responsible for management supports local quality and access program self-management partnerships programs: • Local/regional assure: • Training payment • Access • Marketing agreements & • Quality processes • Participant assurance registration • Marketing • No centralized functions • Centralized “one- • Centralized, stop shop” for shared core payers: functions: • Payment • Registration • Program • Payment provider network • Data collection & access reporting • Data collection & reporting • Quality assurance 7
Appendix H Comparison of Leading Options: 1. Regional Partnership with Central Roles & Responsibilities Payment/Data System Core Functions State (OHA) Statewide Regional CCOs Local Entity Partner- Self- ship Mgmt Providers Access, Equity and Quality x x x Oversight Program Content Licensing x Administrative/Infrastructure x x x Funding (seed funding) (ongoing) (ongoing) Program Funding x x x Payer Contracting x x Provider Network Administration x x x (technical assistance) Program Marketing x x x Registration, Data Management x and Payment Processing 8
Appendix H Regional Partnership with Centralized Payments/Data Strengths • Promotes local efforts and innovation • Centralizes key functions : payments & data management • Leverages emerging payment models and system reforms for large non-OHP populations (PEBB/OEBB, commercial market) Weaknesses • Challenging timing : • Key components of the new system are still being established • Key players are focused on other priorities
Appendix H Comparison of Leading Options: 2. Centralized Hub Infrastructure Roles & Responsibilities Core Functions State (OHA) Statewide Regional CCOs Local Self- Entity Partner- Mgmt ships Providers Access, Equity and Quality x x x Oversight Program Content Licensing x Administrative/Infrastructure x x Funding (seed funding) (ongoing) Program Funding x x x Payer Contracting x x Provider Network Administration x x (TA) Program Marketing x x Registration, Data Management x and Payment Processing 10
Appendix H Centralized Hub Infrastructure Strengths • Efficiency for payers and providers through standardized payment process • Economies of scale via centralized systems • Increases access to/for commercial market and public employees • Statewide attention to equity and access • Provides neutral selection process/opportunity via public RFP Weaknesses • Less local/regional “face” for programs • Infrastructure may not be well aligned with Coordinated Care Organizations
Appendix H Comparison of Leading Options: 3. All Regional Roles & Responsibilities State (OHA) Statewide Regional CCOs Local Self- Core Functions Entity Entities Mgmt Providers May be Access, Equity and Quality x x involved – varies by region Program Content Licensing x Administrative/Infrastructure x x Funding (seed funding) (ongoing) Program Funding x x Payer Contracting x Provider Network Administration x x (TA) Program Marketing x x Registration, Data Management x and Payment Processing 12
Appendix H All Regional Strengths • Promotes local efforts and innovation • Leverages existing transformation efforts and organizations Weaknesses • Complex to administer • OHA’s capacity to support existing network will diminish as complexity increases • Lacks statewide billing for non-CCO covered lives • Lacks statewide data collection/reporting
Appendix H Recommendation 1. Regional Partnerships with Central Payment / Data System • Regional self-management program partnerships between program delivery organizations, insurance plans and local public health assure: • Access • Quality assurance • Marketing Strengths • Centralized, shared core functions: • Promotes local efforts and innovation • Registration • Centralizes key functions : payments & data • Payments management • Data collection & reporting • Leverages emerging payment models and system reforms for large non-OHP populations (PEBB/OEBB, commercial • Total combined budget ≈ $200,000 market) (possible additional funding through pending grant proposal) Weaknesses • Challenging timing : • Key components of the new system are still being established • Key players are focused on other priorities 14
Appendix H Getting From Here to There: A Proposed Partnership Pilot How Will It Work? • OHA contracts with statewide third-party administrator for Goals billing capacity & data management • Begin building infrastructure and ‘proof of concept’ for • OHA provides grants to develop Partnership Model (#1) regional self-management provider partnerships • Build capacity for local business partnerships between • Requires that the applicable CCO’s and other payers and CCO(s) are active participants, self-management program with special consideration for providers commercial and/or public payers involvement • Demonstrate a sound business case and identify models for • OHA provides metrics / statewide development requirements and assistance to support business development and connection to billing structure 15
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