Health System Transformation Quarterly Progress Report November 2013

This week is Interim Legislative Days at the Oregon Capitol in Salem, Oregon. The House and Senate Health Care Committees met together to hear updates on several health related topics. See the update presentations from the Oregon Health Authority and Cover Oregon below. 

Health System Transformation Quarterly Progress Report 

November 2013 

Task Force on Individual Responsibility and Health Engagement 

Cover Oregon Update

	FOR IMMEDIATE RELEASE November 18, 2013 CONTACT: Katie Briedwell CCO Community Engagement Coordinator Yamhill County Care Organization kbriedwell@yamhillcco.org; 503-434-7339

Health care reform

Yamhill County Care Organization celebrates a year of progress; Designs Early Learning Hub

McMinnville, Ore. — Yamhill County Care Organization (Yamhill CCO) celebrates its first year of operations this month. While planning for more health-care improvement objectives in the months and years ahead, Yamhill CCO is marking the anniversary with a look back at the past year’s accomplishments, and anticipating a Letter of Intent from the Early Learning Council to award one of the state’s first Early Learning Hubs to Yamhill County.
Yamhill CCO manages care for the physical and mental health care needs of Oregon Health Plan (OHP) Medicaid members in Yamhill County, and by July 2014 will add transportation and dental care. It is one of 16 local Coordinated Care Organizations (CCOs) established to comply with state statutes affecting OHP clients.
Although most CCOs were formed by existing health care providers, including regional health plans and individual practice associations, Yamhill County leaders and providers chose to apply as a new non-profit organization, which gives more local control and accountability to the public. Its board members represent the spectrum of health care and community service interests within Yamhill County and serving mostly Yamhill County citizens.
“Community input and involvement is highly valued by Yamhill CCO,” says Jim Carlough, Yamhill CCO executive director. While all CCOs must have clinical advisory panels (CAPs) and community advisory councils (CACs), Yamhill CCO has broadened this shared responsibility with good results, he says. “Yamhill CCO held a joint session of its board of directors, clinical advisory panel and community advisory council; and, a member of the CAC serves on the Board of Directors.”
“Our community forum in June led to new ideas and goals for Yamhill CCO for 2014 and beyond,” Carlough says. The three bodies will meet jointly again this fall to review progress, and to project the work over the next months, including the task of implementing the expansion of Medicaid under the federal Affordable Care Act.
“It’s a major accomplishment for us to have such a productive forum where health providers, citizens and OHP members can brainstorm on how to improve and impact community health,” Carlough says.
Here are some of the current efforts:
YAMHILL CCO has funded two rounds of “Invest Forward” projects to address needs identified by the community. These projects are:

• Project ABLE, operated in coordination with the Traditional Health Care Worker Hub, will work with physicians and wellness teams to help clients who use a lot of health services to learn how to avoid unnecessary hospitalizations and emergency room visits.
• Virginia Garcia Memorial Health Center will increase access to comprehensive primary care, prevention services, mental health, and dental care for Oregon Health Plan members when the Affordable Care Act is expanded in 2014.
• Patient Activation Measure assessment tool will allow OHP care providers to evaluate and support patients in improving their own health.
• Behaviorists in Primary Care is a program supported by clinical leaders from George Fox University to place mental health clinicians (behaviorists) in practice settings at medical homes throughout the county.
• Community HUB Project will deploy North West Senior & Disability Services’ traditional health workers to ensure access and coordination of care for the most medically fragile members.
• Care Coordinator and Panel Manager staff have been deployed at Physicians Medical Center in McMinnville as key members of the patient-centered primary care home.
• Crimson Care Registry is a health information technology that will help the provider community to bridge the gap between various electronic health record systems and aggregate clinical data for the broader community coordination of care.

Another great community accomplishment over the past year is the work of the Yamhill Early Childhood Coordinating Council (ECCC), which led to a partnership with Yamhill CCO and a collective effort to apply to be a local Early Learning Hub.
“By having the Early Learning Hub under the Yamhill CCO umbrella, we create the capacity to achieve the core missions of both these entities toward better health and education outcomes for Yamhill County children and families,” Carlough says. “Children comprise 70 percent of our current membership, and health is a primary factor in their readiness to learn.”
With leadership from the two advisory groups, Yamhill CCO has also been working to improve quality of care throughout provider organizations.
“Yamhill CCO is committed to improving community health and wellness,” says Silas Halloran¬Steiner, director of Yamhill County Health and Human Services and chair of the Yamhill CCO board of directors.
“There are great opportunities for system coordination and improved care due to the high degree of community and provider involvement in Yamhill CCO,” Halloran¬Steiner says.

• For more information about Yamhill County Care Organization, contact Jim Carlough at jcarlough@yamhillcco.org.
• For information about Oregon’s Early Learning Hub initiative, see http://oregonearlylearning.com/other-priorities/community-based-coordinators-of-early-learning-services-hubs/.

Stakeholder Survey from OHA

Dear Stakeholder:

In our recent agreement with CMS regarding health system transformation, Oregon agreed to “conduct an exploratory stakeholder process that would result in a report to CMS regarding the integration of DHS Medicaid-funded LTC for the aged or people with disabilities into CCO global budgets.”

To accomplish DHS will engage a small group of approximately 20 Stakeholders from across a number of interests.  Our goal is that these stakeholders represent both the long term care and health care systems.  Additionally, we are seeking a balance between provider and consumer representatives.  We plan on beginning the detailed work in May 2013.  At this point, we anticipate monthly 4-hour work sessions over the course of six months.  The goal is finalize the report in November with CMS submission in December.  DHS is the lead agency for conducting this work but will partner strongly with OHA.

If you are interested in participating in this study, please submit an email to Susan Otter that answers the following questions: 

Name:

Title:

Organization:

Do you represent the provider or consumer perspective?

Why are you interested in participating in this exercise?

Can you commit to approximately six 4-hour work sessions from May 2013-November 2013?

Can you commit to reviewing and potentially editing materials resulting from work sessions?

Please send an email with the answers to these questions to susan.otter@state.or.us by February 19, 2013.  We will select approximately ten individuals from the health care community to participate in this exercise.

You can review the OHA announcement and informational materials about the Accountability Plan online athttp://www.oregon.gov/oha/OHPB/Pages/health-reform/cms-waiver.aspx

Sincerely

Bruce Goldberg, M.D.

Director

Oregon Health Authority

State Finalizes Federal Grant

Oregon announced a the finalization of a comprehensive agreement with the Centers for Medicare and Medicaid Services (CMS) that sets expectations for Oregon’s Coordinated Care Organizations. The agreement fulfills the Special Terms and Conditions of last July’s 1115 Medicaid demonstration.

Entitled “Oregon’s Accountability Plan  and Expenditure Trend Review,” the plan “lays out the methods, measurements and accountability” for Oregon’s health system transformation including:

• How Oregon will be held accountable for reducing the state’s Medicaid expenditure growth trend while improving quality and access;

• Details on the health quality improvement metrics to be used to measure progress. These metrics include a set established by a stakeholder-led Metrics and Scoring Committee that will provide financial incentives for CCOs that show performance improvement.

• How the 2 percentage point reduction in per capita medical expenditure trend will be lowered; and,

• Quality assessments - and the penalties that would occur if health quality were to diminish among the OHP population.

View the Agreement

Included in the agreement are 17 CCO Quality Pool Metrics established by the stakeholder Metrics and Scoring Committee and additional metrics that CMS will expect over the long term. All are geared towards ensuring that transformation of the health system, improved outcomes and bending of the cost curve will occur.

OHA will hold a webinar on January 4^th at 2:00 p.m. to go over the key elements of the Accountability Plan and allow stakeholders to ask questions. 

Register for the Webinar

	FOR IMMEDIATE RELEASE November 9, 2012 CONTACT: Katie Briedwell Executive Assistant Yamhill County Care Organization 503-434-7339 briedwellk@co.yamhill.or.us

Yamhill County Care Organization names Carlough new Executive Director

 Yamhill County Care Organization, one of Oregon’s newest Coordinated Care Organizations (CCOs) serving recipients of the Oregon Health Plan, has named James Carlough as its new Executive Director.

With more than 18 years experience working with managed care services and multiple health care delivery systems, Carlough combines business acumen with a broad knowledge of the community members served by the Oregon Health Plan, according to Silas Halloran-Steiner, the CCO’s board chairman.

“Jim’s experience in senior leadership positions with a diversity of health plans, will allow him to make an immediate contribution to Yamhill County Care Organization’s strategic planning and implementation efforts,” says Halloran-Steiner.

“Jim has lived with his wife and children in Newberg since 2005, so he is not only familiar with local concerns, but committed to our community’s well-being.”

Carlough, who says he feels deeply committed to vulnerable populations and delivery system enhancements, spent several years working with a Medicaid plan in Arizona. Most recently, Carlough served as senior manager, provider services, for CareOregon, the largest managed care organization serving OHP members.

Carlough’s task will be to manage both operations and coordinate with partner organizations, such as CareOregon and Mid-Valley Behavioral Care Network (MVBCN), which provide claims processing, provider contracting and other services for the CCO. He also will work with the board, member advisory council, and clinical advisory panel in developing a transformation plan demonstrating how Yamhill County Care Organization will work to improve health outcomes, increase member satisfaction and reduce costs. Each CCO is required to develop a transformation plan geared specifically to the needs of the local community it serves.

“I am excited about the opportunity to work with Yamhill County Care Organization,” says Carlough. “My goal is to increase access to services, help reduce costs, and benefit my local community.”
Yamhill County Care Organization has approximately 18,000 members.

# # #

If you have further questions please contact:

• Jim Carlough, Executive Director, Yamhill County Care Organization
  carloughj@careoregon.org  or 503-416-8038
• Silas Halloran-Steiner, Director, Yamhill County Health and Human Services
  halloras@co.yamhill.or.us or (503) 434-7523
• Gil Munoz, CEO, Virginia Garcia Memorial Health Center
  gmunoz@vgmhc.org or (503) 352-8610
• Dan Ordyna, CEO, Willamette Valley Medical Center
  daniel.ordyna@capellahealth.com or (503) 435-6320
• Alan Olive, CEO, Providence Newberg Medical Center
  Alan.Olive@providence.org or (503) 537-1701
• Jim Russell, Executive Manager, Mid-Valley Behavioral Care Network
  jimr@mvbcn.org or (503) 585-4991
• Patrick Curran, Director of Business Integration, CareOregon
  curranp@careoregon.org or (503) 416-4100

 For general questions, e-mail carloughj@careoregon.org  or visit http://yamhillcco.com/

Oregon Health Policy Board to host public forum on progress of health system transformation

From the Oregon Health Policy Board "Health News"

The December Oregon Health Policy Board meeting will focus on the progress to date of Oregon’s Medicaid health system transformation and provide a format for public input in the early stages of the new Coordinated Care Organizations.

The board meeting will be a forum for consumers, advocates, and stakeholders to offer feedback on certain questions related to health system transformation and Oregon's coordinated approach to care. More information will be provided as the meeting approaches.

The meeting will be held at its usual time Tuesday, Dec. 11, from 1 p.m. – 5 p.m. but will be conducted at the Multnomah County Commissioner's office, 501 Southeast Hawthorne Blvd., Portland, OR 97214.

If you or your organization wish to give a public comment, please email the Oregon Health Policy Board staff at ohpb.info@state.or.us with the subject line: Health System Transformation Feedback. For those around the state who cannot travel to Portland, alternative means of commenting will be provided.

DCOs and Legislators Ask for OHA Rule Change

Dentistry Would Be Mandated Through DCOs Until 2017

Mike Shirtcliff of Advantage Dental and two state legislators, Senator Alan Bates and Representative Tim Freeman have filed a petition with the Oregon Health Authority to require that CCOs must contract directly with Dental Care Organizations if they are to provide dental care to their members. The change would specifically prevent CCOs from contracting with any other dentist, dental hygienist, or dental organization.

View the Petition Here.