oregon’s health system transformation: …new coordinated care model starting in medicaid, aiming...
TRANSCRIPT
Oregon’s Health System Transformation:
Coordinated Care ModelNovember 2013
Jeanene Smith MD, MPHOHA Chief Medical Officer
The Challenges Oregon Faced
•
Rising healthcare costs outpacing state budget in Oregon
Health Plan (Medicaid) and in state employees benefits•
85 percent of Oregon Health Plan clients were “managed”
in
silos: 16 managed physical health care organizations10 mental health organizations8 dental care organizations.
•
Traditional vendor relationships with health plans in both
Medicaid and State Employees, without directed accountability
nor incentives to be innovative. •
Only a few alternative payment reform efforts by some payers
and a few patient‐centered medical home pilot efforts
2
Smith
Oregon Chose a New Way
Better health, Better Care & Lower Costs•
Governor’s Vision – Transform the Delivery System
•
Robust public process
•
Bi‐partisan support
•
Federal waiver approved ‐
$1.9B investment tied to quality
and reduction in costs •
New coordinated care model starting in Medicaid, aiming to
spread to other state purchased coverage, and into Oregon’s
Health Insurance Exchange, private payers
Coordinated Care Organizations
Smith
Transforming the health care delivery system
What we have accomplished so far
May 2012CMS
agreement$1.9B
April 2012$1B
procurement to establish CCOs starts
Nov. 20122 CCOs launch
June 2012First CCO
RFPs completed
July 2012Waiver approved;
contracts with new CCOs
finalized
Aug. 20128 CCOs launch
Sept. 2012
5 CCOs launch
March 2012SB 1580
passed, waiver completed and
submitted 600,000 OHP members
transitioned to 15 CCOs in 3 months
CCOs: Governed Locally
www.health.oregon.gov
State law says governance must include: •Major components of health care delivery system•Entities or organizations that share in financial risk•At least two health care providers in active practice
–
Primary care physician or nurse‐practitioner
–
Mental health or chemical dependency treatment
provider•At least two community members•At least one member of Community Advisory Council
Federal- State Partnership: Cost and Quality Accountability
•
July 5 waiver signed with Centers for Medicare & Medicaid
(CMS), finalized terms and conditions Dec 17, 2012•
Approval for CCOs
as delivery system
•
Oregon agreed to: –
lower per capita cost by 2 percentage points–
Improve quality and accessor lose the federal investment of $1.9billion
•
Transparency ‐
Ability to compare CCO performance
–
Metrics will be reported quarterly and posted on OHA website –
Financials posted quarterly
Cost and Quality Accountability for the CCOs via Quality Pool:
Incentive payments tied to 17 metrics in seven areas critical to
reducing costs and improving quality:•
Addressing chronic conditions
•
Reducing preventable and costly utilization
•
Integrating physical and behavioral health care
•
Improving access to effective and timely care
•
Improving perinatal
and maternity care
•
Reducing preventable rehospitalizations
•
Improving primary care for all populations
STATUS TODAY
www.health.oregon.gov
•February 2012: Bipartisan legislation passed •March – July: 1115 Waiver and statewide
procurement for CCOs
•16 CCOs
certified and
operational as of today.•~90% of Medicaid recipients get care through a CCO•“Proof of concept”
in Medicaid, then to extend the
care model.
First CCOs have been operating ~ 400 days…and the youngest is
~300 days old
Just Some of the Current and Future Challenges We Are Working to Address
•
Integrating dental care•
Ensuring robust provider networks to meet client
needs•
Anti‐trust
•
Integrating with early learning and education systems
Just Some of the Current and Future Challenges We Are Working to Address
•
Increasing consumer engagement and personal responsibility for health
•
Training and using new health care workers•
Health information exchange
•
Robustly transforming care and paying for outcomes
•
Accounting for “flexible”
services
Just Some of the Current and Future Challenges We Are Working to Address
•
Change is hard •
Change is very hard
•
Time, resources and expectations•
No time, limited resources and large
expectations•
Operating in both an old and new paradigm
How we move forward – Health Reform 2.0
•
Changing care model to bend the cost curve and improve health
•
“Proof of concept”
in Medicaid, then to extend the care model.
•
Align purchasing of care model: begin with Oregon Health Plan, extend to other state purchasing and
then align with private sector purchasing
Coordinated Care Model Spreading Beyond Medicaid
•
State Purchasing Power: Key elements of
accountability included in just‐released State employees
RFP for 2015 plan year•
Multi‐payer partnerships underway in Primary Care
Home enhanced payments via CMMI/Medicare and local
and national private payers•
Oregon Transformation Center ‐
aim to include CCOs
and other payers in learning collaboratives
on alternative
payment methodologies, share innovations•
Oregon’s Insurance Exchange’s Qualified Health
Plans: development
underway to include similar
elements, metrics, accountabilitySmith
To learn more….
www.health.oregon.gov