Embracing Transformation: How alliances drive Innovation and create opportunities
Robin Richardson, Senior Vice President, Moda
Moda Transformational Initiatives Medical Homes
Coordinated Care Network (CCN)
Comprehensive Coordinated Care (C3)
NEW The Coordinated Care Model -Eastern Oregon Coordinated Care Organization (EOCCO) -The Summit and Synergy Partnerships
Plan Design
Consumer Education
Enhancement of Evidence-Based Protocols
Provider Payment Model
Prioritizing Target Savings opportunities
Performance Measures
Disease Management
Wellness Services
Assembly of Appropriate PCP Based Care Model
Develop Physician Leadership
Change Physician Behavior
Define and Assemble Appropriate Provider Mix
EHR Implementation/Integration
Clinical Collaboration
Legal Compliance
Distribution Channel
Claims Processing
Actuarial Expertise
Data Analytics, Predictive Modeling
Utilization Management Capability
Accounting ValidationFinancial Models
Sales and Marketing
Synergy and Summit Partners Moda
Shared
Opportunity for Coordination/Partnership
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The Coordinated Care Models
A new approach to transformation and innovation
The Coordinated Care Model (CCM)Oregon’s Vision
“Governor Kitzhaber’s ambition is to adopt this model for: -Medicaid -Large State Controlled Insurance pools (OEBB & PEBB) -The Exchange -Eventually, the private market”
Interview with The Nation, May 21, 2013
The Coordinated Care Model(CCM) Components
Global Budget
Metrics and Accountability for Quality (17 CCO Metrics)
Payment Transformation (Provider Performance Risk Models, Medical Home payments)
Medical Homes (A patient centered healthcare experience)
Care Transformation and Efficiency (Reduced ED visits, integration of mental health, oral health and physical health)
The Coordinated Care Model (CCM): Benefits to Members and Employer Groups
Best Practices to manage and coordinate care
Shared responsibility for health
Measured performance (accountability for quality)
Pay for outcomes and health (value)
Information and transparency
Sustainable rate of growth (global budget)
The Coordinated Care Model (CCM)
Gobal Budget + The Triple Aim
The Coordinated Care Model:
Eastern Oregon Coordinated Care Organization (EOCCO)-Medicaid
EOCCO Service Area
Quick Facts About Eastern Oregon CCO
Land Area: 49,929.75 sq. miles› 52% of Land Area of State of Oregon› Larger than Land Area of 19 states
◦ MS, PA, OH, VA, TN, KY, IN, ME, SC, WV, MD, HI, MA, VT, NH, NJ, CT, DE, RI
Population: 194,592› 4.99% of Oregon’s population› 1/3 the population of WY (least populous state)› Equivalent to the combined populations of Salem, Lake Oswego and
Lebanon, Oregon
EOCCO Six Counties previously had Medicaid managed care
organizations (ODS, Family Care, CareOregon)
Ten Critical Access Hospitals
Federally Qualified Clinics (i.e. Mirasol)
Rural Health Clinics
Large IPA—Pendleton IPA
Umatilla County
EOCCO County Governments received mental health funds
Care going out of state—Idaho, Washington, Northern California
Care going out of the service area within Oregon----Bend, The Dalles, Portland
Eastern Oregon politics/culture
Oregon Health Authority had to approve in each county
EOCCO
Readiness Review
Global Budget process
Network Adequacy
The Rest of the Requirements Community Meetings
Community Advisory Councils
Board of Directors
EOCCO Board of Directors -Dennis Burke, CEO, Good Shepherd Hospital-Union County -Kevin Campbell-GOBHI -Bruce Carlson, MD, Umatilla, Gilliam Counties -Russ Demianew, CEO Pendleton IPA-Umatilla County -Ray Gibbons, CEO, St. Alphonsus, Baker & Malheur Counties -Renee Grande, MD, Winding Waters Cliinic, Wallowa County -Sandy Hata -Bob Houser, CEO, Blue Mountain Hospital, Grant County -Ken Kestner, County Commissioner, Lake County
EOCCO Board of Directors -Diane Kilkenny, Public Health Nurse, Morrow County -Carlos Olivera, Mirasol, Clinic, Umatilla County -Jim Mattis, CEO, Grande Ronde Hospital, Union County -Robin Richardson, ODS -Jim Schlenker-CEO, St. Anthony’s Hospital, Umatilla County -Chris Siegner, Director, Symmetry Health, Harney County -Mike Smith, County Commissioner, Sherman County
Getting the Providers as Partners Hospitals
The Pendleton IPA
Mirasol
Legal (Memorandum of Understanding and the operating agreement)
Shared Savings and Shared Risks
Investors Moda (25%) Greater Oregon Behavioral Health (25%) Good Shepherd Hospital (10%) Grande Ronde Hospital (10%) St. Alphonsus Hospitals (Ontario and Baker City) (10%) St. Anthony’s Hospital (10%) Pendleton IPA (1%) Mirasol Clinic (1%) Future---(8 % held in reserve for Counties, Dental, other providers
EOCCO Transformation Plan
Transformation Summits
Non-Emergent Transportation
Clinical Advisory Council
Dental
Dual eligible application to CMS
Long Term Care
EOCCO Goals/Opportunities/Challenges
Profitable operations within the global budget
Care Transformation
Meeting all of the OHA/CMS requirements/metrics
The Coordinated Care Model:
The Synergy and Summit Partnerships-Commercial
The Synergy and Summit Networks: Two Sentinel Events
OEBB’s Strategies, Evidence and Outcomes Workgroup (SEOW) requests a revised and updated CCN alternative.
PEBB’s Bid-Fall of 2013 for an effective date of January 1, 2015 -Required either a Regional Coordinated Care Model (CCM) or a statewide PPO bid
The Synergy and Summit Networks The Synergy and Summit Concept -A Commercial Coordinated Care Model patterned after the Eastern Oregon Coordinated Care Organization (EOCCO) developed by Moda *Global Budget *Accountability for quality *Payment Transformation *Medical Homes *Care Coordination/transformation
-Regional integrated delivery systems capable of addressing the Coordinated Care Model requirements of the PEBB bid and capable of being considered by OEBB for October 1, 2014
The Summit Network Original Model was the Eastern Oregon Coordinated Care network and
concept
Network already formed with ODS Plus Network to fill in gaps
Selected as a new regional option for OEBB, effective 10/1/14
Selected as a new option for PEBB for the Eastern Oregon Region, effective 1/1/15
Additional work: -Commercial provider performance risk arrangements with individual Hospitals and Providers -Tertiary Hospitals---none in the geography---getting provider performance risk arrangements with them -Addressing the Boise and Eastern Washington provider networks for OEBB and PEBB
The Synergy Network Initial/Original Partner---OHSU -Insurance Risk -Provider Performance Risk -Employees in the network
Other Health Systems added for network footprint and adequacy -Peace Health (Vancouver and Eugene) -Portland Adventist (East Metro) -Legacy (Metro Primary Care footprint) -Salem Health (Marion and Polk Counties) -Salem Clinic
Selected as a new regional OEBB option effective 10/1/14
Selected as a new regional PEBB option effective 1/1/15
The Synergy and Summit Networks
The Coordinated Care Model:
Payment Transformation
Primary Care Providers
All Primary Care Providers are included in the Synergy and Summit networks except those primary care providers owned by health systems not currently participating in the Synergy or Summit Networks
Payment for Medical Home Status -EOCCO-over 65% of membership in a medical home -OEBB-over 80% of OEBB members in a medical home
Payment for C3 Patients Risk Pool Sharing -Hospital -Specialist -Pharmacy
The Coordinated Care Model:
Benefit Design/Patient Engagement
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Program cornerstones
Characterizing the Employer’s
role and commitments
Engaging identified
members and building trust
Strengthening Medical
Home/PCP relationships
Tracking progress and
outcome measures
Relationship-based care and social determinants of health
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Moda Passport to Health Healthy Foundations (HF) & Comprehensive Coordinated Care (C3)
› Developed Spring 2011, 2nd full year of implementation› C3 designed to accommodate larger scaled populations
High intensity patient centered coordinated care & advocacy › Target population 3-5%
Distributed model versus central model› Scalable for 5000 to 100,000 +
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Analytics and Attribution Top 5% of utilization Diagnostic profile Risk scores
› Prospective Pharmacy data
› Medication adherence Geo mapping Focus groups & value stream
Identify members design incentives outreach/engage build trust measure ♦ ♦ ♦ ♦
outcomes
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Preliminary results Members are better self-managers, and are seeking more preventive care
› Reflected as more appropriate pharmacy and outpatient use› Members are utilizing outpatient visits rather than the ER
50% decrease in annual ER visit rate after active engagement
37% decrease in annual ER cost per member per month
Average length of stay shortened after active engagement compared to pre-program episodes of care
Improvement in patient activation and quality of life indicators including PHQ9 depression scores and overall function
100% of members rated their experience with Healthy Foundations as positive and would refer others to the program
The Coordinated Care Model:
The 4th Partner: Supporting Transformation
Center for Evidence-based PolicyAddressing Policy Challenges With Evidence and Collaboration.
Grant Submissions per County
2/15/3
7/3
2/1
5/5
6/4
52 letters of intent received/48 grant applicationsreceived
4/1
Multiple counties: 4/5
3/2 6/6
5/3
2/3
1/1
Letters of intent / Submitted grant applications
Center for Evidence-based PolicyAddressing Policy Challenges With Evidence and Collaboration.
Grant Proposals
Topic # of Proposals
# of Counties Total Amount Requested
% of Total Funds Requested
Care coordination 10 6 + 2 multiple county proposals
$733K 26%
IT/telemedicine/EHRs 7 5 $422K 15%
Health education/screening
6 4 + 1 multiple county proposals
$346K 12%
PCPCH & Transportation 4 3 + 1 multiple county proposal
$371K 13%
Co-location mental health in primary care
3 3 $277K 10%
Mental health services/training
3 2 + 1 multiple county proposal
$222K 8%
Obesity Prevention 3 2 $216K 8%
Other 2 2 $235K 8%
TOTAL 38 12 $2.8K 100%
OEBB/Moda Health Grant Program
• $3 M grant fund provided by Moda Health on behalf of OEBB
• Investing in improving the health and healthcare of OEBB members and the communities where they live
• Guided by the fundamental premise that funding can incentivize sustained commitment
• Committed to identifying and supporting evidence-based, measurable, and equitable initiatives
MIT/TruvenAnalytics
OEBB BenefitSelection Tool $485
OCHIN School-based Clinic Billing Support $225
Oregon PublicHealth Division OEBB Wellness $165
Public Health Foundation of
Columbia CountyPrimary Care $112
NW Mother’sMilk Bank
Donor Distribution Centers $100
Legacy HealthSystem School-based Clinic $100
OHSU School of Medicine
Physician Substance Abuse Training $90
Community Connection of
NE OregonDiabetes Prevention & Wellness Program $125
RenaissanceHealth
Purchaser/Payer/ Provider Project $50
OHSU Diabetes Center Diabetes Prevention $50
Oregon Healthcare Quality Corp.
Electronic Medical Record Claims $40
OSAA Drug Use Prevention & Wellness $50
OEBB/Moda Health Grant Program
*In thousands