Columbia Pacific Coordinated Care Organization Transforming

Report
Columbia Pacific
Coordinated Care Organization
Transforming health care for
Oregon Health Plan
(Medicaid) members
Creating Health Together
• Launched September 1, 2012
• To manage care of 15,000 Oregon Health
Plan members
• In Columbia, Clatsop and Tillamook counties
and Reedsport in Douglas county
• Bringing together social service agencies,
educators, counties, public health, health
plans, hospitals, mental and physical health
providers and members
• To address health and health care needs
unique to our communities
WHY HEALTH
TRANSFORMATION?
It’s for our neighbors…and us
• Most OHP members
are children
• Pregnant women
• Age 65 or older
• One-quarter don’t
speak English as a
first language
• All OHP members are
low income
Calculated from CareOregon membership, June
2013
Healthier communities benefit us all.
The current system
• For sick care, not
preventive care
• Fee-for-service rewards
doctor and hospital visits
and procedures, not
keeping people healthy
• Fragmented, disconnected
care, not a coordinated
system of care
We pay more and get less
Highest per capita costs
Health ranking
Mortality
1. United States
$8,233
1. France
398
2. Norway
$5,388
9. Austria.
420
3. Switzerland
$5,270
11. Norway
425
4. Netherlands
$5,056
17. Netherlands
427
6. Denmark
$4,464
20. Switzerland
371
7. Canada
$4,445
23. Sweden
410
8. Austria
$4,395
25. Germany
441
9. Germany
$4,338
30. Canada
401
10: France
$3,974
34. Denmark
501
12. Sweden
$3,758
37. United States
505
Organization for Economic CoOperation & Development, 2012
World Health Organization,
2000
U.S. Health in International
Perspective, National
Academy of Sciences, 2013
Our health care spending is
astronomical
$2.4 trillion in U.S. health care
spending (2008) could make a pile of
$100 bills to the moon.
And still leave enough $100 bills to
pile up four more stacks to the moon.
Past ways we reduced costs
CUT, CUT, CUT
 Reduce provider payments for services
 Reduce number of people covered
 Reduce type of services covered
What do cuts actually do?
Which way for Oregon?
• We don’t accept less care, and lower
quality of care.
AND
• We don’t accept turning away sick people
from care.
AND
• We don’t accept rising health care costs.
Coordinated Care Organizations
Columbia Pacific Coordinated
Care Organization tasks
•
•
•
•
Integrate physical, mental and oral health care
Common information system
Medical homes
Additional support for those in greater need of
health services
• Strengthen community engagement
• Build on current provider system
• Benefit the entire community
What really affects health?
Our objectives
• Provide care for potentially 8,000 new
Oregon Health Plan members in the
Columbia Pacific service area
• Meet the care needs of newly insured
members
• Improve primary care access, especially in
rural areas
• Inform patients, providers and communities
about the CCO model of care
Columbia Pacific Coordinated Care Organization
Community
Advisory
Council
CPCCO Board
of Directors
Columbia Pacific
CCO, LLC
CareOregon
Physical health risk
Provides administrative
services
Clinical
Advisory
Panel
GOBHI
Mental health
risk delegated
Columbia Pacific
Coordinated Care Organization
Board of Directors
• Debra Birkby, Clatsop County Commissioner
• Ellen Boggs, CEO, Rinehart Clinic
• Kevin Campbell, CEO, Greater Oregon
Behavioral Health, Inc
• James Coffee, CEO, Coastal Family Health
Clinic
• Patrick Curran, CEO, CareOregon
• Tom Duncan, Family Physician, Astoria
• Michael Blauer, CEO, Providence Seaside
Hospital
• Earl Fisher, Columbia County Commissioner
• Frank Hanna-Williams, Executive Director,
Tillamook Family Counseling Center
• Diane Hutson, Practice Manager, OHSU
Family Medicine Scappoose
• Walter A. Larson, CFO, Tillamook Adventist
Hospital
• Roland Migchielsen, Executive Director,
Columbia Community Mental Health
• Debbie Morrow, Community Leader
• Janet Patin, Family Physician, Dunes Family
Medicine
• Marlene Putman, Administrator, Tillamook
County Health & Human Services
• Sandra Reese, Administrator, Lower Umpqua
Hospital
• Bruin Rugge, Medical Director, OHSU Family
Medicine Scappoose
• Erik Thorsen, CEO, Columbia Memorial
Hospital
• Jim Tierney, Executive Director, Community
Action Team, Inc.
• Sumuer Watkins, Executive Director, Clatsop
Behavioral Health
CACs: voices for each community
• Columbia Pacific
Community Advisory
Council
•
•
•
•
Columbia County
Clatsop County
Tillamook County
Reedsport
Community
Health Assessment
•
•
•
•
What are the needs in each of the four counties?
What services can address those needs?
Who will provide them?
How will they be provided most effectively and
efficiently?
Clinical Advisory Panel
•
•
•
•
Is broadly representative of clinician disciplines
Sets targets for clinical transformation
Promotes best practices
Reviews and recommends care models and
financial incentives
• Oversees achievement of quality goals
Columbia Pacific Coordinated Care Organization
Transformation Plan
• Integrating behavioral and primary care
• Improving capability of clinics to be patientcentered primary care medical homes
• Conducting community health needs
assessments
• Addressing addictions, pain and unplanned
care that result in emergency care
What does Columbia Pacific Coordinated Care
Organization mean for providers?
• Patients now without insurance will be covered,
with coordinated care
• One place to process claims for mental health and
physical health for Oregon Health Plan members
• Opportunity to collaborate for care quality
improvement
• A means to participate in community health
improvement
What does Columbia Pacific Coordinated Care
Organization mean for members?
• One organization for physical, mental and oral
health care
• Providers collaborate, so your care is better
• Your health records available to all Coordinated
Care Organization providers
• Help taking charge of your own health
• Chance to give your input about care system
What does Columbia Pacific Coordinated Care
Organization mean for the community?
• Community health needs assessed, addressed
• Local voice in health system decisions
• Focus on prevention, chronic illness management
for all, not just Columbia Pacific Coordinated Care
Organization members
• Coordinated care
• Patient-centered medical homes
How can you participate?
• To know more about Columbia Pacific Coordinated Care
Organization, visit colpachealth.org.
• To be involved, contact Mimi Haley, 503-416-3679 or
[email protected]
• If you know others who would benefit from this
presentation, please let me or Mimi know.
• If you know of small-business operators who are
concerned about covering their employees under health
care reform, please refer them to CoverOregon.com.
Questions?

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