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?