As a result of the passage of health care transformation legislation, House Bill 3650, Governor Kitzhaber has created four workgroups to help establish the new system of Coordinated Care Organizations; Coordinated Care Organization Criteria, Global Budget Methodology, Outcome, Quality and Efficiency Metrics, and Medicare-Medicaid Integration. The workgroups will to make recommendations to the Oregon Health Policy Board as they prepare a proposal for legislative approval in February. Together the workgroups consist of 133 members, representing all health care sectors and communities across the state. Each group will meet four times between now and November.
The transformation outlined in HB 3650 is aimed at changing the way healthcare is provided in the state of Oregon by establishing a Coordinated Care Organization delivery system to replace our current Managed Care system. The CCOs will shift the focus from acute care towards a community based system by integrating physical, mental, and dental health for Oregon Health Plan patients. CCOs will operate on a global budget, breaking down the current, siloed delivery system. By integrating these services, CCOs will help reduce redundancies with OHP and Medicare, create costs savings, and provide a more patient oriented experience. Pending legislative approval, the first CCOs will begin to launch in July of 2012.
Health Care Transformation Updates
Coordinated Care Organization Criteria
The CCO Criteria Workgroup will focus on providing input to the Oregon Health Policy Board on Criteria for CCO certification, as well as the CCO statement of work.
Discussion at the first meeting was focused on criteria for CCO certification. The work group members expressed the need to ensure that certified CCOs have participated in a community input process, can provide needed services and are financially viable. The group also discussed the need to have a different process that encourages innovation while having appropriate oversight and accountability.
Other topics of discussion included standards for services the CCOs must provide, readiness of the provider community to transition to CCO model, potential to scale beyond Medicaid population, and the harsh budget realities facing the health care system.
Paulina Cockrum, RN, an ONA member at Columbia Memorial Hospital was selected by the Governor to serve on this Committee.
Global Budget Methodology Workgroup
The Global Budget Methodology Workgroup will consider how Medicaid and Medicare dollars should flow through the global budget for CCOs.
Workgroup members were asked to consider which programs should be included in the CCO and which should be excluded, what the criteria for inclusion/exclusion should be, how to manage the financial risks and benefits of the CCOs, and how to sustain CCOs over time.
Members expressed a desire to have a uniform formula for inclusion/ exclusion decisions. Recognizing the need to include as many groups of people and programs as possible, many of the members thought the standard should be inclusion and the uniform formula should outline the requirements a program must meet if it would like to be excluded from the CCOs.
Outcome, Quality and Efficiency Metrics
The Outcome, Quality and Efficiency Metrics Workgroup will consider how to measure the success of CCOs. In their first meeting, they discussed the principals for determining these metrics. This group will help determine how current metrics and reporting systems can be useful in the operation of CCOs and what additional measurements should be taken into account and how to develop a system to measure the social determinants of health.
The group identified the importance of choosing practical measurements, moving away from tracking anything that is reasonably outside the control of the CCO and the benefit of possibly using metrics not currently tracked in health care.
Susan King, RN, ONA’s Executive Director and Megan Haase, NP, Mosaic Medical were selected by the Governor to serve on the Outcome, Quality and Efficiency Metrics Workgroup.
The Medicare/Medicaid Integration Workgroup discussed the challenges of integrating the current Medicaid and Medicare systems to the CCOs. Members of the group indicated some of the largest integration challenges include discovering a more patient centered way of providing care, establishing solids lines of communication between care providers, avoiding unnecessary and costly treatment and incorporating other health factors into the system.
There was general agreement among the members that a one-size-fits-all CCO model is not feasible. Patient’s needs and levels of access vary from community to community and CCOs need to be able to recognize and accommodate the differences.
Mary Rita Hurley, RN, Executive Director of the Center for Nursing, Jennifer Hanh, GNP, President of the Oregon Geriatric Society and Veronica Sheffield, RN, WVP Health Authority were selected by the Governor to serve on the Medicare/Medicaid Integration Workgroup.
To receive monthly updates about the work of these committees by email, please email Jenn Baker at email@example.com