Health Care Transformation Workgroup Meetings: Round 3
The third round of the health care transformation workgroup meetings has concluded. As always, please do not hesitate contact me with any questions or concerns you may have at firstname.lastname@example.org. If you’re interested in participating by providing feedback to the Oregon Health Authority (OHA), please CLICK HERE.
Global Budgeting Methodology Workgroup
The Global Budget workgroup reviewed a proposed business plan outline for House Bill 3650, including details about the existing market environment and industry analysis, services to be offered by a CCO, ownership and management of services offered by CCOs and payment and accountability. The outline is still in draft form at this time but is available online for public review. In addition to the business plan, OHA will submit a more in-depth study to the legislature for their review in February.
The Global Budget workgroup discussed key risk adjustments that ought to be made prior to the launch of the first CCOs and an incentive system that will be capable of holding CCOs accountable. Many of the members in the group seemed to believe that there is a limited number of factors to base risk adjustment off of, including: age, gender, and pharmaceutical date. There was general consensus within the group that OHA’s current risk adjustment system works well and needs little or no alteration. However, it was noted that further social factors could be added to improve the current system, such as ethnicity, race, income level and language.
The group believed that incentives ought to be focused on improving long term care outcomes. Many members of the group agreed that the key to altering the long term outcomes is the ability to encourage and assist patients with behavioral changes.
Medicare/Medicaid Integration of Care and Services:
The Medicare/Medicaid integration workgroup discussed care coordination and transition of care. The group identified care coordination as coordination between multiple providers, including primary and specialist providers. Generally, the group believed the key to successful coordination was an interdisciplinary team assigned to work with patients to increase their knowledge and understanding of their health issues. There was also a general consensus that a universal software system would need to be adopted and utilized by all providers within a CCO, including physical, dental, and mental and addiction services, to make successful coordination possible.
Transition of care was identified as appropriate follow up following a patient’s discharge from the hospital or treatment center. This could mean coordination between a longer term care provider or in home care provider and the hospital, or simply the patient and their care coordinator. The group believed that appropriate and successful care transition will focus on the patient’s lifestyle. Many members of the group stressed that an effective and successful transition of care would not necessarily force the patient to make dramatic lifestyle changes. Rather, the patient’s lifestyle as a whole would be accepted and a viable care plan would be adopted that would include changes being gradually worked into the patient’s life.
Coordinated Care Organization Criteria:
The CCO criteria workgroup discussed financial solvency, governance and community engagement. The members heard a presentation that offered an overview of different purchasing strategies and models of governance, financial solvency and the business structure. The workgroup felt it was important to ensure community representation and diversity in the governance structure. They expressed the desire to have a process for assuring community voice, and were typically in support of a structure that would allow for multiple advisory committees to best assure that consumers and community members had a meaningful avenue for input. There was not total clarity or agreement around the type of organization the CCO should be, whether it should be non-profit, for profit, or a public private partnership.
The group felt reinsurance was a vital tool in solvency, and recognized that perhaps it would be appropriate to allow a 5 year commitment on behalf of the CCOs to achieve solvency. However, there was no recommendation as to how the CCO would transition in those five years or who would be responsible for providing financial assistance.
Outcomes, Quality and Efficiency Metrics Work Group:
The metrics workgroup discussed potential accountability measures by service areas, primary, acute, behavioral and oral health care. The group largely agreed that readmission to the hospital and engagements in follow up treatment are two key metrics that ought to be monitored to help determine the success of each case. However, the group questioned the divide between measuring the success of individual providers within the CCO and measuring the success of the CCOs in general.
It was suggested that larger, more broad metrics be established for CCOs, for instance, are the patients receiving the appropriate care or are they being over or under treated. The group agreed that CCOs ensuring that each member receives the appropriate care improves the members’ experience, case outcomes and reduces unnecessary treatments, tests and costs. Another proposed metric by which to gage each CCO could be the percentage of each CCO’s patients who have received their three most vital immunizations.
The workgroup members suggested that metrics for individual providers can include, but are not necessarily limited to, health screenings, emergency room visits and preventable hospital admissions, such as Diabetes short-term complications, chronic heart failure, bacterial pneumonia and adult asthma. It was noted that mental health screenings and medication reconciliation ought to be included, as well.
Next & Final Meeting:
The final round of meetings will occur the week of Monday, November 14th. If you are interested in viewing the materials for the final meetings or minutes from past meeting, please CLICK HERE.
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