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News: 2011-12-01 Health Care Transformation Workgroup Meetings Update 4

Health Care Transformation Workgroup Meetings: Round 4

The final meetings of the Health Care Transformation Workgroups have concluded. Based on the ongoing discussions, the Oregon Health Authority has released an updated action plan and timeline. Although the workgroups do not have another formal meeting scheduled, the Oregon Health Authority and the Oregon Health Policy Board have asked the members of each group to continue to be involved in the transformation process. The Oregon Health Authority will be accepting public comments through December 5th. All comments submitted will be presented to the Oregon Health Policy Board for consideration. CLICK HERE to submit your input. We will send out our next update once the Oregon Health Policy Board has a plan ready for legislative approval.

Coordinated Care Organization Criteria Work Group

In the final meeting of the CCO Criteria Group, discussion focused on patient engagement, rights, and responsibilities, as well as coordination of care through the CCOs. In HB 3650, patients are seen not solely as recipients of services, but as partners with their providers in developing and sticking to a care plan. There was general agreement around the table that this is the right approach, and that patients stand to benefit from being more engaged in their care. The group felt that more engaged patients would have better health outcomes, and that tying provider pay to outcomes and evidence based care was a step in the right direction. An example they used was the savings generated by moving away from non-medically necessary inductions before 39 weeks. They also mentioned incentive programs such as offering a new car seat to women who take advantage of a full prenatal care program, or a cash bonus or gift card to a CCO member who successful quits smoking.

The group was concerned that some patients will actively make a choice not to be engaged in their care, and hesitated to hold CCOs accountable for the outcomes of patients who, given all the information they need, choose not to engage.

In the breakout discussion, several small groups contemplated the degree to which the CCO should be responsible for developing and implementing a community outreach plan that fully utilizes the community assessment in helping encourage patients to engage in their care plan. Some felt strongly that the CCO should offer on ongoing wellness program, use advisory groups to describe meaningful engagement and make sure their plan outlines how it improves existing access to and delivery of care, particularly as related to over and under use. The group felt the CCO had a responsibility to work with its members on health education and literacy, giving people the tools they need to engage.

Global Budget Methodology

The Global Budget Methodology members were given a large list, compiled over the last three meetings, of all the services that could be included within a CCO global budget. Noticeably missing from the list of physical health programs is dental. Although the legislation allows dental to be included, it does not require its inclusion until 2014. Many members of the group were concerned with the late integration of dental services. Many members of the group thought there was little to no benefit in waiting to have the CCOs incorporate dental. It was recommended that the Health Policy Board establish a path of integration, outlining when and how services, such as dental, that need to be incorporated eventually but may not be included from day one, be added in. There was a great deal of concern that anything carved out initially will be neglected through the entire process.

The members were also given a CCO Financial Savings Framework, outlining the steps necessary to actualize savings during the transformation process. The framework is broken down into four steps; 1) Inputs, including implementation of accountability structure for care, community involvement, opportunities to partner with CMS to improve coordination and additional opportunities for federal financial participation, 2) Strategies, including patient centered primary care homes, coordinated physical and mental health, shared accountability between acute and long term care, alternative payment methods, adoption of evidence based guidelines and expanded use of electronic health records, 3) Outputs including proper ER utilization, reduced hospitalization and readmissions, controlled specialty costs, reduced administrative burden and barriers, increased access to primary care, early intervention and prevention services , and 4) Outcomes, focusing on improved population health, a better patient experience of care, and cost savings.

Outcomes, Quality and Efficiency Metrics

The final meeting of the Outcomes, Quality and Efficiency Metrics workgroup was focused on identifying performance standards and determining which standards are core and which are developmental. The Oregon Health Policy Board provided feedback on a number of the issues brought to light in the first three Outcomes, Quality and Efficiency Metrics workgroup meetings. The board recognized moving to a community centered model of care would need to be based on infrastructure, including transportation, schools, housing, environmental health, parks and social cohesion. The board recognized that there is still a need for more clarity on a number of issues, such as how the responsibility for a community’s health will be divided among the local providers, the CCOs, and local government.

Many members of the group were still concerned with establishing a baseline for all the CCOs to start at and allowing for incremental change and a gradual introduction of performance standards. Without the incremental change and in the face of state level budget cuts, they fear the burden will be too great for the CCOs to succeed.

Medicare-Medicaid Integration of Care and Services

The Medicare-Medicaid Integration workgroup discussed the separation of the Long Term Care (LTC) system and the CCOs. They were presented with three financial strategies for shared accountability between the CCOs and LTC, aimed at eliminating cost shifting between the two systems and were asked to discuss the pros and cons of each plan. Many of the members of this group were still concerned that LTC would not be part of the CCOs.

Option One: Incentive Payment and/or Penalties Based on Performance Metrics

Option one would reward or penalize CCOs based on performance metrics and the % of clients served in the community. The group liked that this option included flexibility in targeting incentives and could be tailored to large or small CCOs. However, there were concerns that there may not be funding available for any incentive programs right away. The group agreed that success of this option would largely depend on the metrics selected, which were not specified.

Option Two: Shared Cost and/or Savings Compared to a Spending or Caseload Benchmark.

This option requires CCOs to share additional cost of a nursing facility if above the projected costs and allows them to share savings if they are below. The group liked that this option utilizes metrics that are currently being tracked, rather than creating a new set of metrics to base the cost/savings. They were concerned that there would be issues with sharing savings and that this may not motivate enough change.

Option Three: Ensuring Correct Allocation of Costs between LTC system and CCOS.

This option would transfer responsibility and funding for nursing home cost in the first 180 days that are primarily medical in nature to the CCOs. The members of the group thought that this option appropriately shifted the cost to the right party and gave CCOs greater flexibility to care for patients in the most appropriate setting. However, they were concerned that it would be difficult to determine what costs could be considered primarily medical in nature and what costs would always be considered LTC.

To submit your thoughts on the transformation process or any feedback you may have, to the Oregon Health Authority and the Oregon Health Policy Board, click here. If you have any additional questions or concerns, please contact Jenn Baker at baker@oregonrn.org

 

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