Lessons Learned from CCO 2.0 Plans & Ongoing Work within OHA
Highlighting lessons learned from CCO 2.0 plans, payment grids, and ongoing initiatives within the Oregon Health Authority (OHA). Explore the background of Traditional Health Workers (THWs) in Oregon, legislative requirements, and strategies to enhance THW integration for culturally responsive care.
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Highlighting Lessons learned from CCO Highlighting Lessons learned from CCO 2.0 Plans, Payment Grids, sharing any 2.0 Plans, Payment Grids, sharing any Ongoing Work within OHA. Ongoing Work within OHA. Presenter: Abdiasis Mohamed, MSW, BA, CHW THW Program Coordinator Oregon Health Authority
Provide Overview of THW s Background in Oregon Questions and discussion Overview: CCO 2.0 Contract Requirements and Reporting Questions and Discussion CCO THW paymentsfor CY2020 Ongoing Initiatives at OHA regarding THWs (Enter) DEPARTMENT (ALL CAPS) (Enter) Division or Office (Mixed Case) 2
OREGON LEGISLATIONS HB 3650 (2011) Requires State to establish criteria, descriptions, and education/training requirements for community health workers, peer wellness specialists, personal health navigators, and other providers not regulated by theState SB 1580 (2012) Requires utilization of these health care workers in Health Systems Transformation HB 3407 (2013) Establishes the THWCommission to advise the Oregon Health Authority on THW policy and programissues.
HB2024 (2015) Adds oral health training requirement for certification of all THWs More Oregon THW Legislation HB 2304 (2017) Adds PeerSupport Specialists and sub-worker types (Family and Youth Support Specialists) to THW Commission
Driving Forces Behind Increased Use of Traditional Health Workers Q: How do we better ensure provider cultural responsiveness, language accessibility, a diversified workforce, and access to critical services across the state within a CCO and its provider network that reflects the population served by the CCO? Policy goal Recommended Strategies Enhance integration and utilization of Traditional Health Workers to ensure delivery of high quality, and culturally and linguistically appropriate care to improve health outcomes Designate a CCO liaison as a central contact for THWs Identify and include THW affiliated with organizations listed under ORS 414.627 in the development of CHAs and CHPs Implement recommendations of the THW Commission, including requiring CCOs to: Create plan for integration and utilization of THWs Incorporate alternative payment methods to establish sustainable payment rates for THW services Integrate best practices for THW services in consultation with THW commission 8
The intended impact of the new CCO contract language regarding THWs is as follows: 1) increase the THW workforce by creatinga livable and equitable payment system. Intended Impact of the THW Contract Reforms 2) show a positive return on investment by increasing access to preventative,high-quality care beyond the clinical setting thus improving health outcomes. 3) increase access to culturally and linguistically diverse providers beyond the clinical setting. 9
THW Logic Model Link between the deliverable and the Vision for improved Health OHPB Recommendation Implement recommendations of the Traditional Health Worker (THW) Commission Activities andResources CCOs develop & implement a plan that includes: THW integration into service delivery, member & provider communication re scope of practice, benefits, and availability of THW services; plan for increasing THW utilization, and THW service delivery model that reflects best practices from THW Commission. CCOs establish sustainable payment rates using APMs for THW services. CCOs provide REALD data by THW category. OHA provides TA & learning collaborative to supportCCOs. Short-term Expected Outcomes (2-4years) Increase in THW workforce integration, utilization, retention, & payment. Decrease in average wait time for accessing THW services. Increase in # and proportion of care teams that include THWs, as appropriate for members healthcare needs. Visibility into the demand for THWs by type and alignment with memberneeds. Long-term Expected Outcomes (5+years) Improvement in health outcomes, and decrease in health inequity factoring race, ethnicity, and primary language. Delivery of culturally competent navigation, education, and coordination that actively supports member health and social needs. Transitions of care involving THWs are intentional/plannedwithinthedeliverysystemto support ongoing memberhealthandsocial needs. 10
CCOs w/ Multiple Payment Models CCOs w/Multiple Payment Models Multiple Payment Models One Payment Model Advanced Health CCO All Care CCO Cascade Health AllianceCCO Columbia Pacific CCO EOCCO Health Share of OregonCCO No 8% IHN CCO Jackson Care Connect Yes 92% PacificSource CCO Trillium CCO Umpqua Health AllianceCCO Yamhill CCO 13
CCOs Using Fee-for-Service Fee For Service No Fee for Service CCOs using Fee for Service All Care CCO Advanced Health Cascade Health AllianceCCO IHN CCO Columbia Pacific CCO EOCCO No 17% Health Share of OregonCCO Jackson Care Connect Yes 83% PacificSource CCO Trillium CCO Umpqua Health AllianceCCO Yamhill CCO
CCOs Using Contracts Contracts No Contracts CCOs using Contracts Cascade Health AllianceCCO Advanced Health CCO Columbia Pacific CCO All Care CCO EOCCO Health Share of OregonCCO Yes 42% Trillium CCO IHN CCO No 58% Yamhill CCO Jackson Care Connect PacificSource CCO Umpqua Health AllianceCCO
CCOs Using Alternative Payment Methods Alternative Payment Methods (inc. Capitation, Flex, Advanced Payment and Care Model, Case Rate, Per Member Per Moth, Value-Based Payment & Population-Based Payment No Alternative Payment Methods CCOs using Alternative Payment Methods Advanced Health CCO (APCM) All Care CCO Columbia Pacific CCO (APM addedto CMHP) Cascade HealthAlliance CCO EOCCO (VBP/PMPM) No 25% Health Share of Oregon CCO (VBP & Flex) Jackson Care Connect IHN CCO (PMPM & Capitation) Yes 75% PacificSource CCO (PMPM & Case Rate) Trillium CCO (NO APMmethod provided) Umpqua Health Alliance CCO(PMPM, Capitation, & Case Rate) Yamhill CCO (PMPM & Capitation)
CCOs Using Direct Employment Direct Employment No Direct Employment CCOs using Direct Employment Advanced Health CCO All Care CCO Columbia Pacific CCO Cascade HealthAlliance CCO Health Share of Oregon CCO EOCCO Jackson Care Connect IHN CCO No 42% Yes 58% PacificSource CCO Umpqua HealthAlliance CCO Trillium CCO Yamhill CCO
CCOs Using Grants CCOs using Grants Grants No Grants Columbia Pacific CCO Advanced Health CCO EOCCO All Care CCO Health Share of Oregon CCO Cascade HealthAlliance CCO Jackson Care Connect IHN CCO Yes50% Yes50% Pacific Source CCO Umpqua HealthAlliance CCO Trillium CCO Yamhill CCO
OHAs ongoing initiatives to support THWs Integration Work Ongoing Work within OHA : 1115 Waiver: Flexibility in payment for THW services- Waiving federal payment requirements and implementing innovative contracting and payment for THW services. Health related Services THW Guidance Document by Transformation Center. Payment Reform Collaborative Workgroup- with Transformation Center. Expanding the billing/payment opportunities through the development of in lieu of services (ILOS). Services provided by THWs were identified as one potential area in which ILOS could be utilized by CCOs.
Continues Creating THW Liaison Workgroup to provide support and technical assistance for CCOs CCO 2.0 THW Universal Draft Report Template to be released to THW Commission, THW liaisons, and other stakeholders for feedback. CCO 2.0 CY 2020 Summary Report to be Released on the fall New Learning Collaboratives Opportunity with Community Based Organization to Support the Integration of THWs i.e., MHAAO, ORCHWA etc. Plans to start Late July through June 30, 2022. Developing and Updating Billing Guidance for Peers
QUESTIONS? ABDIASIS MOHAMED Traditional Health Worker Program Coordinator Oregon HealthAuthority Equity and Inclusion Division Mohamed.abdiasis@dhsoha.state.or.us http://www.oregon.gov/OHA/oei THW Commission Website: http://www.oregon.gov/oha/oei/Pages/thw-commission.aspx Subscribe to mailing list through website forupdates. THW Program information : https://www.oregon.gov/oha/oei/Pages/Traditional-Health-Worker-Program.aspx HB3311 Report:www.oregon.gov/oha/legactivity/2012/hb3311report-doulas.pdf
