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2019 CCO Transformation and Quality Strategy:
Social Determinants of Health
January 23, 2018
Presented by:
Sara Beaudrault, Policy Analyst
Amanda Peden, Transformation Analyst
Webinar Agenda
1. Provide overview of TQS purpose and deliverables
2. Define social determinants of health and social
determinants of health equity
3. Provide examples of social determinants of health
interventions
4. Q&A
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Why we do this work…
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TQS foundational principles
TQS is a means for CCOs to report health transformation and quality work. The work is
determined, developed and implemented by the CCOs with the direction from the CACs,
community, and CCO leadership. OHA’s role is monitoring, spreading best practices and
providing technical assistance for implementation with community and state subject
matter experts.
The Oregon Health Authority recognizes that the programs and projects included in the
CCO Transformation and Quality Strategy submissions are a showcase of current CCO
work addressing TQS components that aim to make significant movement in health
system transformation. Additionally, OHA recognizes that the work highlighted in the TQS
is not a comprehensive catalogue or full representation of the CCO’s body of work
addressing each component. CCOs are understood to be continuing other work that
ensures the CCO is meeting all OARs, CFRs, and CCO contract requirements.
The template addresses three key principles:
1. Meets CFR, OAR, 1115 waiver and CCO contractual requirements
2. Pushes health transformation through alignment with quality and innovation
3. Decrease administrative burden
• Supports OHA’s use of information to monitor CCOs’ progress to benchmarks.
• Incorporates narrative style and specific/measurement methods.
• Combines two annual deliverables from prior years 2012-2017.
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Deliverables schedule
• TQS due annually on March 16 (effective January–December) or closest
business day.
• TQS progress report due on September 30 (progress for January–June) or
closest business day.
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Components and subcomponents
1. Access
– Access: Availability of Services
– Access: Cultural Considerations
– Access: Quality and
Appropriateness of Care
Furnished to all Members
– Access: Second Opinions
– Access: Timely
2. CLAS Standards and Provider
Network
3. Grievances and Appeals System
4. Health Equity and Data
– Data
– Cultural Competence
5. Health Information Technology
– Health Information Exchange
– Analytics
– Patient Engagement
6. Integration of Care
7. Patient-Centered Primary Care
Home
8. Severe and Persistent Mental
Illness
9. Social Determinants of Health
10.Special Health Care Needs
11.Utilization Review
12.Value-based Payment Models
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2019 TQS TA and Documents
• All technical assistance and guidance documents are on the OHA
Transformation Center website: www.oregon.gov/oha/HPA/dsi-
tc/Pages/Transformation-Quality-Strategy-Tech-Assist.aspx
– Template
– Guidance document
– Health Equity Lens Guidance document
– FAQ
– Sample TQS
– Webinar recordings
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What are the social determinants of
health (SDOH)?
Oregon’s Medicaid Advisory Committee defined SDOH and the
underlying social determinants of health inequities:
• Social determinants of health: The social, economic, political, and
environmental conditions in which people are born, grow, work, live,
and age. These conditions significantly impact length and quality of
life and contribute to health inequities.
• Social determinants of health equity: Systemic or structural factors
that shape the unfair distribution of the social determinants of health
in communities. These structural factors are evident in social norms,
policies, and political systems, both historical and current.
Institutionalized racism is one example.
Looking for examples? See next slide…
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▪ Social integration
▪ Civic participation/community engagement
▪ Meaningful social role (e.g. meaningful work)
▪ Discrimination (e.g. race, ethnicity, culture,
gender, disability)
▪ Citizenship/immigration status
▪ Corrections
▪ Trauma (e.g. adverse childhood experiences)
▪ Early childhood
education and
development
▪ Language and literacy
▪ High school graduation
▪ Enrollment in higher
education
▪ Poverty
▪ Employment
▪ Food insecurity
▪ Diaper insecurity
▪ Access to quality childcare
▪ Housing instability, including
homelessness
▪ Access to banking/credit
SOCIAL DETERMINANTS OF
HEALTH EQUITY
SOCIAL DETERMINANTS OF
HEALTH EQUITY
▪ Access to healthy foods/protection from food
“swamps”
▪ Access to transportation (non-medical)
▪ Quality, availability, and affordability of housing
▪ Crime and violence (including domestic violence)
▪ Environmental conditions
▪ Access to the outdoors/parks
racism sexism
ableism Homophobia & transphobiaageism
▪ Access to health care
▪ Culturally and linguistically
appropriate care
▪ Health literacy
SDOH Graphic - Medicaid Advisory Committee May 2018
Why Social Determinants of Health
(SDOH) in the TQS?
• Addressing SDOH is
critical to health
system transformation
• Oregon’s 2017-2022
Medicaid 1115 waiver
prioritizes SDOH
• It aligns with CCO and
community priorities
and existing initiatives
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40%
10%
30%
20%
Factors that determine health outcomes*
Social & Economic
Physical environment
Healthy behaviors
Clinical care (quality and access)
SDOH
Three tips for strong SDOH initiatives
• Recognize the link between SDOH and
health disparities
• Identify and address member and
community needs/priorities
• Collaborate with community partners and
follow their lead
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2018 TQS areas of opportunity: Overall
Overall: Background/rationale link to the program and/or project across
components
General OHA feedback:
The background/rationale in the quality assessment was often missing an
analysis of the CCO’s local community. Without that analysis and a
demonstrated gap, it is difficult to show why a project or program would achieve
the desired outcome.
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2018 TQS areas of opportunity: Overall
Overall: Explanation of how specific projects and/or programs will
address identified gaps across components
General OHA feedback:
• Missing enough detail to help understand how a project will result in
improvement.
• For example, if the only activity is to collect data on members with
SDOH needs, it is unclear how the activities will lead to
improvements for the members. Similarly, if the only activity is to
address SDOH needs of individual members, it is unclear exactly
how that will make improvements to SDOH needs across the
member population.
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2018 TQS areas of opportunity: Social
determinants of health
Social Determinants of Health: Missed linkages to clearly
demonstrate how specific projects addressed social determinants of
health (SDOH).
Examples of strong SDOH projects: Included a clear emphasis on
addressing the needs of the CCOs’ greatest needs members.
• CCO sits on the executive committee of a collective impact organization that
works toward a trauma-informed community. Within this collaborative work,
the CCO also implemented ACEs training efforts for CCO staff.
• CCO partially funded Collaborative Learning for Educational Achievement
and Resiliency (CLEAR) program implementation. CLEAR provides ongoing
training of teachers and school staff to implement trauma-informed practices
in schools.
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2019 TQS Guidance Document and
Sample TQS
• TQS Guidance Document
• Sample TQS for SDOH
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More examples from CCOs
• Veggie Rx: patients and families are screened for food insecurity
and issued Veggie Rx vouchers which can be filled for whole fruits
or vegetables at farmers markets and grocery
– SDOH: Food Insecurity
– Partners: food banks, food distributors, local public health authorities,
community-based organizations, FQHCs, schools
• Re-entry support: Housing supportive services, employment
services, and other re-entry services for justice-involved individuals
– SDOH: Corrections
– Partners: community-based organizations, corrections, housing partners
• ACES training: support of school-based training on ACEs and
trauma-informed care
– SDOH: Trauma
– Partners: Community-based organizations, local government, schools
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Resources
• Oregon Medicaid Advisory Committee SDOH report and
recommendations for CCOs: https://www.oregon.gov/oha/HPA/HP-
MAC/Documents/MAC_AddressingSDOH_CCOmodel_Recommend
ations_FINAL.pdf
• Health Leads SDOH Roadmap: https://healthleadsusa.org/resource-
library/roadmap/
• Social Interventions Research and Evaluation Network (SIREN)
Evidence Library: http://sirenetwork.ucsf.edu/tools/evidence-library
• Commonwealth Fund’s ROI Calculator for Addressing SDOH:
http://tools.commonwealthfund.org/roi-calculator
• Center for Health Care Strategies: Social Determinants of Health
Resources and Projects
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Q&A
• Please type your questions and comments into the
“Questions” box on your GoToWebinar control panel.
• We will update our Frequently Asked Questions after
each webinar in this series.
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For more information:
• Presenter contacts:
– Sara Beaudrault: [email protected]
– Amanda Peden: [email protected]
• Other contacts:
– Lisa Bui: [email protected]
– Anona Gund: [email protected]
• All TQS resources, including the templates, guidance document,
examples and technical assistance schedule are available on the
Transformation Center website: www.oregon.gov/oha/HPA/dsi-
tc/Pages/Transformation-Quality-Strategy.aspx
• CCOs’ 2018 TQS submissions and progress reports are also posted
on the Transformation Center website.
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