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Delivery System Transformation Committee December 14, 2017 4:30 – 6:00 pm
Samaritan Walnut Building, Endeavor Conference Room
Dial in: 866-439-0933 Code: 5093665467
1. Introductions Sherlyn Dahl, Executive Director,
Community Health Centers
of Benton and Linn Counties
4:30
2. Transformation Update
• Breastfeeding Support Services (BSS) Time-Only Extension Approved. 8 Yes, 0 No, 0 Abstain
• Chrysalis Therapeutic Support Groups (CTSG) Scorecard Results
• Colorectal Cancer Screening Campaign (CRSC) Scorecard Results
• Workgroup Semi-Annual Reports
• Health Information Exchange/Regional Health Information Collaborative Grant Application
• DST Calendars
p. 7
p. 8
p. 11-18
p. 19-21
Jenna Bates, Transformation
Manager, IHN-CCO
4:35
3. OHA Innovator Update
p. 22-24 Joell Archibald, Innovator Agent,
OHA
4:55
4. Physician Wellness Initiative (PWI) Closeout p. 25-29 Jana Svoboda, LCSW 5:05
5. How to Get the Story Out p. 31 Sherlyn Dahl, Executive Director,
Community Health Centers
of Benton and Linn Counties
5:25
6. Wrap Up
• Scorecard collection
• PWI: https://www.surveymonkey.com/r/__PWI
• Next Meeting: January 11, 2018
Sherlyn Dahl, Executive Director,
Community Health Centers
of Benton and Linn Counties
5:55
COMMONLY USED ACRONYMS AND MEANING
Acronym Meaning ACEs Adverse Childhood Experiences APM Alternative Payment Methodology CAC Community Advisory Council CCO Coordinated Care Organization CEO Chief Executive Officer CHIP Community Health Improvement Plan CHW Community Health Worker COO Chief Operations Officer CRC Colorectal Cancer DST Delivery System Transformation Committee ED Emergency Department EHR Electronic Health Records ER Emergency Room HE Health Equity IHN‐CCO InterCommunity Health Network Coordinated Care Organization LCSW Licensed Clinical Social Worker MOU Memorandum of Understanding OHA Oregon Health Authority PCP Primary Care Physician PCPCH Patient‐Centered Primary Care Home PMPM Per Member Per Month PSS Peer Support Specialist PWS Peer Wellness Specialist RFP Request for Proposal RHIC Regional Health Information Collaborative RPC Regional Planning Council SDoH Social Determinants of Health SHP Samaritan Health Plans SHS Samaritan Health Services SOW Statement of Work THW Traditional Health Worker TQS Transformation Quality Strategies UCC Universal Care Coordination WG Workgroup
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Minutes Delivery System Transformation Committee
November 30, 2017: 4:30 – 6:00 pm Samaritan Health Services Walnut Building: Endeavor (conference room)
Dial in: 866-439-0933 Code: 5093665467 Introductions Kim Whitley Present: Bettina Schempf, Sherlyn Dahl, Bill Bouska, Ronda Lindley-Bennett, Jenna Bates, Kim Whitley, Rebekah Fowler, Britny Chandler, Tyra Jansson, Kevin Ewanchyna, Brigetta Olson, Stephanie Jensen, Kevin Cuccaro, Joell Archibald, Tony Howell, Hilary Harrison, Jeff Blackford, Christine Mosbaugh, Chi Blatt, Kristi Reher, Danny Magana, Rachel Petersen, Charlie Fautin Phone: Matthew Sinnott, Yuberca Pena
Jenna Bates Transformation Update
• Breastfeeding Support Services (BSS) is asking for a time-only extension.
• Social Determinant of Health (SDoH) with a Veggie Rx Intervention pilot time-only extension was approved. 6 votes yes, 0 no or abstain.
• Health and Housing Planning Initiative (HHPI) closeout results are on page 8 of the packet.
• The audit of the Medicaid program, by the Secretary of State was discussed.
• SB 558 Cover All Kids go-live date is unknown.
• Children’s Health Insurance Program (CHIP) was approved through April 2018 in Oregon. o General Funds will be paying for the program and the State is hoping the Federal government will fund.
Colorectal Cancer Screening Campaign (CRSC) Follow Up Kevin Ewanchyna
• Why is the higher achieving clinic doing better? o The clinics identified in the evaluation as high performing were considered highly engaged in CRSC
projects. That could mean that the clinic was motivated to participate on their own (possibly wanting to improve their metrics). It also was related to other CRSC projects being implemented by state organizations and IHN-CCO.
o Because there are so many extenuating factors to a clinic being highly engaged, it cannot be said if that engagement and subsequent improvement in their screening rates was due to the pilot or a combination of the pilot and others.
• Can you expand on the three-month implementation process? o The implementation process was to help clinics create a closed-loop referral process. Once that is set
up, the clinic could work on improving it by doing a quality improvement project. o The pilot expanded upon this implementation process with the Lincoln Community Health Center with
the SRCH (Sustainable Relationships for Community Health) grant.
• Is there a manual for the implementation process? o There is no manual outside of the evaluation materials that were created. This process is very specific by
clinic. Some of the clinics might have something that they made, like a clinical workflow. A sample workflow was created in the clinical lessons learned one pager.
• Discussion: o With highly engaged staff you will have a highly engaged project. Team meetings on regular basis,
problem solving up front, and the administrative and physician champion are key. o Different approaches were and are being made for cultural and ethnic groups.
▪ A task force was created for additional cultural considerations. o How many people were screened?
Pilot Closeout Chrysalis Therapeutic Support Groups (CTSG) Chi Blatt and Kristi Reher
• Summary:
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o Chrysalis is a psychoeducational support group for female survivors of trauma.o These groups are school based and run from October until the end of the school year. A Trillium
therapist partners with a school counselor.o The transformation pilot funded 4 groups at Philomath High School, West Albany High School, Corvallis
High School, and Crescent Valley High School.
• Key Findings:o Using data from the pre and post test SCARED (The Screen for Child Anxiety Related Disorders) surveys,
results indicate that Chrysalis participants experienced an overall reduction in anxiety symptoms.o There was also a significant reduction in panic disorder symptoms.o Participants reported a significant reduction in general anxiety disorder symptoms.o There was a significant reduction in separation anxiety symptoms.o Lastly, there was a significant reduction in school avoidance.
• Successes:o As reported in their end of the year anonymous surveys, 95.5% reported that they now know more
about trauma and 100% reported that it was helpful to them to learn about trauma.o Data from the Pre/Post Anonymous Test (final data analysis):
▪ Participants reported using alcohol within the last 3 months: pre-test 41.3%, reduced to 22.7%post-test.
▪ Using marijuana within the last 3 months: pre-test 32.6%, reduced to 27.3% post-test▪ Riding in a car being driven by someone who was drunk/high within the last 3 months: pre-test
54.3%, reduced to 22.7% post-test.▪ Using drugs or alcohol to relax within the last 3 months: pre-test 39.1%, reduced to 18.2% post-
test.▪ Using drugs or alcohol alone within the last 3 months: 37% pre-test, reduced to 4.5% post-test.▪ Someone had talked to them about concern for their drug/alcohol use within the last 3 months:
15.2% pre-test, reduced to 9.1% post-test.▪ Sharing naked or revealing pictures of themselves within the last 3 months: 34.8% pre-test,
reduced to 18.2% post-test.
• Remaining Challenges:o The pilot was going to have a group at Monroe, but due to the small school size did not have enough
participants to create a group dynamic.o Currently 3 (of the 4 groups from last year), are running again this year with funds from the school
districts. Funding is always tight in school districts, so there are no guarantees for the future.o There was difficulty with collecting meaningful data from the schools around attendance. Having a
consistent control group or way to measure change was/is a challenge.
• Sustainability:o 3 of the 4 groups are running again this year.o West Albany High School, Corvallis High School, and Crescent Valley High School are running due to
funding from the respective school districts and funding from Trillium Family Services.
• Discussion:o The curriculum is an evidence-based program created by Trillium.o Approached smaller and more diverse schools, but there was not enough students to create a group
dynamic.o The school provides potential students for Chrysalis and there is a screening process with a question
that asks the student if they believe they qualify.o Most students were not utilizing Trillium outpatient services. Over half of the psychologist time was
dedicated to depression screenings, safety planning and other screenings.o IHN-CCO members were a priority when screening the applications.o Providing attendance data equates to money for the schools. Suggested to gather pre-attendance data.
DST Budget Kim Whitley
• Social Determinants of Health Workgroupo Use the funds for a Masters level intern to help launch the workgroup work.
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o Request: $36,000
• Health Equity Workgroup o Goals within the Strategic Plan with the focus on stories of the region around health equity work. o Create video stories and materials on how to move health equity forward. o How are we moving equity forward and what organizations can do to support and transform equity?
▪ What is Health Equity, why is it important, how to implement health equity? o Request: $36, 000
• Traditional Health Workers Workgroup o Training for Traditional Health Workers (THWs) and a summit bringing THWs and their supervisors
together. ▪ Annual and quarterly events or meetings to continue to come together to learn.
o Request: $36,000
• Universal Care Coordination Workgroup o Bring in consulting resources for system impact. o Establish care coordination educational events. o Potentially hire someone for strategic planning and direction instead of paying for people to bring back
information. o Cannot pay stipends to workgroup members, so the allocation of money would go to bring in consulting
resources for system impact and establish care coordination educational events. o Request: $36,000
• Benton County and IHN-CCO to have a contracting discussion and bring back information at the December 14, 2017 DST meeting.
• Bring together the workgroups after the funds have been exhausted to have a mini innovation café type of lesson learning.
How to Get the Story Out Kim Whitley
• The Dental Medical Integration for Diabetes pilot received national recognition in a paper Commissioned by the Roundtable on Health Literacy, Health and Medicine Division, the National Academies of Sciences, Engineering, and Medicine.
o Create a one page ‘what you want to know about it’ for easier understanding of the larger paper.
• Still working on the Internal Roadshow.
• Kevin Ewanchyna has been invited to Capitol Hill in February 2018 to talk about senators and legislators about what IHN-CCO has been doing.
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IHN‐CCODSTChrysalisTherapeuticSupportGroupsPilotScorecardResults
Criteria Results Outcome Achievement 7.67 Measurement Sufficiency 6 Improved Health Outcomes 6.27 Reduces Costs 4.4 Improved Access 5.17 State Metrics 3.18 Transformational 6.17 Barriers 7.42 Scalable 7.92 Replicable 8.33 Self‐Sustaining 5.25 Number of Reviews 12
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Criteria Results
Outcome Achievement 7.4
Measurement Sufficiency 6.6
Improved Health Outcomes 6.8
Reduces Costs 5.4
Improved Access 6.4
State Metrics 6.2
Transformational 5
Barriers 6.2
Scalable 6.4
Replicable 6.4
Self-Sustaining 5.5
Number of Reviews 5
IHN-CCO DST Colorectal Cancer Screening Campaign Pilot Scorecard Results
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InterCommunity Health Network Coordinated Care Organization (IHN-CCO)
2017 Semi-Annual Workgroup Reports
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Semi‐AnnualReportandEvaluationWorkgroup:AlternativePaymentMethodologies(APMs)
Workgroup Purpose: To provide the following community participation and instruction: Define key elements in a sustainable Alternative Payment Methodologies. Evaluate APM pilots that will lead to payment models that promote and support transformation at the
system and care level. Implement, monitor, and provide direction for Patient‐Centered Primary Care Home (PCPCH) APMs. Develop proposals for delivery system‐wide APMs (such as in‐patient services, specialty, out‐patient
hospital, dental, behavioral health, etc.).
Reporting Period Report Submission Date April 1, 2017 – September 30, 2017 October 6, 2017
October 1, 2017 – March 31, 2018 April 6, 2018
April 1, 2018 – September 30, 2018 October 5, 2018
October 1, 2018 – March 31, 2019 April 5, 2019
A. Quarterly progress:
Short Term Goals Results to Date
Manage the APM Roadmap that drives the expansion of fully‐integrated quality‐based payment models.
The subgroup reviews the APM Roadmap at each meeting to ensure that we’re on schedule for transitioning provider payments. To date the workgroup is on schedule. Here is where the workgroup is at:
Increase subcommittee participation.
No change.
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Expand knowledge of alternative payments to impact specialists and inpatient services.
Our Basecamp site is continually updated to include industry models that should be reviewed. These are discussed at the APMs.
Continue to be a resource for pilots in recommending opportunities for an APM. Put a process into place to have ongoing communication from the Delivery System Transformation (DST) approved pilots, so that the best potential APMs that are suitable for the service delivery can be determined, as appropriate.
A Transformation Team representative at the APM has volunteered to report pilots that have been approved to the APM Subcommittee. This will help the workgroup determine what types of models would be appropriate if the pilot becomes operational.
Developed an introductory tutorial for all APM Subcommittee members and placed on Basecamp.
Expand knowledge, and make recommendations for building CCO risk‐stratification model.
IHN‐CCO is not going to purchase the Primary Care Activity Level (PCAL) recommended by the workgroup. IHN‐CCO is pursuing the Chronic Disability Payment System (CDPS) model, also recommended by Bailit.
Provide direction to IHN‐CCO on metrics that should be considered part of the IHN‐CCO metric catalog used in contracting APMs with providers.
All metrics are reviewed at the APM Subcommittee each meeting. When new ones are recommended, they are added to the list for IHN‐CCO to use where it makes sense in contracting.
Long Term Goals Results to Date
Evaluate progress and use information to develop APMs above and beyond the Transformation Plan deliverables in collaboration with all facets of the community, based on experience of sustainability and those that are replicable.
The APM subcommittee reviews the Pay For Performance (PFP) models that IHN‐CCO has put in place based on the type of provider clinic or service provider. The subcommittee continues to determine what is important, from an APM standpoint, with contracting. The subcommittee reviews outcomes of capitation models to determine what may need to be revised and/or how to continue moving forward with enhancing other provider models.
Refine the tool box, check list, and roll out process for APMs to be used when implementing the APM.
This is complete to date. The subcommittee, through pilots in 2015, was able to give IHN‐CCO a toolbox that allows for simple implementation of APMs. The toolbox will continue to be built upon depending on the type of APM.
Maintain the payment methodology platform for which to build PFP contracts that will drive the growth of more quality‐driven reimbursement.
The base payment model is reviewed at the end of the contracting period.
Evaluate the outcomes of approved APMs to determine success based on
The subcommittee will be reviewing the outcomes of all the contracts at the end of the contract period.
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B. What has been successful? The workgroup has successfully moved many contracts to an appropriate APM and the toolbox, to do
so, is complete. It used to take three to six months for implementation where now it only takes aboutone to two months to fully implement an APM contract. We have also come to an agreement on a riskstratification tool and participation is increasing a little bit.
C. What are the challenges and how are you addressing them? Now that IHN‐CCO has really operationalized APM implementation and contracting based on the
subcommittee’s work and recommendations over the year, including the findings based off of two DSTapproved and funded pilots, it has been difficult figuring out the continued role of the subcommittee.This has caused a major decrease in attendance.
D. Have there been any significant changes to your Workgroup Goals? If so, why? No.
Triple‐Aim goals in our community.
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Semi-Annual Report and Evaluation Workgroup: Health Equity (HE)
Workgroup Purpose: Identify areas of health disparities and develop a strategic plan to address these disparities. Support work that addresses Transformation Elements 7 and 8: (7) Meeting the culturally diverse needs of Members and (8) Eliminating racial, ethnic and linguistic disparities.
Reporting Period Report Submission Date
April 1, 2017 – September 30, 2017 October 6, 2017
October 1, 2017 – March 31, 2018 April 6, 2018
April 1, 2018 – September 30, 2018 October 5, 2018
October 1, 2018 – March 31, 2019 April 5, 2019
A. Semi-Annual progress:
Goals Results to Date
Identify disparities based on diagnosis, IHN-CCO metrics, health outcomes, and other measures decided upon.
The Data Committee focused on the proposed strategic plan and reviewed proposed goals, actions, and measurements.
In the latest pilot proposal round all applicants were asked to include equity considerations in their application and in the evaluation of their projects.
Identify data that will inform the Quality Improvement Plan (QIP) and Performance Improvement Plan (PIP).
This work will be started when the strategic plan is approved and changes will be made to the goals in line with the approved plan.
Identify and engage partners to participate in projects to address identified disparities.
The group continues to engage current and new partners. Workgroups for the five strategic goals will recruit partners as the specific work gets underway.
The workgroup worked with the Linn Benton Health Equity Alliance to develop a comprehensive proposal for equity training and technical assistance.
Identify root causes for disparities and brainstorm strategies and initiatives to address those root causes.
This work is ongoing and will continue as the strategic plan is implemented. The workgroup provided input for the IHN-CCO Transformation Team to use in the latest funding round.
Implement a strategic plan to address disparities. The strategic plan was approved by the Delivery System Transformation (DST) at the meeting on September 21, 2017 and is now being reviewed by the Regional Planning Council (RPC). Five workgroups are starting their work to implement the plan.
A key collaboration for the training goal is starting with the Linn Benton Health Equity Alliance and their approved pilot project to bring equity training and awareness to all three counties.
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B. What has been successful?
The workgroup name was changed to Health Equity (from Health Disparities).
The Strategic Plan was refined and updated to reflect the feedback from the DST. It was approved onSeptember 21, 2017 and is now going to the RPC.
The IHN-CCO Community Advisory Council (CAC) endorsed the proposed plan.
The shared proposal with the Linn Benton Health Equity Alliance is an exciting opportunity to move thetraining goals forward.
C. What are the challenges and how are you addressing them?
It has been a long process to get the plan approved: it was both challenging and invigorating to see thesupport from the DST community for the work that is included in the plan. The conversations are makinga real difference in moving forward with the equity goals.
D. Have there been any significant changes to your Workgroup Goals? If so, why?
Not yet. The goals will be replaced with the goals in the strategic plan and they will be updated for thenext report after RPC approval is gained. More refinement will also take place as the subgroups starttheir work.
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Semi-Annual Report and Evaluation Workgroup: Universal Care Coordination (UCC)
Workgroup Purpose: Convene and align community around a common referral process that can be
electronically captured and made available to the Primary Care Provider (PCP) at the time of service to capture
Social Determinants of Health (SDoH) in an electronic form, have a common assessment form for all programs
that have assessments, and reduce duplication of services along with helping members navigate the healthcare
system (and potentially other systems).
Reporting Period Report Submission Date
April 1, 2017 – September 30, 2017 October 6, 2017
October 1, 2017 – March 31, 2018 April 6, 2018
April 1, 2018 – September 30, 2018 October 5, 2018
October 1, 2018 – March 31, 2019 April 5, 2019
A. Quarterly progress:
B. What has been successful?
There has been significant increase in community partner engagement in the meetings over only threesessions. Participants from both clinical/medical and social services/community partners have been ableto share their involvement in care coordination. Topics covered included both challenges & successesalready gained from forging interagency relationships.
C. What are the challenges and how are you addressing them?
The overarching challenge of Care Coordination is so broad and encompasses so many players withseemingly divergent agendas that it is a challenge to identify a shared path forward. This workgroup hasopted to address this challenge by evaluating processes and common roles across the community. TheUCC workgroup is also hoping that the Care Coordination definition will provide quick alignment andquick success for the group to achieve momentum to move forward.
D. Have there been any significant changes to your Workgroup Goals? If so, why?
There have not been significant changes as of yet, but do anticipate growth of the current goals to fullyrealize the workgroup purpose & goals of the larger UCC summit.
Goals Results to Date
Implement a shared resource for services Multiple community organizations have produced their own version of a community resource guide. The workgroup will continue to address how to integrate these multiple guides into one shared tri-county wide resource guide.
Develop common language across regional healthcare systems and community services
Started work on definition for Care Coordination term which represents all members of the community providing this service.
Create a joint/shared community services intake form Asked members to gather their current intake forms. Received feedback on county-level activities to this end already in progress.
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Semi-Annual Report and Evaluation Workgroup: Traditional Healthcare Worker (THW)
Workgroup Purpose: Advance the development of THWs in the transformation of healthcare to advance the Triple Aim.
Reporting Period Report Submission Date
April 1, 2017 – September 30, 2017 October 6, 2017
October 1, 2017 – March 31, 2018 April 6, 2018
April 1, 2018 – September 30, 2018 October 5, 2018
October 1, 2018 – March 31, 2019 April 5, 2019
A. Quarterly progress:
Short Term Goals Results to Date
Implement the THW training center in the Linn Benton area that will serve the mid-Willamette area
THW workgroup notified that Traditional Health Worker Hub (THW) training hub pilot proposal was funded. Benton County Health Services is serving as “backbone agency” for the project
Intern hired to assist with deliverables. Intern will be working initially to develop and implement THW environmental scan/survey in Linn/Benton/Lincoln counties. This scan will look at number and type of THWs currently being used and assess agency interest and readiness in using THWs for service delivery.
Negotiations for licensing of state-approved Community Health Worker (CHW) curriculum with Community Capacitation Center in Multnomah County have begun.
Work with the Health Equity (HE) Subcommittee on an ongoing quarterly basis to align goals and strategies.
Currently the THW committee and the HE committee have a joint meeting once per quarter.
THW and HE workgroup will continue to have joint meetings once per quarter to collaborate and impact common goals for both groups; i.e. training, THW development, and each group’s pilots.
Long Term Goals Results to Date
Improve the THW delivery system, allowing THWs to better support and educate members in navigating the health care system and ensure appropriate, timely care.
Membership in THW committee has increased and diversified.
Beginning implementation of THW training hub.
Ongoing discussion, testing, and sharing of strategies for funding of THWs (Alternative Payment
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B. What has been successful?
The THW subcommittee sponsored and was awarded the THW Training Hub pilot.
Subcommittee supported proposal for peer wellness curriculum development by Family Tree ReliefNursery. This proposal will coordinate closely with the THW Training Hub pilot.
The new DST requirement that pilots using THWs need to participate in the THW subcommittee hasincreased and diversified subcommittee membership.
C. What are the challenges and how are you addressing them?
Challenges continue to be finding time to work on any subcommittee goals that are outside normalscope of each member’s work, as well as developing ways to realistically and sustainably fund THWservices.
D. Have there been any significant changes to your Workgroup Goals? If so, why?
The workgroup goals have not changed since our last Statement of Work (SOW). The only change isthat we now know that we have been funded to do the work, so we are beginning the work itself.
Methodologies [APM], fee-for-touches, Per Member Per Month [PMPM])
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DST2017CalendarAcrynom Pilot Name End Date
January12th , 26th
APM2Alternative Payment Methodology (2)
12/31/16
February9th, 23rd
PMH 11/30/16
BH PCPCHBehavioral Health in the PCPCH
12/31/15
March9th 23rd
CPC 8/31/16 CAPEIChild Abuse Prevention & Early Intervention
12/31/16
April6th, 20th
CVAIS10/31/16
PPC5/30/17
CHW2Community Health Worker (2)
12/31/16
May4th, 18th
COMPAR12/31/16
WG Discussion
CMAS CMA Scribes 03/31/17
June1st, 15th, 29th
YWES12/31/16
SANE7/31/17
TFAT12/31/16
CRSCColorectal Screening Campaign
12/31/16
July13th, 27th
CMAS3/31/17
CHW212/31/16
Non‐THW APM
DMID1/31/17
RFP UpdateLegistlative update
CTSGChrysalis Therapeutic Support Groups
06/30/17
August10th, 24th
PSWTP (1st) CSAS VRxL HEST MHEM RHEH (1st) CSL CDP USSE DMIDDental Medical Integration for Diabetes
01/31/17
September7th, 21st
HE WG Strategic Plan
BH PCPCHHow to get the story out
HE WG Health Equity Workgroup N/A
October5th, 19th
CAPEI12/31/16
MHC12/31/16
How to get the story
outCharter/TQS
How to get the story
outHHPI
Health & Housing Planning Initiative
08/31/17
November2nd, 16th, 30th
HPC6/30/17
Charter/TQSHHPI
8/31/17Charter/TQS
How to get the story
outCRCS Follow Up HPC Home Palliative Care 06/30/17
December14th
PWI6/30/17
IPRPImproving the Pain Referral Pathway in the PCPCH
06/30/17
MHC Maternal Health Connections 12/31/16
PSWTP: Peer Support Wellness Training ProgramCSAS: Children's SDoH and ACE Screening VRxL: Veggie Rx Pilot in Lincoln County: A Strategic Collaboration Against Food InsecurityHEST: Tri‐County Health Equity Summits and TrainingsMHEM: Mental Health Education MattersRHEH: Regional Health Education Hub SPC SHS ‐ Palliative Care 09/30/17CSL: CHANCE Saving Lives CDP: Community Doula ProgramUSSE: Universal Social Service Entry
YWESYouth WrapAround & Emergency Shelter
12/31/16
SNN2School/Neighborhood Navigator (2)
06/30/17
Tri‐County Family Advocacy Training
TFAT 12/31/16
PWI Physician Wellness Initiative 06/30/17
SANESexual Assault Nurse Examiner
07/31/17
HE WG
RFP Process
Pilot Proposal Key: August 10 & August 24 Meetings
RFP Process
RFP Decisions
Workgroup Discussion
DST FundingDST Budget DST Funding
How to Get the Story Out
Meeting 1 Meeting 2 Meeting 3 (June and November)
2017
CCCM9/30/16
Planning Planning
Planning ‐ Workgroups Planning
Planning Debrief PIHL
12/31/16Top 5
No MeetingHE WG
Strategic Plan
COMPAR12/31/16
Funding
Tenative extension Booked extension
Tenative workgroup
LOI Review
CTSG06/30/17
Tentative closeout Booked closeout
Tentative update Booked update
Booked workgroup
KEYTentative
transformationBooked transformation
revised 12/11/2017 sj
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DST 2018 Calendar
Acronym Pilot Name End Date
APMWG Alternative Payment Methodologies Workgroup N/A
BSS Breastfeeding Support Services 12/31/17
C2C CHANCE 2nd Chance 6/30/18
CDP Community Doula Program 12/31/18
CHWL Community Health Workers in N. Lincoln 12/31/17
COMPAR Community Paramedic 2 6/30/18
CSAS Children's SDoH and ACE Screening 12/31/18
EDCT Eating Disorders Care Teams 2/28/18
EHCC Expanding Health Care Coordination 4/30/18
FSP Family Support Project 12/31/17
HEST Health Equity Summits and Trainings 12/31/18
HEWG Health Equity Workgroup N/A
IICH Improving Infant and Child Health 6/30/18
IPRP Improving the Pain Referral Pathways 6/30/17
OHEV Oral Health Equity for Vulnerable Pop. 6/30/18
PDBC Pre-Diabetes Boot Camp 12/31/17
PMP Pain Management in the PCPCH 12/31/17
PPC Pharmacist Prescribing Contraception 5/31/18
PSWTP Peer Support Wellness Training 12/31/18
RHEH Regional Health Education Hub 12/31/18
SDoH Social Determinant of Health Screening 6/30/18
SPC SHS-Palliative Care 9/30/17
THWH Traditional Health Worker Hub 6/30/18
THWWG Traditional Health Worker Workgroup N/A
UCCWG Universal Care Coordination Workgroup N/A
VRxL Veggie Rx in Lincoln County 12/31/18
WPNT The Warren Project: Nature Therapy 4/30/18
YCRC Youth & Children Respite Care 3/31/18
SDoHWG Social Determinants of Health Workgroup N/A
Jan
uar
yFe
bru
ary
Mar
chA
pri
lM
ayJu
ne
28th
July
12th
26th
Au
gust 9th
23rd
Sep
tem
ber 6th
20th
5th
19th
3rd
17th
31st
14th
11th
25th
8th
22nd
8th
22nd
13th
APM2
Oct
ob
er 4th
18th
No
vem
ber
1st
15th
29th
Dec
.
Strategic Planning
Strategic Planning
Strategic Planning
Strategic Planning
Booked update
Booked extension
Tentative workgroup Booked workgroup
Tentative closeout
Tentative update
Key
Tentative miscellaneous Booked miscellaneous
Tentative extension
Booked closeout
Updated: 12/12/2017
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Innovator Agent Update IHN CCO Delivery System Transformation (DST) (December 14th, 2017)
• OHA has developed a web page for all information related to “Medicaid IssuesResolution”; the web page includes letters from the Governor to OHA Director Pat Allenand the work of the agency in responding to and resolving the issues raised. This publicweb page can be found at this link:http://www.oregon.gov/oha/HSD/OHP/Pages/Medicaid-Issues-Resolution.aspxIndividuals can also subscribe to receive information each time the page is updated.
• The concept of “Flexible Services” by CCOs as cited in Oregon’s 2012-2017 Waiverwith CMS has now shifted to “Health Related Services” with the approval of the state’s2017-2022 Waiver. OHA has developed an issue brief about “Health Related Services”that can be found here:http://www.oregon.gov/oha/HPA/CSI-TC/Resources/OHA-Health-Related-Services-Brief.pdf
• Oregon’s Secretary of State released findings of an audit conducted on OHA Programs atthe end of November. OHA’s response is publicly posted at this website:http://www.oregon.gov/oha/HSD/OHP/Documents/OHA_Response_To_SOS_Medicaid_Payment_Audit.pdf
• OHA’s Oral Health Program is proposing to permanently amend administrative rulesrelated to Certification for Local School Dental Sealant programs. The proposedamended rules allow for the application of glass ionomer sealants and makes minorclarifications to the certification and recertification of the program. View the proposedamended rules and provide public comment by the January 5th deadline at this link:http://www.healthoregon.org/sealantcert
• The Health Information Technology Oversight Council (HITOC) had completed anupdate to their strategic plan. The plan sets the vision for HIT and HIE to advance theadoption and use of Health IT in Oregon. The strategic plan update document isavailable here: :www.oregon.gov/oha/HPA/OHIT-HITOC/Documents/OHA%209920%20Health%20IT%20Final.pdf
• The Transformation and Quality Strategy (TQS) will replace the CCO TransformationPlan and Quality Assurance Performance Improvement plan in 2018. This streamlinedapproach aims to reduce duplication, align CCO priorities, and enhance innovationsupported by targeted activities. CCOs will submit an annual TQS using a sharedtemplate (beginning March 16, 2018) and a 6-month progress report. The Transformation
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and Quality Strategy (TQS) webinar series has been completed. Recordings and slides are available on the TQS web page at this link: http://www.oregon.gov/oha/HPA/CSI-TC/Pages/Transformation-Quality-Strategy.aspx Monthly office hours are scheduled through March. All templates, resources and examples are available online. The guidance document and FAQs will be updated by early January. For questions related to the TQS, please contact Anona Gund ([email protected] or 971-673-2832).
• Oregon Health Authority’s WIC (Women Infant and Children) Program has released anew white paper on breastfeeding in Oregon. Find this document here:http://www.oregon.gov/oha/PH/HEALTHYPEOPLEFAMILIES/BABIES/BREASTFEEDING/Documents/bf-whitepaper-2017.pdf
• OHA released RFPG #4495 for Sustainable Relationships for Community Health(SRCH) and it is posted on ORPIN (Oregon Procurement Information network) athttps://orpin.oregon.gov/open.dll/welcomeThe RFPG was extended through December 14th. Through the SRCH initiative,leaders from Local Public Health, CCOs and others involved with delivering evidence-based self-management interventions and services will collaborate to prevent andimprove chronic conditions and improve community-clinical linkages.
• Metrics Specific Information
A. Draft specifications for the 2018 CCO Metrics were posted for review until December11th, 2017 OHA staff will incorporate feedback and publish the final TechnicalSpecifications by the end of December. Click here for the most current informationon CCO metrics:http://www.oregon.gov/oha/HPA/ANALYTICS/Pages/CCO-Baseline-Data.aspx
B. The Transformation Center has announced a new TA opportunity related toBehavioral Health Integration. Up to 10 hours of behavioral and physical healthintegration technical assistance, focused on one topic area. All requests must besubmitted to the Transformation Center by April 15, 2018, with technical assistancehours completed by October 31, 2018.CCOs should use the Request form found at this link::http://www.oregon.gov/oha/HPA/CSI-TC/Documents/BHI-TA-Request-Form-2017-2018.docxQuestions should be directed to [email protected] or 971-673-3387.
C. An overview of all TA opportunities currently available through the TransformationCenter for CCOs and clinics in available at:http://www.oregon.gov/oha/HPA/CSI-TC/Documents/Transformation-Center-TA-Opportunities.pdf
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• Conferences and Training Information
A. CCO Oregon’s 2018 Winter Conference: Innovations in Primary Care will be heldJanuary 30th in Salem. Join the discussion an learn more about integrating behavioraland oral health with primary care, health equity, team-based workforce development,alternative payment structures and financing. Learn more and register at:https://www.ccooregon.org/events/2018/01/30/2018-winter-conference/
B. OHA’s Innovation Café is tentatively scheduled for June 12, 2018 in Salem
C. 2018 Forum on Aging in Rural Oregon: Save the Date– May 16-18 in Pendleton.More info at:http://www.ohsu.edu/xd/outreach/oregon-rural-health/about/aging-forum/index.cfm
D. Oregon’s Oral Health Coalition Conference is scheduled for Friday, November 2nd,2018
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Final Report and Evaluation Pilot Physician Wellness Initiative
Use the following format to provide a summary of your project. Please include:
A. Amount of pilot funds used. Were additional funds used from other sources? If so, how much?
$270,076
B. Final Measures and a brief narrative/summary of Goals, Activities, Measures, and Results.
Goals Outcome Measure(s)
Activities Final Results
Development of communication pathways with Physicians.
Convene a Physician Wellness Advisory Committee (PWAC).
Completed 4 quarterly meetings held; additional advisory work through email and phone calls as needed.
Develop Survey with input from the Advisory to gather information on factors that contribute to burnout and the degree of burnout perceived by IHN-CCO physicians.
Individual and group meetings with providers to discuss work satisfaction, burnout information.
Completed
Completed
Mini-Z selected.
Individual interviews completed with 49 IHN-CCO providers in the Linn, Benton, Lincoln county areas.
9 clinic meetings with providers and three community focus groups held to gather, discuss results.
Assessment of Burnout. Assessment survey administered to IHN-CCO physicians.
Completed 49 providers completed via survey monkey
Report on the state of burnout in IHN-CCO physicians.
Completed Report delivered in forums, via email and committees. Burnout is in keeping with national levels, with over 50% reporting symptoms.
Development of ongoing wellness monitoring plan.
Identification of quality measures for ongoing assessment of burnout.
Completed Recommendation report delivered to managers, medical directors, new wellness committee, providers. See narrative for what has been adopted.
C. What were the most important outcomes of your Pilot?Increased awareness to the importance of the Quadruple Aim in transformational healthcare: the wellbeing ofthe providers. Helping providers understand they are not alone in experiencing stress with changes in healthcare delivery, and connecting them with resources for self-care. Development of ongoing processes withinprimary IHN provider for assessment and amelioration of burnout.
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Managers were given materials on recognizing and addressing burnout and work behaviors and encouraged to make these elements part of ongoing performance evaluations and “stay” interviews (meetings designed to catch issues before they become problematic). Clinics were introduced to the AMA Steps Forward program, a comprehensive free curriculum for improving teams, work flow, efficiency and morale. Burnout was lowest in areas with high functioning teams whose managers/medical directors use a transformational vs a transactional leadership style. Transformational leadership is collaborative, inclusive, representative, and focuses on building a team culture of mutual trust, support and empowerment to utilize skills and: “we’ve got your back”. Burnout was highest when providers felt as if they were working in isolation, were not recognized for their efforts, had highest percentages of IHN patients, and were on production vs salary. IHN patients in general were more likely to no show appointments affecting production salary, and to have more complex and previously untreated health needs that required unpaid coordination efforts. Increasing provider awareness of pre-existing resources, such as EAP services and individualized electronic record skills tutoring, was an unexpected and positive outcome.
D. How has your Pilot contributed to Triple Aim of improving health; increasing quality, reliability, and availability of care; and lowering or containing the cost of care? Research is clear that morale and burnout affects health care costs and patient satisfaction (Sinsky, et al, Dewa). Intervention reduces litigation, early separation, medical mistakes.
E. What has been most successful? The creation of an ongoing Provider Wellness Committee within Samaritan that is interdepartmental and includes providers as well as corporate executives. Roll out, publicizing and use of Vital Work Life for provider support, coaching and counseling. Increased understanding and buy-in of the problem and need to address it, especially by executive staff. Increased provider representation in administration groups (empowered medical director, naming of a physician as Provider Wellness Leader). Socials and forum groups were well attended.
F. Were there barriers to success? How were they addressed? 1) Initial reluctance by providers to discuss personal burnout and to document it on surveys. LCSW met with
them in groups and individually for interview after first meeting them in casual groups to explain process and the common nature of burnout nationally in the current health care delivery model.
2) Providers have very limited free time and many work demands already that intrude on non-patient hours. Meetings were held in evenings combined with a social hour, over lunch or walks, via phone, combined with pre-existing meetings.
3) Lack of a dedicated researcher to the pilot. Did what we could without. 4) Complexity of system: multiple levels of permission and buy-in needed for interventions, communication.
Decisions affecting providers were made in isolation with no representation. Project focused on communicating the national and local findings to as many departments and levels within departments as possible, and sharing a common document that outlined ways each can positively impact provider wellness.
G. How readily would the pilot be scalable or replicable? Describe cautions and considerations when considering
scaling, or replicating the Pilot. (i.e. Success dependent on personality/skills set, or activities appropriate under certain conditions like size, target population, etc.) The cost of replacing one primary care physician is estimated to be well over quarter-million dollars. For a reasonable mid-management level salary, one person within a mid to large system could oversee and coordinate similar program at a cost savings to agency if turnover is reduced at all. Tasks would include ongoing support for administration in understanding cause and results of burnout, tracking retention, process improvement of on-boarding, distribution of resource materials, connecting struggling providers to appropriate departments or outside agencies, etc. Success would depend on the agency support of the position. The person need not be a
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provider but a thorough understanding of modern health care delivery systems and demands of providers is needed.
H. Will the activities and their impact continue? If not, why?Both major medical systems in the tri-county area are committed to ongoing work on improving morale, worksatisfaction and retention among their providers, and are made aware of impact of the problem as well asknown interventions. This commitment has been voiced from managers, medical directors, recruiting, CEOs andVPs. Both large IHN community employers have identified addressing and intervention as a primary goal in theupcoming fiscal year.
The area’s largest employer of IHN providers now has an ongoing, functioning Provider Wellness committee. It meets monthly and includes providers, top administration, resident faculty, recruiting and wellness departments and recently designated a long-term respected physician as the Provider Wellness Leader. Monies from the grant were used to bring a nationally recognized expert in provider wellness and process improvement, who will hold six sessions in three counties, open to all IHN providers, and is consulting on ongoing wellness efforts. Additionally, the committee is planning Provider Summits starting in January to keep a pulse on current issues and impact of efforts, is planning socials for providers, and is increasing a focus on process improvement for mentorship for new and struggling providers. Medical directors are more empowered in decision making and can present changes to providers in language that is meaningful to them.
The agency is also using a national provider support service that offers confidential in person and phone crisis, relational, personal, legal and other counseling and wellness coaching. The employer’s internal wellness department is offering more targeted services to agency providers.
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How to get the story out – generated from DST discussion Action Item Resource
1 Provide a universally approved logo for use on materials/presentations 2 Record videos of pilot champions and post on the IHN‐CCO website 3 Create one page summary documents on key findings, successes, etc. Transformation Dept. 4 Create an Elevator Speech that aligns the message of the DST 5 Share stories from the patient perspective/experience (written/video) and use on the IHN‐CCO website, at the legislature level,
in newspapers, local media, etc. 6 Add a question to the quarterly reporting form asking pilots if they have presented at any local, state, or national conferences
and share this information out Transformation Dept. 7 Hire a storyteller to tell the story; documents, toolkit for pilots, telling the story along the way of the pilot, show the impact of
the pilots. Potential resource suggested by Joell Archibald is the Center for Digital Storytelling (www.StoryCenter.org) 8 Inform pilots/workgroups of upcoming conferences asking for poster submissions, focused presentations, etc. Transformation Dept. 9 Educational Roadshow Transformation Dept.
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