Embracing Transformation: How alliances drive Innovation and create opportunities

Robin Richardson, Senior Vice President, Moda

Moda Transformational Initiatives Medical Homes

Coordinated Care Network (CCN)

Comprehensive Coordinated Care (C3)

NEW The Coordinated Care Model -Eastern Oregon Coordinated Care Organization (EOCCO) -The Summit and Synergy Partnerships

Plan Design

Consumer Education

Enhancement of Evidence-Based Protocols

Provider Payment Model

Prioritizing Target Savings opportunities

Performance Measures

Disease Management

Wellness Services

Assembly of Appropriate PCP Based Care Model

Develop Physician Leadership

Change Physician Behavior

Define and Assemble Appropriate Provider Mix

EHR Implementation/Integration

Clinical Collaboration

Legal Compliance

Distribution Channel

Claims Processing

Actuarial Expertise

Data Analytics, Predictive Modeling

Utilization Management Capability

Accounting ValidationFinancial Models

Sales and Marketing

Synergy and Summit Partners Moda

Shared

Opportunity for Coordination/Partnership

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The Coordinated Care Models

A new approach to transformation and innovation

The Coordinated Care Model (CCM)Oregon’s Vision

“Governor Kitzhaber’s ambition is to adopt this model for: -Medicaid -Large State Controlled Insurance pools (OEBB & PEBB) -The Exchange -Eventually, the private market”

Interview with The Nation, May 21, 2013

The Coordinated Care Model(CCM) Components

Global Budget

Metrics and Accountability for Quality (17 CCO Metrics)

Payment Transformation (Provider Performance Risk Models, Medical Home payments)

Medical Homes (A patient centered healthcare experience)

Care Transformation and Efficiency (Reduced ED visits, integration of mental health, oral health and physical health)

The Coordinated Care Model (CCM): Benefits to Members and Employer Groups

Best Practices to manage and coordinate care

Shared responsibility for health

Measured performance (accountability for quality)

Pay for outcomes and health (value)

Information and transparency

Sustainable rate of growth (global budget)

The Coordinated Care Model (CCM)

Gobal Budget + The Triple Aim

The Coordinated Care Model:

Eastern Oregon Coordinated Care Organization (EOCCO)-Medicaid

EOCCO Service Area

Quick Facts About Eastern Oregon CCO

Land Area: 49,929.75 sq. miles› 52% of Land Area of State of Oregon› Larger than Land Area of 19 states

◦ MS, PA, OH, VA, TN, KY, IN, ME, SC, WV, MD, HI, MA, VT, NH, NJ, CT, DE, RI

Population: 194,592› 4.99% of Oregon’s population› 1/3 the population of WY (least populous state)› Equivalent to the combined populations of Salem, Lake Oswego and

Lebanon, Oregon

EOCCO Six Counties previously had Medicaid managed care

organizations (ODS, Family Care, CareOregon)

Ten Critical Access Hospitals

Federally Qualified Clinics (i.e. Mirasol)

Rural Health Clinics

Large IPA—Pendleton IPA

Umatilla County

EOCCO County Governments received mental health funds

Care going out of state—Idaho, Washington, Northern California

Care going out of the service area within Oregon----Bend, The Dalles, Portland

Eastern Oregon politics/culture

Oregon Health Authority had to approve in each county

EOCCO

Readiness Review

Global Budget process

Network Adequacy

The Rest of the Requirements Community Meetings

Community Advisory Councils

Board of Directors

EOCCO Board of Directors -Dennis Burke, CEO, Good Shepherd Hospital-Union County -Kevin Campbell-GOBHI -Bruce Carlson, MD, Umatilla, Gilliam Counties -Russ Demianew, CEO Pendleton IPA-Umatilla County -Ray Gibbons, CEO, St. Alphonsus, Baker & Malheur Counties -Renee Grande, MD, Winding Waters Cliinic, Wallowa County -Sandy Hata -Bob Houser, CEO, Blue Mountain Hospital, Grant County -Ken Kestner, County Commissioner, Lake County

EOCCO Board of Directors -Diane Kilkenny, Public Health Nurse, Morrow County -Carlos Olivera, Mirasol, Clinic, Umatilla County -Jim Mattis, CEO, Grande Ronde Hospital, Union County -Robin Richardson, ODS -Jim Schlenker-CEO, St. Anthony’s Hospital, Umatilla County -Chris Siegner, Director, Symmetry Health, Harney County -Mike Smith, County Commissioner, Sherman County

Getting the Providers as Partners Hospitals

The Pendleton IPA

Mirasol

Legal (Memorandum of Understanding and the operating agreement)

Shared Savings and Shared Risks

Investors Moda (25%) Greater Oregon Behavioral Health (25%) Good Shepherd Hospital (10%) Grande Ronde Hospital (10%) St. Alphonsus Hospitals (Ontario and Baker City) (10%) St. Anthony’s Hospital (10%) Pendleton IPA (1%) Mirasol Clinic (1%) Future---(8 % held in reserve for Counties, Dental, other providers

EOCCO Transformation Plan

Transformation Summits

Non-Emergent Transportation

Clinical Advisory Council

Dental

Dual eligible application to CMS

Long Term Care

EOCCO Goals/Opportunities/Challenges

Profitable operations within the global budget

Care Transformation

Meeting all of the OHA/CMS requirements/metrics

The Coordinated Care Model:

The Synergy and Summit Partnerships-Commercial

The Synergy and Summit Networks: Two Sentinel Events

OEBB’s Strategies, Evidence and Outcomes Workgroup (SEOW) requests a revised and updated CCN alternative.

PEBB’s Bid-Fall of 2013 for an effective date of January 1, 2015 -Required either a Regional Coordinated Care Model (CCM) or a statewide PPO bid

The Synergy and Summit Networks The Synergy and Summit Concept -A Commercial Coordinated Care Model patterned after the Eastern Oregon Coordinated Care Organization (EOCCO) developed by Moda *Global Budget *Accountability for quality *Payment Transformation *Medical Homes *Care Coordination/transformation

-Regional integrated delivery systems capable of addressing the Coordinated Care Model requirements of the PEBB bid and capable of being considered by OEBB for October 1, 2014

The Summit Network Original Model was the Eastern Oregon Coordinated Care network and

concept

Network already formed with ODS Plus Network to fill in gaps

Selected as a new regional option for OEBB, effective 10/1/14

Selected as a new option for PEBB for the Eastern Oregon Region, effective 1/1/15

Additional work: -Commercial provider performance risk arrangements with individual Hospitals and Providers -Tertiary Hospitals---none in the geography---getting provider performance risk arrangements with them -Addressing the Boise and Eastern Washington provider networks for OEBB and PEBB

The Synergy Network Initial/Original Partner---OHSU -Insurance Risk -Provider Performance Risk -Employees in the network

Other Health Systems added for network footprint and adequacy -Peace Health (Vancouver and Eugene) -Portland Adventist (East Metro) -Legacy (Metro Primary Care footprint) -Salem Health (Marion and Polk Counties) -Salem Clinic

Selected as a new regional OEBB option effective 10/1/14

Selected as a new regional PEBB option effective 1/1/15

The Synergy and Summit Networks

The Coordinated Care Model:

Payment Transformation

Primary Care Providers

All Primary Care Providers are included in the Synergy and Summit networks except those primary care providers owned by health systems not currently participating in the Synergy or Summit Networks

Payment for Medical Home Status -EOCCO-over 65% of membership in a medical home -OEBB-over 80% of OEBB members in a medical home

Payment for C3 Patients Risk Pool Sharing -Hospital -Specialist -Pharmacy

The Coordinated Care Model:

Benefit Design/Patient Engagement

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Program cornerstones

Characterizing the Employer’s

role and commitments

Engaging identified

members and building trust

Strengthening Medical

Home/PCP relationships

Tracking progress and

outcome measures

Relationship-based care and social determinants of health

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Moda Passport to Health Healthy Foundations (HF) & Comprehensive Coordinated Care (C3)

› Developed Spring 2011, 2nd full year of implementation› C3 designed to accommodate larger scaled populations

High intensity patient centered coordinated care & advocacy › Target population 3-5%

Distributed model versus central model› Scalable for 5000 to 100,000 +

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Analytics and Attribution Top 5% of utilization Diagnostic profile Risk scores

› Prospective Pharmacy data

› Medication adherence Geo mapping Focus groups & value stream

Identify members design incentives outreach/engage build trust measure ♦ ♦ ♦ ♦

outcomes

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Preliminary results Members are better self-managers, and are seeking more preventive care

› Reflected as more appropriate pharmacy and outpatient use› Members are utilizing outpatient visits rather than the ER

50% decrease in annual ER visit rate after active engagement

37% decrease in annual ER cost per member per month

Average length of stay shortened after active engagement compared to pre-program episodes of care

Improvement in patient activation and quality of life indicators including PHQ9 depression scores and overall function

100% of members rated their experience with Healthy Foundations as positive and would refer others to the program

The Coordinated Care Model:

The 4th Partner: Supporting Transformation

Center for Evidence-based PolicyAddressing Policy Challenges With Evidence and Collaboration.

Grant Submissions per County

2/15/3

7/3

2/1

5/5

6/4

52 letters of intent received/48 grant applicationsreceived

4/1

Multiple counties: 4/5

3/2 6/6

5/3

2/3

1/1

Letters of intent / Submitted grant applications

Center for Evidence-based PolicyAddressing Policy Challenges With Evidence and Collaboration.

Grant Proposals

Topic # of Proposals

# of Counties Total Amount Requested

% of Total Funds Requested

Care coordination 10 6 + 2 multiple county proposals

$733K 26%

IT/telemedicine/EHRs 7 5 $422K 15%

Health education/screening

6 4 + 1 multiple county proposals

$346K 12%

PCPCH & Transportation 4 3 + 1 multiple county proposal

$371K 13%

Co-location mental health in primary care

3 3 $277K 10%

Mental health services/training

3 2 + 1 multiple county proposal

$222K 8%

Obesity Prevention 3 2 $216K 8%

Other 2 2 $235K 8%

TOTAL 38 12 $2.8K 100%

OEBB/Moda Health Grant Program

• $3 M grant fund provided by Moda Health on behalf of OEBB

• Investing in improving the health and healthcare of OEBB members and the communities where they live

• Guided by the fundamental premise that funding can incentivize sustained commitment

• Committed to identifying and supporting evidence-based, measurable, and equitable initiatives

MIT/TruvenAnalytics

OEBB BenefitSelection Tool $485

OCHIN School-based Clinic Billing Support $225

Oregon PublicHealth Division OEBB Wellness $165

Public Health Foundation of

Columbia CountyPrimary Care $112

NW Mother’sMilk Bank

Donor Distribution Centers $100

Legacy HealthSystem School-based Clinic $100

OHSU School of Medicine

Physician Substance Abuse Training $90

Community Connection of

NE OregonDiabetes Prevention & Wellness Program $125

RenaissanceHealth

Purchaser/Payer/ Provider Project $50

OHSU Diabetes Center Diabetes Prevention $50

Oregon Healthcare Quality Corp.

Electronic Medical Record Claims $40

OSAA Drug Use Prevention & Wellness $50

OEBB/Moda Health Grant Program

*In thousands