Coalition for a HEALTHY OREGON
The Coalition for a Healthy Oregon Annual Report 2014 Transformation through Collaboration
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MISSION
The Coalition for a Healthy Oregon (COHO) is an association of eight organizations that work with coordinated care organizations (CCOs) and provider groups.
“Promoting the delivery of accessible, high-quality and cost-effective health care through communitybased managed care delivery systems.”
COHO plans serve almost half of the Oregon Health Plan (OHP) population, the majority of whom are children. This innovative partnership guarantees access to quality health care for Medicaid members and provides the most cost-effective use of taxpayer dollars. • Cost: COHO plans receive a fixed payment for services, offering consistency to the state budget • Quality: COHO plans work outside of the normal fee-for-service Medicaid model to coordinate care, review outcomes and ensure OHP members receive the highest quality comprehensive care • Access: COHO plans ensure members receive prompt and appropriate access to care at all levels
TABLE OF CONTENTS From the President...................................................................................................................................................... 3 Financial Report............................................................................................................................................................ 4 A Timeline of Success................................................................................................................................................. 6 Our Members.................................................................................................................................................................. 8
For media or legislative inquiries please contact:
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Josh Balloch Government Relations Director 8600 SW St. Helens Drive Wilsonville, OR 97070 (503) 685-9400 balloch@pacwestcom.com
www.cohoplans.org
A Message from the President Dear friends, It is with great pride that I introduce the Coalition for a Healthy Oregon’s (COHO) 2014 Annual Report. COHO and our Coordinated Care Organizations (CCOs) have accomplished a great deal for Oregon Health Plan (OHP) members, including better integrated care, increased preventative care services and significantly reduced emergency room visits. When we began this journey in 2012, we were committed to making CCOs work. I am excited to say that we have now integrated mental, physical and dental care. In 2014, we were able to successfully enroll the Affordable Care Act (ACA) expansion population, an increase of nearly 50 percent. Even more impressive, we accomplished this feat while expanding access for the newly enrolled members. While COHO and our allies have made great strides, this is a pivotal time for our fledgling CCOs. Our future holds great opportunity and many uncertainties. We are determined to maintain access for all Oregonians served by the OHP, but our CCOs cannot do it alone. They must have access to vital resources that allow them to provide the highest quality care to the members they serve. We must achieve long-term financial and programmatic stability. Our focus on transforming health care must not be diverted from this vital mission. While we’ve had many successes, this is also an important time for COHO. We must secure sustainable funding in order to continue providing world-class care. I welcome you to review this report and learn about all the innovative work we are doing. In good health,
Ruth Bauman
President, Coalition for a Healthy Oregon Chief Executive Officer, ATRIO Health Plans Chairman of the Board, Willamette Valley Community Health
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Increase in CCO Membership (2011 – 2014) Increase of 2011 Enrollment: 228,568
2014 Enrollment: 408,061
Long-Term Health Programs
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CCOs are charged with creating and investing in programs to improve the long-term health of the members they serve. For instance, Trillium Health Plan funded and launched an innovative program called The Good Behavior Game. Working directly with teachers, Trillium implemented the program in several elementary schools. The Good Behavior Game has been shown to reduce smoking rates among students by up to 90 percent. While this is helpful for the health of the community, the program’s financial benefits will not be fully realized for another generation. CCOs help benefit the community by making needed investments in long-term health programs. However, CCOs require sustainable resources to continue doing impactful work like this.
Coalition for a Healthy Oregon: A Wise Investment The landscape of health care in Oregon has shifted dramatically over the past three years. COHO members have driven this shift and helped make remarkable improvements in health care for thousands of Oregonians. As COHO plans have grown in membership, they have worked hard to ensure members can access the quality health care they need. This success is due to countless providers, community partners and strong leaders, many of whom helped transition managed care organizations (MCOs) into CCOs. However, the CCOs still face many challenges. With the increased responsibility of more members and services, CCOs are bound by law and fiduciary responsibility to double their reserves. This will ensure CCOs can continue to offer high quality care to members. The CCOs quickly expanded with new populations and are still making great strides in improving the quality of care. CCOs have integrated mental, physical and dental health. To bolster this integration, they have developed new partnerships to provide wraparound services, such as non-emergency medical transportation. These partnerships have already helped thousands of Oregonians, but institutionalizing and refining these collaborations will take more time and critical resources. These advances have set Oregon apart from the nation, showing that our state values the health and well-being of each resident. In order for the state’s CCOs to continue lighting the way for the nation on health care reform, CCOs must maintain a strong financial foundation.
COHO plans serve nearly half of the OHP population in regions across Oregon.
Future Investments Required for CCOs • • • •
Double reserve requirements Create innovative programs that will result in long-term community health Ensure access to care for increased membership Improve integration among mental, physical and dental health providers 5
COHO has become a leading voice within Oregon’s health care system. Together, COHO has led statewide health reforms through: •
A bipartisan approach utilizing the patientprovider relationship, not politics
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Geographical diversity to ensure holistic solutions
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Leveraging local legislative relationships for the good of the organization
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Offering a wealth of knowledge and experience into proposals, both at the agency and legislative levels
Coalition for a HEALTHY OREGON
2014 December Cuts to CCOs prevented in the OHA rebalance.
2014 November
CCOs increased access for new members; new innovative programs showed success.
2014 March First CCOs received PEBB contracts.
As a result, COHO has become a trusted leader in health policy.
2014 September 2014 January The current model will continue to serve COHO organizations in the challenging years ahead. COHO is poised to become the new normal for Oregon’s health care industry. COHO can only protect its member organizations from other major powers— pharmaceutical companies, hospitals and insurers—by working together.
CCOs hit their quality metrics.
2010 Early
OHA moved toward a single payer system with the passage of HB 2009.
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ACA expansion population rolled into CCOs; plans saw near 50% increase in enrollment.
2011 February OHA rolled out a plan to have only 3-5 CCOs. Most COHO members were in danger of being dissolved.
A Timeline of Success 2015 February Start discussion around reforming mental health.
2015 November
2016 May
2016 January
2015 June
Maintain strong funding for CCOs. Allow CCOs to take care of OEBB members.
2017 July
New OEBB contracts to be awarded.
Start of the PEBB contract renegotiations.
Other insurance metrics will align with CCO metrics.
New CCO contracts to be awarded by OHA.
2017 January
Feds no longer paying 100% for ACA expansion population.
2013 July
2013 February
COHO stopped hospital attempts to destroy CCOs by lawsuit; groundwork was laid for CCOs to start serving PEBB members. COHO passed 5-year contract bill.
COHO maintained CCO governance structure.
2013 June
2013 November
CCOs saw 4.5% increase in rates and $30 million in transformation funds. Hospitals relented to provider tax without hurting fledging CCOs.
Average CCO enrollment increased by 25%; CCOs proved to be financially stable.
2012 August
COHO plans began to be certified as CCOs.
2011 March
COHO convinced the Governor to go another direction; new plan opted to build CCOs on MCO model. Gave MCOs control of all health services and focused on local control.
2011 September
Governor leveraged CCOs to bring in $1.9 billion extra in federal funds, preventing a 33% cut to providers.
2012 February
COHO wrote CCO-enabling legislation; solidified local control of CCOs.
2011 June
COHO used geographical diversity to leverage bipartisan support for using MCOs as the foundation of CCOs.
2011 November
Hospital Par Rate moved down to 68%; reserve requirements were not exponentially increased.
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AllCare Health Plan 49,086 Oregonians served The Maternal Child Health Program, created by AllCare, aims to support expectant women throughout Jackson, Josephine and Curry counties. Maternity care coordinators reach out to pregnant members, offering health assessments, connections to resources and advocacy. Services include home visits, childbirth education classes, breastfeeding support, a smoking cessation program and more. At any given time, AllCare has a caseload of 500 to 600 members who are receiving these important benefits that make a difference to both moms and babies.
Architrave Health 26,432 Oregonians served In 2014, Architrave, in conjuntion with its CCO Umpqua Health Alliance, launched Kick Start Douglas County (KSDC), a community wellness collaboration that sponsors events to promote exercise and healthy living during the summer months and beyond. KSDC was created to promote activities that support healthy lifestyles, which is one of five focus areas established in the Douglas County Community Health Improvement Plan. UHA teamed up with several community organizations, including the YMCA of Douglas County, to host more than 300 wellness events last summer. 8
Cascade Health Alliance 16,063 Oregonians served For many in Klamath County, the biggest barrier to health care is geographic isolation and limited public transportation. Cascade Health Alliance met this community need by pairing community health workers with Medicaid enrollees requiring high health care utilization. By providing non-emergency medical transportation, community health workers are able to reduce unnecessary and preventable emergency department visits and coordinate care for Medicaid patients so they stay connected with resources to improve their health and self-sufficiency.
Doctors of the Oregon Coast South 20,343 Oregonians served In 2012, Doctors of the Oregon Coast South (DOCS) recognized that new foster parents face a myriad of challenges within the first month of child placement, including physical, mental and dental checkups. Dr. Carla McKelvey, a pediatrician and member of DOCS, proposed a revolutionary solution: bring all providers under one roof. New foster families are now able to complete all mandatory appointments at one convenient time. Because of these checkups, medical issues are identified early, giving these families the best opportunity to thrive. 9
FamilyCare 112,788 Oregonians served FamilyCare serves and supports a diverse population of OHP members in the Portland metro area, including more than 4,000 self-identified Asians. In order to increase health literacy and provide more culturally competent care to this group, FamilyCare teamed up with the Asian Health and Services Center (AHSC) to build an innovative outreach program. Participating members receive welcome calls in their preferred language, assistance establishing a primary care provider who understands their culture, help scheduling appointments and access to wraparound social services.
Oregon Health Management Services 10,913 Oregonians served
Among the many innovative programs Oregon Health Management Services (OHMS) has implemented to improve health outcomes for Medicaid patients in Josephine County is the design and implementation of a local maternal medical home at the Women’s Health Center of Southern Oregon. By systematically enhancing the delivery system, the clinic has demonstrated sustained improvement in timeliness of prenatal care, prenatal substance abuse screening, and prenatal and postpartum screening for clinical depression. The program has also reduced elective delivery before 39 weeks. 10
Trillium Community Health Plan 75,580 Oregonians served Trillium Community Health Plan has received national recognition for an innovative program known as The Good Behavior Game. The game is a collaborative effort between community health organizations and local school districts to educate children about healthy lifestyles and behaviors. Administrators have found that students who participate in The Good Behavior Game are more focused and reap long-term benefits as well. Studies have shown the game can reduce smoking rates among kids by 26 percent and hard drug use by half.
WVP Health Authority 96,856 Oregonians served
Since 2006, WVP Health Authority has dramatically reduced substance abuse among pregnant women with its innovative MOMS Program. Through comprehensive case management and peer-to-peer counseling, the program aims to ensure universal prenatal care and provides pregnant women with the tools they need to stay clean and sober during and after pregnancy. The MOMS Program has served more than 450 women and boasts a high success rate. 11
A Transformative Force in Oregon Health Care: The Coalition for a Healthy Oregon (COHO) Since its inception, COHO has risen above many obstacles to remain an indispensable part of the Oregon health care system. Although many challenges remain, COHO is committed to ensuring providers have the tools they need to care for the OHP members they serve. www.cohoplans.org 12