OHSU Center for Health & Healing
3303 SW Bond Ave, 3
rdfloor Rm. #4
8:30 a.m. to 11:30 a.m.
Live web streamed at:
OHPB Live Web Streaming
#
Time
Item
Presenter
Action
Item
1
8:30
Welcome, call to order and roll
Zeke Smith, Chair
2
8:35
Director’s report
Lynne Saxton, Director, OHA
3
9:00
Legislative update
Courtney Westling, OHA
4
9:15
Review of OHPB January planning
session summary and next steps
Action Item:
Approval of 1/6/15 Summary
Leslie Clement, OHA
Diana Bianco, Artemis Consulting
X
5
10:00 Break
Chair
6
10:15
Health System Transformation
report
Lori Coyner, OHA
Lillian Shirley, OHA
Pam Martin, OHA
7
11:15 Public testimony
Chair
8
11:30 Adjourn
Chair
Next meeting:
March 3, 2014
OHSU Center for Health & Healing
3303 SW Bond Ave, 3
rdfloor Rm. #4
8:30 a.m. to 12:00 p.m.
This measure amends or repeals statutes to align new statutory language as well as reflect current organizational structure and allow flexibility at the Oregon Health Authority (OHA).
• Changes Oregon Health Policy and Research (OHPR) to Oregon Health Authority (OHA) throughout statutes. Deletes references to OHPR Advisory Committee because it referred to when OHPR was outside of OHA/DHS.
• Expands the qualifications and experience that would qualify someone to be appointed as the State Public Health Officer (Public Health Division)
• Modifies definition of “health care interpreter” and revises membership of Oregon Council on Health Care Interpreters to better align with current business practice within OHA and those that govern CCOs.
• Removes all statutory references to Blue Mountain Recovery Center in ORS 426.010 and ORS 426.020 (Addictions and Mental Health Division)
• Aligns references relating to screening interviews and treatment programs for alcohol and drug diversion programs.
• Removes reference to prescription drugs and replaces the current definition of illegal drugs with the definition used in the Americans with Disabilities Act, allowing for people to be evicted if they have relapsed on alcohol or another controlled substance in
residential treatment.
SB 227 (LC 474) – TBI Registry
The measure amends the statute that established the Oregon Trauma Registry (OTR) to allow the state to create a Traumatic Brain Injury Registry, utilizing OTR data. The state will compile a case list from the Trauma Registry of persons who experienced a traumatic brain injury (TBI). The compiled case list would be shared with the Department of Human Services (DHS), Seniors and People with Disabilities program. DHS staff would use the case list information for services planning and to conduct outreach and follow up with people with TBI. The measure amends the Trauma Registry statute to allow data from the Trauma Registry to be used for public health epidemiologic studies that will support overall system improvement and prevention of injuries. The Trauma Registry was enacted in 1999.
SB 228 (LC 475) – RPS Fees
RPS programs are 100% user-fee supported and are used to recover the direct costs of Radiation Protection Services (RPS) operations and administrative functions relating to the regulation of radiation. RPS is requesting a fee adjustment through statute to increase X-ray and tanning device registration fees and increase the radioactive material licensing fee cap. This will allow the RPS program to maintain fiscal solvency, and avoid staff reductions which could result in inadequate regulatory oversight.
SB 229 (LC 476) – Travel Stipend
This concept will permit members of the Oregon Consumer Advisory Council (OCAC) to receive a stipend and travel reimbursement. This will align the compensation and expense
This concept will require individuals charged with a misdemeanor or Class C felony and unable to aid and assist in their own defense due to a mental illness to be interviewed by the
Community Mental Health Program Director or designee. The interview is to determine if the services, supports and supervision are available in the community to divert the individual from the state hospital to the community for restoration.
HB 2421 (LC 480) – MH Drugs to CCOs
This measure would transfer the responsibility for management of all mental health drugs from FFS to CCOs and shift the associated dollars spent on these drugs from FFS to CCOs. This will allow the CCOs to coordinate all health delivery costs for their mental health clients.
SB 230 (LC 481) – Healthcare Workforce Information Collection
This measure requires all health care regulatory boards to participate in the Oregon Healthcare Workforce Database, created by HB 2009 in 2009. Expanded data collection will allow the Legislature, OHA, and other industry and education stakeholders to better understand Oregon’s current health care workforce and plan for future needs.
SB 231 (LC 483) – Primary Care Transformation Initiative
This concept establishes an initiative that will strengthen investment and infrastructure for Oregon’s primary care delivery system. Specifically, itwould formalize a multi-payer primary care collaborative in statute and direct the group to design an initiative in which payers: a) pilot a small number of alternative primary care payments and develop benchmarks for success that would trigger continuation of the initiative past pilot phase; and b) make equitable investments in primary care transformation assistance.
Contact: Courtney Westling, Director of Legislative and Government Affairs, Oregon Health Authority, 503-602-1646, courtney.c.westling@state.or.us
SUMMARY
On January 6, 2015, the Oregon Health Policy Board held a planning session to:
Review and affirm the role of the OHPB;
Reach a shared understanding of the OHPB’s priorities over the next 1-3 years;
Discuss and reach agreement on the how the board will work together to accomplish its goals All current Board members were present for the session.
Priorities from the Governor
Sean Kolmer, Health Policy Advisor to Governor Kitzhaber, shared the following priority areas that the Governor would like the Board to engage in over the coming year:
1. Integration of mental health and physical health systems.
2. Highlighting the success of PEBB (and soon, OEBB) in adopting the coordinated care model 3. Support in improving the behavioral health system and the community mental health system
(both issues will be seen in the legislative session).
OHPB Role
The Board discussed its role and scope of its responsibilities. The Board is the policy-making and
oversight body for the Oregon Health Authority. Through its policy-making role, the Board identifies and focuses on high-priority issues that require review, direction and insight. The board will seek to focus on issues of significant scope, magnitude and impact (“biggest worst first” and “burning platform”). The board’s oversight role is focused on accountability – to determine, for example, whether policies are moving in the intended direction; to ensure that systems or programs are coordinating or aligned whenever possible; and that CCOs continue to make progress.
The oversight and policy-making roles are connected through a cycle of action. The Board first focuses on a priority issue, then initiates the policy-making process, which leads to the need for oversight and monitoring during development and implementation of that policy. The oversight that the Board provides allows for adjusting policies or programs midstream (e.g., providing feedback to staff or identifying potential areas of concern), as well as assessing the results of a fully implemented policy and identifying next steps (potentially restarting the cycle of action).
To bolster its effectiveness and focus, the Board will continuously strengthen relationships with the Director of the Oregon Health Authority, the Governor’s office, and the Legislature in order to ensure alignment, coordination, efficiency and accountability.
timeliness, and will:
Frame the question, challenge, or problem for the Board;
Articulate the pros and cons of recommendations;
Be transparent about point-of-view/position;
Highlight the connections between different areas of work across the state and agency;
Include information about other advisory or stakeholder groups working on the issue, and how Board consideration or action would contribute uniquely.
The Board also may identify issues that potentially warrant the Board’s attention and ask staff for additional information.
Issue Prioritization
In order to determine a work plan for 2015 (and for the future), the Board identified a number of principles to guide the prioritization process. When presented with an issue, risk, or challenge to potentially address, the Board will consider:
The Triple Aim: How does this issue impact Oregon’s goal of better health, better care, and lower costs?
The governor’s agenda: Does this align with the governor’s priorities?
Urgency and impact: What is the scope, magnitude, and timeliness of this issue? Is it a
significant barrier to health care transformation? Does this issue affect a substantial number of Oregonians?
Unique role: Are there other groups, agencies, or organizations already addressing this issue, or will the Board be able to offer a unique perspective?
Oregon Health Policy Board 2015 Priorities
The Board identified three overarching priorities for 2015: 1. Health System Transformation Monitoring
The Board will continue to monitor and track the successes and challenges of CCO
implementation. In the coming year, efforts such as integration of behavioral health, oral health and physical health systems in CCOs and the implementation of alternative payment
methodologies will possibly be a focus. Additionally, the Board will continue to support the spread of the coordinated care model principles into PEBB, OEBB, and the commercial market.
Relevant work groups: Coordinated Care Model Alignment work group; Sustainable Health Expenditures work group (SHEW), All Payer All Claims Technical Advisory Group
Children’s Services Advisory Council, Oregon Consumer Advisory Council, and other ad hoc groups as convened by the Governor’s office and OHA.
3. Public Health
The Public Health Modernization process will be addressed during the 2015 legislative session. The Board will follow the legislation and be ready to act accordingly. Population health issues will be routinely included in relevant health system discussions.
In addition to these three priorities, the Board will continue to:
Oversee alignment and integration between health care system transformation and early learning system transformation via the Early Learning Council/OHPB Joint subcommittee;
Identify ways in which the Workforce Committee can support work in the priority areas;
Monitor the implementation of health information technology and movement on the HITOC legislation.
Next Steps
Staff will gather information that pertains to the role of the Board in relation to the behavioral health and public health systems in the state for future discussion, including:
o Funding streams at the federal, state, and local levels;
o Articulation of a specific role that the Board can play in each arena;
o Expected or ideal timeline for achieving milestones or addressing issues;
o Specific ask for a concrete list of current challenges in each area;
o Definitions (e.g., “integration”);
Staff will connect with the Governor’s office to further clarify ways in which the Board might be involved in conversations related to the spread of the coordinated care model.
Further Board discussion at February meeting will center on:
o Board decision-making process;
Health System Transformation
2014 Mid-Year Performance Report
Oregon Health Policy Board February 3, 2015
Lori Coyner Director of Health Analytics
Game Plan
1. What have we learned about the ACA
population?
2. What are we learning about the
Coordinated Care Model?
3. What can we learn about areas within
Behavioral Health and Public Health?
3
Oregon Health Authority accountability
Core Performance Measures
• Included in Oregon's 1115 demonstration waiver - some focus on population health • There are no financial incentives or
penalties associated with them State Performance Measures • Annual assessment of statewide
performance on 33 measures.
• Financial penalties to the state if quality goals are not achieved.
CCO Incentive Measures
• Annual assessment of CCO performance on 17 measures.
• Quality pool paid to CCOs for performance. • Compare 2013 performance to 2011
baseline.
2014 Mid-Year Performance Report
State and CCO progress is reported for July 1, 2013 through June 30, 2014; compared with calendar 2013 and baseline year 2011.
No quality pool payments were made based on this data, or included in this report.
5
2014 Mid-Year Performance Report:
What’s New?
Core Performance Measures: Population health measures reported to CMS each year as part of Oregon’s 1115 waiver.
Expansion Population: Data on key measures for the 380,000+ Oregonians who enrolled in the Oregon Health Plan since the ACA took effect January 1, 2014.
Enhanced Financial Data: New visualizations and drill-downs for cost and utilization.
7
Oregon Health Plan:
Changing Demographics
Oregon Health Plan:
Changing Demographics
9
ED Utilization since January 1, 2014
See similar pattern for avoidable ED visits.
What next?
• Monitor ED visit use and outpatient visits with a full year
of data.
• Work to understand more about the new members – are
they relatively healthy or is the decrease in ED use the
result of a change in health care delivery?
COORDINATED CARE MODEL
11
• ED visits decreased 21 percent since 2011, despite an influx of 20 percent new enrollment from ACA expansion.
Emergency Department Costs
Decreased by 20%
13 51.8% 78.6% 79.6% 76.9% 80.4% 2012 2013 Q1 2014 Q1 528,689 739,023 827,939 868,392PCPCH Enrollment Increased by 55%
since 2012
2014 Q2 2014 Q315
• Overall PMPM outpatient costs have decreased.
• Primary care spending has increased
Outpatient Costs
What are we learning about the
Coordinated Care Model?
How Are We Doing?
•
Incentive Metrics:
Statewide improvement on all nine of
the incentive metrics (compare 2011 to mid-year 2014)
•
State Performance Metrics
: statewide improvements
on 10 of the 14 state performance metrics (compare
2011 to mid-year 2014)
•
Core Performance Metrics
: Statewide progress was
mixed – first time reporting
19
More work is needed…
Child and adolescent access to primary care providers
Access declined for all age groups at the statewide level (results were not reported at the CCO level).
Initiation and engagement of alcohol or other drug treatment (engagement phase)
Nine of 16 CCOs declined on this measure.
Tobacco use prevalence
Nine of 16 CCOs declined on this measure, and none have reached the benchmark.
BEHAVIORAL HEALTH –
WHAT CAN WE LEARN
21
• Continued improvement over 2011 baseline.
• Modified measure specifications allow community providers to complete follow-up, promoting behavioral and physical health care integration.
Progress on SBIRT
25
• Inpatient PMPM costs have declined 5.7 percent since 2011. • Greatest declines were in mental
health and maternity.
Inpatient Costs
• Overall PMPM outpatient costs have decreased.
• Spending for mental health ahs remained roughly the same
Outpatient Costs
PUBLIC HEALTH – WHAT CAN
WE LEARN
27
Children on OHP have about the same proportion of
completed immunizations as all children in Oregon
Lagging behind the benchmark
33
Main messages
•
Incentive measures get the attention -- $$ drives
improvements
•
Progress in some areas appears to be accelerated for
Medicaid when compared to other payers
•
Measures show progress and some challenges for
improving behavioral health and population health
CCO
Incentive
Metrics for 2015
Retired: Early elective delivery
Follow-after medication for ADHD Added: Dental sealants for children
Effective contraceptive use among women at risk of unintended pregnancy
Modified: SBIRT for adolescents
Dental health assessments for children in foster care Challenge SBIRT
pool metrics: Depression screening and follow-up Diabetes HbA1c poor control
35
Next Progress Report
Will be published late June 2015.
Metrics calculated for calendar year 2014.
Will include CY 2014 quality pool distribution.
Will have expanded cost and utilization information.
For More Information
The 2014 Mid Year Performance Report and all technical specifications are posted online at health.oregon.gov
Contact
Lori Coyner, MA
Director of Health Analytics lori.a.coyner@state.or.us
uses data to identify health disparities that require focused efforts to mitigate.
Measure Current Public Health Division efforts INCENTIVE MEASURES
Adolescent well-child visits PHD supports a network of certified school-based health centers, which are able to provide adolescent well-child visits and other services. PHD also provides guidance to school-based health centers, pediatric and primary care practices on how to provide high quality adolescent well-child visits. PHD has been working with stakeholders across OHA and the Insurance Division to assess policy issues related to the provision of confidential services and the impact of confidentiality on the adolescent well-child visit and other measures (i.e. SBIRT, depression screening, chlamydia
screening and effective contraception use). Alcohol and other substance misuse
(SBIRT)
PHD is collaborating with the Addictions and Mental Health Division on a quality improvement project aimed at integrating SBIRT and depression screening in adolescent well-child visits. PHD participates in the Addictions and Mental Health Division’s Strategic Prevention Framework-State Incentive Grant (SPF-SIG) Advisory Group. In addition, PHD manages a school-based health center mental health expansion grant aimed at increasing access to mental health care for children and adolescents. PHD’s Oregon MothersCare and nurse home visiting programs provide alcohol screening for pregnant women.
Colorectal cancer screening PHD’s colorectal cancer program operates the Cancer You Can Prevent media campaign to promote uptake of colorectal cancer screening.
Controlling high blood pressure PHD’s WISEWOMAN and heart disease and stroke prevention programs promote the use of clinical guidelines to monitor and control high blood pressure. PHD provides access to several chronic disease self-management programs, including the Stanford Chronic Disease Self-Management Program and Walk with Ease, which provide individuals with the skills necessary to manage their
certified school-based health centers across the state are focused on increasing depression screening and follow up via a mental health expansion grant aimed at increasing access to mental health care for children and adolescents. PHD’s nurse home visiting program provides depressing screening services for pregnant and postpartum women.
Developmental screening PHD provides funding to local health departments for maternal and child health services and nurse home visiting programs; these programs offer developmental screening for the parents of infants and young children. Nurse home visitors support families in engaging with preventive health care services. PHD also manages a grant program to CCO and local public health partnerships; Eastern Oregon CCO and the 12 counties in their service region are focused on improving developmental screening rates through partnership with primary care and early learning providers.
Diabetes HbA1c poor control PHD’s WISEWOMAN and diabetes programs promote the use of clinical guidelines to monitor and control high blood pressure. PHD provides access to several chronic disease self-management programs, including the Stanford Chronic Disease Self-Management Program and Walk with Ease, which provide individuals with the skills necessary to manage their ongoing health conditions. Effective contraceptive use PHD administers Oregon’s Title X grant and Oregon ContraceptiveCare, a Medicaid family planning
waiver, through a statewide network of contracted family planning providers. This network of family planning providers receives resources, including training, best practice recommendations and technical assistance to deliver high quality reproductive health services. PHD convenes the Oregon Preventive Reproductive Health Advisory Council (OPRHAC), a statewide group of experts tasked with developing standards for primary care and family planning providers regarding the provision of contraceptive services. PHD also partners with the Oregon Foundation for Reproductive Health to promote the One Key Question intervention. PHD’s nurse home visiting program provides
contraceptive screening services and utilizes the One Key Question intervention. As part of the grant program listed under developmental screening, AllCare, Jackson Care Connect and PrimaryHealth of Josephine County CCOs and Jackson and Josephine County Health Departments are working
together to implement One Key Question in primary care, WIC and family planning offices across the region.
Mental and physical health assessments for children in DHS custody
PHD provides funding to local health departments for the provision of public health nurse home visiting services. Public health nurse home visitors can refer and support mental and physical health assessments for infants and young children. PHD also manages the school-based health center program; school-based health centers can provide services to support children and families. Patient-centered primary care home
enrollment
PHD operates the school-based health center program, which recently provided innovation grants to centers wishing to pursue patient-centered primary care home tier status.
Timeliness of prenatal care PHD’s Oregon MothersCare program supports pregnant women with health insurance enrollment and connection to health care and social services in a timely manner.
CORE MEASURES
All-cause readmissions
Ambulatory care: avoidable emergency department utilization
Ambulatory care: emergency department utilization
Ambulatory care: outpatient utilization
PHD’s health care associated infections program works with hospitals and providers to implement and monitor appropriate protocols to prevent the spread of health care associated infections. PHD operates the senior falls prevention program, which provides educational programs such as Tai Chi: Moving for Better Balance, Stepping On and Otago to providers, community members and their families to reduce the risk of falls and fall-related injuries. PHD promotes several chronic disease self-management programs, including the Stanford Chronic Disease Self-Management Program, Walk with Ease and the National Diabetes Prevention Program, which provide individuals with the skills necessary to manage their ongoing health conditions and utilize health care resources appropriately.
Initiation and engagement of alcohol or other drug treatment
PHD’s maternal and child health program provides support to families so they can access behavioral health resources in the community. PHD’s promotion of SBIRT screening within the context of an adolescent well-child visit can also promote initiation and engagement of youth in treatment. Low birth weight prevalence PHD addresses low birth weight in its tobacco control efforts, through the WIC supplemental
nutrition program and through its maternal and child health programs, which includes efforts to ensure early access to prenatal care and public health nurse home visiting services. Public health nurse home visitors promote healthy birth outcomes for their pregnant clients and appropriate weight for infants and young children.
the Indoor Clean Air Act, work with health care providers to promote tobacco cessation and
promote the adoption of local tobacco control policies such as tobacco-free college and community college campuses, multi-unit housing, parks and fairs. The PHD tobacco prevention and education program also implements a tobacco media campaign, funds the Oregon Tobacco Quit Line and provides tobacco cessation training to CCOs, providers, community health workers and residential treatment facility staff. PHD’s maternal and child health, nurse home visiting and Oregon
MothersCare programs assist pregnant women in quitting tobacco.
STATE PERFORMANCE MEASURES
Appropriate testing for children with pharyngitis
PHD’s antibiotic resistance program offers training and materials to patients and providers focused on appropriate antibiotic use; these materials stress the importance of appropriate testing for children with pharyngitis before antibiotics are administered.
Cervical cancer screening PHD provides access to free screening services for uninsured individuals through its breast and cervical cancer program. PHD’s network of breast and cervical cancer screening providers also receive education on clinical guidelines and best practices which they can apply to their entire panel of patients.
Child and adolescent access to primary care providers
PHD’s school-based health center program provides children, adolescents and families with access to primary care services. PHD’s maternal and child health program also assists families with connecting to primary care providers.
Childhood immunization status PHD operates the Vaccines for Children program, which is designed to improve access to child vaccines. PHD supports provider improvement in vaccine practices and coverage through the AFIX program. PHD also focuses efforts on policies to ensure more children are vaccinated and in compliance with Oregon’s school entry policies. Public health nurse home visitors monitor
immunization status for infants and young children that they are serving. PHD operates the ALERT immunization registry, which allows providers to access a patient’s vaccination history and access tools for clinical decision-making.
screening
Comprehensive diabetes care: HbA1c testing
several chronic disease self-management programs, including the Stanford Chronic Disease Self-Management Program and Walk with Ease, which provide individuals with the skills necessary to manage their ongoing health conditions and utilize health care resources appropriately.
Follow-up for children prescribed ADHD medication
PHD provides funding to local health departments for the provision of nurse home visiting services. PHD also manages the school-based health center program which includes the mental health expansion initiative.
Immunizations for adolescents PHD operates the Vaccines for Children program, which is designed to improve access to child vaccines. PHD supports provider improvement in vaccine practices and coverage through the AFIX program. PHD also focuses efforts on policies to ensure more children are vaccinated and in compliance with Oregon’s school entry policies. PHD operates the ALERT immunization registry, which allows providers to access a patient’s vaccination history and tools for decision-making. Medical assistance with smoking PHD’s tobacco prevention and education program operates the Oregon Tobacco Quit Line, which
providers can offer to patients seeking assistance with quitting tobacco. The tobacco prevention and education program provides information related to comprehensive tobacco cessation benefit design and offers tobacco cessation counseling training to CCOs, providers, community health workers, residential treatment facility staff and others. Both the PHD WIC and maternal and child health programs focus on screening and referring women who smoke to the Oregon Tobacco Quit Line. Diabetes short-term complication
admission rate
Chronic obstructive pulmonary disease or asthma admission rate
Congestive heart failure admission rate Adult asthma admission rate
PHD promotes several chronic disease self-management programs, including the Stanford Chronic Disease Self-Management Program and Walk with Ease which provide individuals with the skills necessary to manage their ongoing health conditions and utilize health care resources
appropriately. PHD also works to prevent tobacco use and obesity (see tobacco use prevalence and obesity prevalence above).
