July CCO Learning Collaborative Meeting Minutes HSB 137 A-D

July CCO Learning Collaborative Meeting Minutes
HSB 137 A-D, 500 Summer St. NE, Salem, OR 97301
July 14, 2014
11:00 a.m. – 12:30 p.m.
Public health and health system transformation session
Session/Objectives
Participants will:
1) Discuss the year-end CCO Incentive Measures data and identify opportunities for improvement.
Meeting Attendees
Attendees: 85
AllCare Health Plan: Cynthia Ackerman, Lyle Jackson, Mark Bradshaw
Cascade Health Alliance: Kaci Davis
Columbia Pacific CCO: No attendees were present.
Eastern Oregon CCO: Laurence Colman (GOBHI), Todd Jacobsen (GOBHI), Dena Sites (GOBHI), Sandy Ryman (GOBHI),
Cynthia Lacro, Neal Mills
FamilyCare Inc: Maureen Gaine, Daniel Roth
Health Share of Oregon: Barbara Carey, Chamaine Kinney, Bobbie Mellor, Tracy Scharn, Emal Wahab, Mike Holmes
Intercommunity Health Network: David Engen, Ellen Altman
Jackson Care Connect: Marilyn Lord, Amit Shah
PacificSource Community Solutions – Central Oregon: No attendees were present.
PacificSource Community Solutions – Columbia Gorge: No attendees were present.
Primary Health of Josephine County: Jennifer Johnstun, Andrew Luther
Trillium Community Health Plan: Holly Jo Hodges, Lynnea Lindsey-Pengelly
Umpqua Health Alliance: Kristi DePriest, Ruth Galster, Rebecca Ross, Christine Seals, Debbie Standridge
Western Oregon Advanced Health LLC: Tracy Muday
Willamette Valley Community Health: Stuart Bradley, Kine Hanson, Vanessa Gutierrez-Ramirez
Yamhill Community Care Organization: No attendees were present.
Other: Gary Allen (Advantage Dental), Barry Benson (Merck), Jody Carson (Acumentra), Priscilla Swanson (Acumentra), Darren
Coffman (HERC), Cat Livingston (HERC), Tiffany Dorsey (Kaiser), Jim Gaudino (Gaudino Consulting), Jeffrey McWilliams (APS),
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Dayna Steringer (DK Strategies, LLC), Corinne Thayer (ODS Dental), Jocelyn Tosch (CareOregon), Jettan Moriniti (Providence),
Melinda West (Access Dental), Ann Ford (Options), Jennifer Lent, Fain Boyd, Kevin Boie (Access Dental), Deborah Loy (Capitol
Dental), Nancy Siegel (Acumentra), Erin Schwartz (Acumentra), Jeremiah Rigsby (CareOregon), Stacy Barnes, Bob Zack, Laura
McKennett
Oregon Health Authority Staff: Ron Stock (Transformation Center), Emilee Coulter-Thompson (Transformation Center), Tom
Cogswell (Transformation Center), Bill Bouska (Transformation Center), Angela Kimball (Transformation Center), Estela Gomez
(Transformation Center), Joell Archibald (Transformation Center), Chris Barber (DMAP), Wally Shaffer (DMAP), Sarah Bartelmann
(Health Analytics), Chris Norman (DMAP), Susan Arbor (DMAP), Roger Citron (DMAP), Rosanne Harksen (DMAP), Hank
Hickman (DMAP), Keri Mintun (DMAP), Ellen Pinney, Tracey Robichaud (AMH), Jeanene Smith, Katrina Suchanek (DMAP),
Denise Taray (DMAP), Sharon Hill (DMAP)
Topic
Notes
1. Introductions and Ron welcomed participants to the learning collaborative and introduced Andy
reflection (Ron Stock, Luther, Medical Director of Primary Health of Josephine Co., to give a reflection
on the session topic:
MD, Director of
Clinical Innovation,
• Andy shared a story about seeing an OHP member-patient recently who
OHA Transformation
hadn’t visited a doctor in a long time and was concerned about their
Center; Andy Luther,
alcohol intake. As part of their transformation grant, his CCO had placed
Medical Director,
alcohol and drug counselors in clinics, so Andy brought up the idea of
PrimaryHealth of
seeing a drug and alcohol counselor. Initially the patient was not
Josephine Co.)
interested. Andy ended up filing a referral to the counselor, and a month
later saw the patient again, who said they had visited the counselor and
had quit drinking.
After Andy’s reflection, Ron introduced the topic and the four guests who
planned to join breakout groups later in the session: Jeff Luck (Oregon State
University), Cindi McElhaney (Oregon Health Care Quality Corporation), Gloria
Coronado (Kaiser Permanente Center for Health Research) and Nikki Olson
(Providence Center for Outcomes Research and Education).
Ron introduced Lori Coyner, Director of Health Analytics, to present on the
2. Presentation:
Health System Transformation 2013 Performance Report:
Health System
Transformation 2013
• We are in the process of summarizing survey responses from the 2015
Action
See the session agenda.
See Lori’s presentation
slides.
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Performance Report
(Lori Coyner,
Director, Health
Analytics)
CCO Incentive Measure Selection, and will be presenting results to the
Metrics and Scoring Committee on Friday, July 18.
• We received a lot of responses from providers, and a lot of feedback about
what communities thought of metrics
• The Oregon Health Care Quality Corporation has been validating the
metrics
• Providence CORE is also looking to develop a dashboard for CCOs that
will eventually replace our monthly progress reports
(Start of PowerPoint slides)
• The 2013 Performance Report includes:
 Final 2013 performance data on the CCO incentive metrics and
state performance metrics
 2013 Quality Pool (and challenge) pool distribution to CCOs
 2011 and 2013 data broken out by race and ethnicity
 New grouper for cost and utilization data
• We realize this was a huge lift to ask CCOs to change 17 metrics and are
very excited with these initial results
• We saw statewide improvements on nine of the 17 incentive measures
• There were only two measures (Chlamydia and cancer screening) where
we didn’t see any improvement statewide or at the CCO level
• Overall, CCOs improved on ambulatory care, developmental screening,
early elective delivery and electronic health record adoption
• We saw mixed results/progress thus far on adolescent well-care visits,
colorectal cancer screening, follow-up after hospitalization for mental
illness and for children prescribed ADHD meds, assessments for children
in DHS custody, prenatal and postpartum care, and satisfaction with care
• Some trends to note:
 We saw decreased emergency department (ED) utilization
 ED utilization changes by race, ethnicity and CCO
 Increased developmental screening
 Increased primary care visits and enrollment in patient-centered
primary care homes
 Decreased hospitalizations for congestive heart failure, COPD and
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3. CCO small group
discussion:
(Ron Stock)
4. Report out and
reflection:
(Ron Stock, Gloria
Coronado, Cindi
McElhaney, Jeff
Luck, Nikki Olson)
adult asthma
• Some areas for improvement:
 SBIRT
 Access to care
• Next steps:
 We will continue to report at the state and CCO level
 We will roll in 2014 data to monitor the expansion population
 We will discuss calendar year 2013 data by race and ethnicity at
the CCO level at the August QHOC learning collaborative
 We will continue a subpopulation analysis of 2013 data
After Lori’s presentation, participants split into four groups to discuss the
following questions:
1. What did you learn from the presentation you just heard?
2. What strategies did you put in place to address the incentive measures that
were successful?
3. What challenges do you anticipate regarding the incentive measures in the
coming year?
After the breakout session, groups reported out on the discussions that took place:
Group #1 report-out from Jeff Luck:
• CCOs’ performances on metrics validated the work being done
• Talked most about emergency department utilization: CCOs have been
working on the issue since 2011 using a lot of innovative strategies such
as navigators/healthcare workers in the ED.
• There was concern over the influx of new members and access challenges
on emergency department use
• One CCO had tried member incentives to increase adolescent well-care
visits, but found this strategy didn’t work as well as calling people on
phone
• Another CCO mentioned they found success with SBIRT by locating a
successful clinic and then working to spread their strategies to other
clinics
• One challenge mentioned was trying to bring new patient-centered
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primary care homes online
There was also a comment from this group on the importance of not losing
ground on care for previous members because of the influx of new
members
Finally, this group made a request for denominator information to be made
available as soon as possible for 2014 to learn as much as possible about
how CCOs are distributing financial incentives within their networks
Group #2 report-out from Gloria Coronado:
• We had several comments about the importance of looking beneath the
data to see what the numbers really mean. For example, there could be
billing or coding issues which can help to explain the changes in data.
• In terms of successes, we had several CCOs who were able to make
providers more aware of the metrics by focusing on a population-based
care approach.
• Some other successes shared in our group:
 Some CCOs were providing feedback to providers
 Other sites were comparing their Medicaid patients to Medicare
commercial patients to see if they could use assistance-based
strategies to see if they could use a tailored approach.
 Others had developed IT programs to see gaps in care in real time
 A few sent patient rosters to clinics for those who needed a
developmental screen
• Some challenges to note:
 Ongoing geographic challenges of providing care
 Keeping up and tracking 17 metrics. There was strong support for
holding metrics stable.
Reconciling local priorities with CCO priorities
Group #3 report-out from Cindi McElhaney:
• The feeling from our group was that everyone was very happy that trends
were going in right direction. However, many were mystified as to how
the improvements were occurring in some cases.
• There was a sense that having to place additional focus on each metric
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5. Next steps:
(Ron Stock, Emilee
Coulter-Thompson,
OHA Transformation
Center)
helped to spur improvements
Some successes to note:
 Improved data collection processes
 One CCO communicates 1-on-1 to clinic managers on incentive
measures
 With alternate payment methodologies (APMs), some realized a
need to focus on improved utilization and quality
Some concerns and challenges to note:
 Measure fatigue
 Concern that physicians just don’t have the resources and are tired
of dealing with the metrics
 Hospital engagement: some of the activities we have put in place
are reducing visits and revenue to hospitals. There is a need to
figure out a better way to engage the hospitals.
 Impact of the Medicaid expansion and increased number of
patients
Group #4 report-out from Nikki Olson:
• The general sense from our group was that we’ve made great progress but
there is still room for improvements
• Many would like additional learning opportunities for incentive measures
• Some successes to note:
 One CCO found success sending postcards (with a gift card) to
members who were ages 12-21 who had not received a well-care
visit
 Another CCO shared that using an intensive transition care team
was very successful
 Mental health specialists focused on high utilizers
Future learning collaborative agenda
• After the report-out, Ron asked the group to vote to prioritize the
September, October and November CCO learning collaborative session
topics
• The top three topics, in order, were Depression Screening, Access to Care
See the full polling
results.
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(CAPHS Survey) and SBIRT
6-month evaluation
• Ron requested that participants complete and submit a 6-month
retrospective evaluation focusing on the CCO learning collaborative
2014 Annual Coordinated Care Model Summit
• Ron briefly announced that the 2014 Annual Coordinated Care Model
Summit will take place on December 3-4 in Portland, OR at the Oregon
Convention Center
Please see the CCM
Summit site for more
information.
August 11, 2014 meeting: Race and ethnicity data
• The August 11 CCO learning collaborative session will focus on race and
ethnicity data. Stay tuned for more information.
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