Public Health & Coordinated Care Organizations

1. Public Health & Coordinated Care Organizations Presentation by Lila Wickham CLHO Chair

2. Quality of Life for All Oregonians Improve lifelong health Increase experience of care Reduce per capita costs • Health Policies • Health Information Technologies • Involved Citizens & Communities Triple Aim

3. CCO Achievements Require • Disease Prevention and Health Promotion • Improving health equity and reducing health disparities • Maximizing the use of primary care health homes • Using evidence-based practices and health information technology • Collecting high quality data to measure health outcomes, quality, and cost • Community-level accountability for improving health • Services that are person-centered, provide choice, and emphasize independence

4. What does the legislation say about public health and CCOs? • HB 3650 has a requirement for CCOs to have agreements with local public health for “point of contact” services including immunizations, communicable disease, STDs, and family planning • SB 1580 is largely silent on local public health • The focus of both bills is the local community organizing around health

5. Public Health Plays Important Roles • Governance Boards • Community Advisory Councils • Community Health Assessment and Improvement Plans • Data sharing, Epi and Informatics • Model of Care Development • Provider of Medicaid services • Clinical prevention & Community Prevention linkages • Experience with Community Health Workers

6. Examples* from across the state • Governance Boards – at least two health administrators will be on the governance boards – many will have other county leadership participating (Commissioners, Human Service Directors) • Community Health Assessments - Many LHDs are taking a leadership role on the Community Health Assessments to meet the Accreditation requirement, the IRS Hospital requirement and the CCO requirement (some counties are negotiating payment for this service to the CCO) * This work is evolutionary and many health departments are currently in negotiations with their CCOs. Examples subject to change.

7. Examples* from across the state • CCOs and providers are working with local public health to develop models of care for Medicaid clients around Maternal and Child Health and Chronic Disease • Data and Epi – At least six county agreements with the CCO includes access to data for analysis and trends. One county is working to negotiate the CCO paying for an epidemiologist in the health department * This work is evolutionary and many health departments are currently in negotiations with their CCOs. Examples subject to change.

8. Examples* from across the state * This work is evolutionary and many health departments are currently in negotiations with their CCOs. Examples subject to change. Community Advisory Councils – At least one health administrator is being recruited to lead the CAC, many health administrators will participate in their CACs for the county Provider of Preventative Services – By the end of the 4th wave of CCOs all local health departments should have agreements with their CCO as a provider. In at least one rural area with a provider shortage the CCO is looking to provide a Nurse Practitioners to the health department to use existing infrastructure

9. Examples* from across the state • At least one county is using the Trust for America’s Health report to negotiate a capitated rate for prevention as payment to the health department of $10 per person • Linking clinical prevention and community prevention – many health departments are using their work on chronic disease prevention as additional entry points to negotiate with CCOs around the important role of local public health * This work is evolutionary and many health departments are currently in negotiations with their CCOs. Examples subject to change.

10. Challenges for Local Public Health • Community Health Assessments were initially thought to be one per region. We are now seeing more than one CCO in rural parts of the state which could increase the duplication of CHAs/ CHIPs around the state • No uniform approach to engaging with local public health • There are small, rural, jurisdictions of the state where they may have more than one CCO. These small counties sometimes have half time administrators managing the whole department.

11. CLHO Strategy for LHD Engagement with CCOs • Point of Contact Service Agreements • Community Health Assessments • Community Advisory Councils • Identification of public health role(s) • Provide OHA with recommendations on the Implementation Proposal, Administrative Rules • Provide a clearinghouse for LHDs to learn from other LHDs

12. Questions?