Integration of Dental Care into the Accountable Care Organizations the Oregon Model
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1 Integration of Dental Care into the Accountable Care Organizations the Oregon Model Mike Plunkett DDS, MPH Senior Director, Dental Care Delivery, Kaiser Permanente Assistant Prof., Oregon Health and Science University Eli Schwarz KOD, DDS, MPH, Ph.D. Professor and Chair, Department of Community Dentistry, Oregon Health and Sciences University
2 Oregon Health Care Transformation A Fast Moving Train Mike Plunkett DDS, MPH Senior Director, Dental Care Delivery, Kaiser Permanente Assistant Prof., Oregon Health and Science University
3 Outline I. Background: Oregon Health Plan & Managed Care in Oregon II. Oregon Health Care Transformation Timeline III. Coordinated Care Organizations: Oregon s ACO IV. Dental Quality Metrics
4 Oregon Health Plan & Managed Care (Demonstration 1.0) Developed in 1993 & championed by then state senator and would be governor Dr. John Kitzhaber. Federal waivers granted by Clinton Administration Managed Care capitation structure Prioritization of services Growth 240, to approx. 900,000 in 2014
5 Oregon Healthcare Transformation Timeline 2009 Policy: HB Created Oregon Health Authority Public Health, Adult Mental Health, Medicaid, Public Employee Benefits Board and Oregon Education Benefit Board under one roof 2010 Environment Affordable Care Act of 2010 passed. Dr. John Kitzhaber re-elected Governor of Oregon 2011 Policy: House Bill 3650 Coordinated Care Organizations (CCO) Medicaid Expansion Health Insurance Exchanges
6 Transformation Work Plan (CMS Application)
7 OHP: Demonstration 2.0 Federal waiver Agreement with federal government to reduce projected state and federal Medicaid spending by $11 billion over 10 years. Lower the cost curve two percentage points in the next two years. $1.9 billion from the U.S. Dept. of Health and Human Services over five years to support coordinated care model. OHA and CCOs will be held to high standards for health outcomes.
8 Coordinated Care Organization (CCO) One organization with a single global budget Delivery, management and quality assurance of care to the specific population of patients enrolled with the organization.
9 Oregon Health Plan (Medicaid) Health Care Delivery system before August 2012 Oregon Health Authority Oregon Health Plan (OHP) 33 OHP contracts Capitation $$ PMPM 8 Dental Care Organization s DCO 15 Fully Capitated Health Plans FCHP 10 Mental Health Organization s MHO Health care delivery OHP benefits Siloed care: Minimal to NO coordination/collaboration Oregon Health Plan Members Approximately 600,000
10 Oregon Health Plan (Medicaid) Health Care Delivery system in 2014 Oregon Health Authority Oregon Health Plan (OHP) $$ PMPM Global Budget 16 Local Community CCOs CCO contracts Oral Physical OHP contracts H E A L T H Mental Navigators Primary Care Homes Oregon Health Plan Members Approximately 900,000 after Medicaid expansions Coordinated care Coordination/collaboration incentives
11 Oregon CCOs 16 statewide All but C3 non profit organizations Physical Health integrated 2012 Mental Health integrated 2013 Dental Health fully integrated June 2014 (community based, local governance, varying degrees of preparedness for complexity of integrated model)
12 CCO Organization Structure
13 Innovator Agent for each CCO
14 Current Status 200K new Medicaid members predicted over span of K enrolled in 1 st month of enrollment Access strains felt immediately Primary care access is heavily effected Adult dental is also heavily strained System has been thoroughly disrupted
15 History and Current Status of Oral Health In CCO Model Petition introduced to OHA to delay dental integration into CCO--Denied Legislation introduced to carve Dental out of Global Budget to Failed CCOs began integrating Dental mid 2013 June 2014 all Medicaid Dental Services will be contracted from state through Coordinated Care Organizations
16 Maternal Child Health Conversation QI with OB offices to screen/ refer direct referral to dental networks Public Health approach WIC Headstarts Payment PCMH Well Child Visits Maternal Medical Home Assisted Living Geriatric Care Emergency Dept Redirection Opiate Prescribing Policy
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19 Positive Results Every CCO is living within their global budget. The state is meeting its commitment to reduce Medicaid spending trend on a per person basis by 2 percentage points. State-level progress on measures of quality, utilization, and cost (for the first 6 months of 2013) show promising signs of improvements in quality and cost and a shifting of resources to primary care. Progress will not be linear but data are encouraging.
20 Progress Decreased Increased ED utilization: 8% Specialty care visits: 9% All readmissions: 12% COPD admission: 28% CHF admission: 29% Asthma admissions: 14% Patient-centered primary care home enrollment: 36% Primary care visits: 18% EHR adoption doubled from 28% to 57%
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