Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael...
-
Upload
pamela-reed -
Category
Documents
-
view
220 -
download
0
Transcript of Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael...
![Page 1: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/1.jpg)
Presenter Disclosures:Alexandra Lowell, Courtney Kappes, Janelle
McLeod, Maureen Hinman & Michael Anderson-Nathe
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose
![Page 2: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/2.jpg)
Oregon’s Alternative
Payment Model Frontier:
A School-Based Health Center Innovation Project
Alexandra LowellCourtney KappesJanelle McLeodMaureen HinmanMichael Anderson-Nathe
![Page 3: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/3.jpg)
Agenda:Healthcare
Transformation and Oregon’s Coordinated Care Organizations
Alternative Payment Models (APMs)
SBHC Alternative Payment Innovation Project (APIP)
Questions and Activities throughout the presentation
Objectives:Describe different
types of APMs Identify strategies to
evaluate your own program’s APM readiness
Identify talking points and strategies for communicating with ACOs
Describe the process and lessons learned from the SBHC APIP work
![Page 4: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/4.jpg)
Health Transformation in Oregon
![Page 5: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/5.jpg)
We Can’t Afford This AnymoreSince 1930, if Food Had Risen at the Same Rate as Medical Inflation:
1 Dozen Eggs $ 80.20
1 Dozen Oranges $107.90
1 Pound Bananas $ 16.04
1 Pound Coffee(1) $ 64.17
(1) Not Starbucks
![Page 6: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/6.jpg)
Source: Oregon Health Authority – Health Transformation webinar, 2014
![Page 7: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/7.jpg)
What is a CCO A network of all types of health care providers who have agreed to work together in their local communities for Oregon Health Plan Members (Medicaid); With one budget that grows at a fixed rate for mental, physical and dental care; Accountable for health outcomes of the population they serve; Governed by a partnership of health care providers, community members, and stakeholders who have financial responsibility and are invested in the results.
![Page 8: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/8.jpg)
CareOregon
Kaiser
Providence
Tuality
Clackamas County
Multnomah County
Washington County
Mental Health Risk
Physical Health Risk
Advantage Dental
Capitol Dental
Family Dental
Willamette Dental
CareOregon
ODS Dental
Managed Dental
Kaiser Dental
Dental Health Risk
Ph
ysic
al
Healt
h P
lan
s
Oth
er
Part
icip
ati
ng
Org
s: O
HS
U,
Leg
acy,
Ad
ven
tist
, C
en
tral
Cit
y C
on
cern
Access Dental
Men
tal
Healt
h
Pla
ns
Den
tal
Healt
h P
lan
s
Service area: Clackamas, Washington & Multnomah Counties
Total Enrollment: 237,000 as of 2/2015
![Page 9: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/9.jpg)
Why Alternative Payment Models (APMs)?
![Page 10: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/10.jpg)
Key APMs:• Primary Care Capitation• Pay For Performance Incentives
• Fee For Specialized Service• Braided & Grant Funding
![Page 11: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/11.jpg)
Primary Care Capitation
Monthly payment received by the health system for each of their members that provides flexibility to deliver care and services in a more cost-effective and patient-centered way.
![Page 12: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/12.jpg)
Pay For Performance Incentives
Incentive payments based on achieving certain metrics or outcomes
![Page 13: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/13.jpg)
Fee For Specialized Service
Execute contractual agreements for specific preventive services to be paid for traditionally unfunded services
Explore Opportunities to Expand FQHC Scope of Service to include SBHC services
![Page 14: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/14.jpg)
Braided & Grant Funding
![Page 15: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/15.jpg)
Questions for the audience:What are some of your experiences with
alternative payment models?
Are there any other models that we have not discussed?
![Page 16: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/16.jpg)
Current Oregon APMs
CareOregon Pay 4 Performance Incentives
Multnomah County Health Dept & Kaiser PM Contract
Oregon Health Authority FQHC APM
![Page 17: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/17.jpg)
Oregon Health Authority FQHC APM
Initiated by the Oregon Primary Care Association in partnership with member FQHCs and the Oregon Health Authority
Health centers are given an attributed list of clients that they are responsible for improving health outcomes for
Receive a Per-Member-Per-Month payment upfront for each attributed client
![Page 18: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/18.jpg)
Oregon Health Authority FQHC APM
How are FQHCs held accountable?• Clinical Outcomes
• Telephone Encounters
• My Chart Encounters
• Telemedicine Encounter
• Care Coordination
• Accessing Community Resources
• Case Management
• Exercise class participation
• Panel Management Outreach
• Supportive Counseling
• Group Education
• Warm hand off
• Home visit (non-billable)
• Transportation Assistance
![Page 19: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/19.jpg)
2013 SBHC Legislation•HB 2445: Established
SBHCs in statute; appropriated funds for SBHC expansion and to incentivize participation in health reform
• SB 436: Encouraged CCOs to partner with SBHCs
![Page 20: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/20.jpg)
SBHC Alternative Payment Innovation
Project (APIP)Goals:Improve the effectiveness of the
delivery of health services through SBHCs for children who qualify for medical assistance
Improve the coordination of the care of patients services by CCOs and SBHCs
![Page 21: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/21.jpg)
SBHC APIP Workgroup
![Page 22: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/22.jpg)
Activity:Using the sheet provided:
Identify the key stakeholders you would need to engage when developing an Alternative Payment Model
Make note of any barriers to their participation and possible solutions
![Page 23: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/23.jpg)
What is the problem
trying to be fixed?
How would an APM fix
the problem?
What is the value of SBHCs?
Who is responsible to pay for
what?
SBHC APIP Key Questions:
![Page 24: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/24.jpg)
What is the problem trying to be fixed?
What is the problem
trying to be fixed?
How would an APM fix
the problem?
What is the value of SBHCs?
Who is responsible to pay for
what?
![Page 25: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/25.jpg)
What is the value of SBHCs?
Need a defined value statement that is linked to the problem that needs to be fixed
Have to be able to show the value of the SBHC to the payor
What is the problem
trying to be fixed?
How would an APM fix
the problem?
What is the value of SBHCs?
Who is responsible to pay for
what?
![Page 26: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/26.jpg)
Activity:For your SBHC program:
Identify all the non-reimbursable services your program provides
Note if they are measured or not, and if so how they are measured
Define the value of your SBHC program
In small groups discuss some of the struggles with communicating about SBHC value and the services provided in the new healthcare landscape
![Page 27: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/27.jpg)
![Page 28: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/28.jpg)
How does an APM fix the problem?
Need to understand SBHC utilization within the larger context of SBHC clients who
have Medicaid
What is the problem
trying to be fixed?
How would an APM fix
the problem?
What is the value of SBHCs?
Who is responsible to pay for
what?
![Page 29: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/29.jpg)
SBHC APIP Utilization Analysis
?Level of Users:• Low: 1-2 visits• Medium: 3-5 visits• Medium-High: 6-9
visits• High: 10+ visits
![Page 30: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/30.jpg)
Utilization Data Cont’d
![Page 31: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/31.jpg)
Who is responsible to pay for what?
![Page 32: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/32.jpg)
Who’s responsible to pay for what?
![Page 33: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/33.jpg)
What is the problem
Next steps moving forward:
What is the value of SBHCS
How does an APM fix the problem
Who is responsible to pay for what
??????
???????
![Page 34: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/34.jpg)
Thank you for your time and attention
Any questions?
![Page 35: Presenter Disclosures: Alexandra Lowell, Courtney Kappes, Janelle McLeod, Maureen Hinman & Michael Anderson-Nathe (1) The following personal financial.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e7a5503460f94b79f47/html5/thumbnails/35.jpg)
Contact Information:Alexandra Lowell:
[email protected] Kappes:
[email protected] McLeod:
[email protected] Hinman: [email protected] Anderson-Nathe:
All APIP materials, including meeting documentation info-graphics and this
presentation can be found on the OSHBA website –
http://osbha.org/ourwork/alternative-payment-innovation-project