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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
Oregon’s Alternative
Payment Model Frontier:
A School-Based Health Center Innovation Project
Alexandra LowellCourtney KappesJanelle McLeodMaureen HinmanMichael Anderson-Nathe
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
Health Transformation in Oregon
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
Source: Oregon Health Authority – Health Transformation webinar, 2014
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.
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
Why Alternative Payment Models (APMs)?
Key APMs:• Primary Care Capitation• Pay For Performance Incentives
• Fee For Specialized Service• Braided & Grant Funding
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.
Pay For Performance Incentives
Incentive payments based on achieving certain metrics or outcomes
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
Braided & Grant Funding
Questions for the audience:What are some of your experiences with
alternative payment models?
Are there any other models that we have not discussed?
Current Oregon APMs
CareOregon Pay 4 Performance Incentives
Multnomah County Health Dept & Kaiser PM Contract
Oregon Health Authority FQHC APM
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
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
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
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
SBHC APIP Workgroup
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
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:
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?
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?
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
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?
SBHC APIP Utilization Analysis
?Level of Users:• Low: 1-2 visits• Medium: 3-5 visits• Medium-High: 6-9
visits• High: 10+ visits
Utilization Data Cont’d
Who is responsible to pay for what?
Who’s responsible to pay for what?
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
??????
???????
Thank you for your time and attention
Any questions?
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
