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The Oregon Living Well
Business Plan and the
Self-Management Alliance
Laura Chisholm, MPH, MCHES
Chronic Disease Self-Management Lead
Oregon Public Health Division / Oregon Health Authority
July 16, 2013
What We’ll Cover Today
A brief snapshot of Oregon
Why create a business plan?
How and when was Oregon’s plan created?
Who provided input?
What’s in the plan?
What next?
Stanford Program participants by county of
residence, 2012
Participants
0
1 - 28
29 - 67
68 - 261
Lake
HarneyMalheur
Lane
Grant
Klamath
Douglas
Baker
Linn
Crook
Jackson
Coos
Curry
Deschutes
Jefferson
Josephine
Lincoln
Benton
Umatilla
Wallowa
UnionMorrow
Sh
erm
anGilliam
Marion
Clackamas
Polk
Tillamook
Clatsop
Yamhill
Colu
mbiaW
ashington
Hood RiverMultnomah
Wasco
Wheeler
Participants by program and year, 2006-2012
Vision & Goals
Vision: Ensure that self-management
programs are available and paid for
statewide, long term
Develop systems and infrastructure to bring
programs to scale
• Reach a greater proportion of Oregonians
with chronic conditions
• Generate revenue -- reinvest to support
program growth and access for all
The Opportunity
Health system transformation is happening!
– Coordinated Care Organizations
– Patient Centered Primary Care Homes
– Increased emphasis on prevention and
wellness
– Shift toward financial incentives for better
outcomes
Our programs can help the emerging
structure achieve the Triple Aim of better
care, better health, and cost control
Early Preparation & Planning
Developed Request for Proposals for business
plan development contractor – winter 2011
Released solicitation (three times) – spring/
summer 2011
Contract executed (fall 2011)
Project planning (November 2011)
Process for Development - 2012
Situation analysis – key informant interviews &
research (January/February)
Develop business model recommendations
(early March)
Stakeholder/advisor review meeting (March 19)
Finalize state business plan (June/July)
Approval through OHA leadership (August/Sept)
Who Provided Input?
Program delivery organizations
• Area Agencies on Aging
• County & state-level public health
• Community clinics & community organizations
• Health care delivery systems
Stakeholders & experts
• Major health care delivery systems
• Provider group and clinic association leaders
• State-level purchasers of health care: Medicaid
and public employee benefit boards
About the Business Plan
Outlines the most efficient, effective and feasible
way to deliver and fund programs
• To guide the Oregon Health Authority’s work with
Living Well (CDSMP) and Tomando Control
Stakeholder advisors agreed that the current
network structure must evolve for programs to
be sustainable long-term
About the Business Plan
Business document for recruiting a partner
organization to create the Oregon Self-
Management Alliance
• Demonstrates potential financial feasibility
• 5-year plan
• Written using business language
• High-level view, lots of detail to be worked out
Outlines structure, systems, partnerships,
markets, customers and delivery networks
needed for financial sustainability
The Business Plan
• Executive summary
• Preface - health system transformation context
• Introduction
• Purpose & methodology
• Background on programs, status information
• Business Description
• Problem definition, core product description
• Mission, vision, guiding values, strategic goals, niche,
strategic focus
The Business Plan
Organizational design & development
Business model: modified franchise
Management & staffing expertise needed
Public-private partnership model
Methods of product delivery: franchisee)(stand-
alone) & contractor
Systems & processes – technology,
administration, financial system, contracting
agreements, information management
The Business Plan
Constituents and markets
• Target markets:
• Medicaid coordinated care organization members
• Public employees
• Medicare Advantage members
• Strategic partnerships
• Public relations & outreach strategies
• Competition
The Business Plan
The Alliance provides access to workshops
and a scale and geographic reach
unmatched by any other program delivery
provider. It is…uniquely able to meet the
demands of Oregon’s large healthcare
system payers and their need for chronic
disease self-management programming.
The Business Plan
Finances
• Estimated expenses: licensing, startup,
operational expenses, staff, product delivery
(leader training, materials, payments)
• Estimated revenues
• Pricing structures
• Turnkey/franchisee budget
• Delivery network contractor budget
• Projected growth over time
• Implementation process
The Business Plan
Appendices
• Interviewees & advisors
• Population breakdown: est. population with
chronic conditions, demographics
• Medicaid coordinated care organization members
• Public employee benefit board beneficiaries
• Medicare Advantage members
Purchasers
Oregon’s Current
Self-Management
Delivery & Financing
Structure
Public Health &
State Unit on Aging Coordinate training & TA
Collect/reports data
Advocate for policy change
(insurance coverage)
Coordinate network
Oregon Living Well Network
? ? ? ?
?
Program
Delivery
Organizations
Oregon Self
Management Alliance
Coordinates workshop
scheduling & payments
Tracks & reports data
Monitors quality & fidelity
Leader training
Marketing
OHA Assures
statewide
reach &
equity
Program Delivery
Network Partners Provide workshops
Receive payments
Stand-Alones Provide workshops
for specific populations
Access to scheduling/
payment system
Purchasers
Oregon’s Proposed
Self-Management
Delivery & Financing
Structure
Oregon Self
Management Alliance
Coordinates workshop
scheduling & payments
Tracks & reports data
Monitors quality & fidelity
Leader training
Marketing
OHA Assures
statewide
reach &
equity
Public – Private Partnership
Oregon Self
Management Alliance
Coordinates workshop
scheduling & payments
Tracks & reports data
Monitors quality & fidelity
Leader training
Marketing
Program Delivery Network
Program Delivery
Network Partners Provide workshops
Receive payments
Oregon Self
Management Alliance
Coordinates workshop
scheduling & payments
Tracks & reports data
Monitors quality & fidelity
Leader training
Marketing
Stand-Alones Provide workshops
for specific populations
Access to scheduling/
payment system
Support for Self-
Contained Programs
Oregon Self
Management Alliance
Coordinates workshop
scheduling & payments
Tracks & reports data
Monitors quality & fidelity
Leader training
Marketing
Purchasers
Statewide resource for
purchasers
Oregon Self
Management Alliance
Coordinates workshop
scheduling & payments
Tracks & reports data
Monitors quality & fidelity
Leader training
Marketing
OHA Assures
statewide
reach &
equity
Stand-Alones Provide workshops
for specific populations
Access to scheduling/
payment system
Purchasers
Oregon’s Proposed
Self-Management
Delivery & Financing
Structure
Program Delivery
Network Partners Provide workshops
Receive payments
In the coming months (2013?) we’ll…
Get implementation personnel on board
Conduct a state contracting process to identify
Alliance partner organization
• Develop scope of work
• Release a competitive request for proposals
• Score proposals against criteria & select the
Alliance contractor
• Develop the Alliance contract & begin
implementation
After that (2014 +) we’ll…
Develop contracting networks
• Program delivery contractors
• Stand-alones (franchisees)
Secure purchasers
• Develop marketing package & develop contracts
• PEBB/OEBB, CCOs, Medicare Advantage
Implement information technology infrastructure
• Platform for data collection, registration,
payments
After that, we’ll…
Transition key functions from OHA to Alliance
• Data collection & reporting
• Training coordination & support
• Technical assistance to licensed organizations
• Quality assurance & fidelity monitoring
• Marketing & recruitment support
• Program licensing
Benefits we hope to achieve
Access to programs statewide
• Single point of contact for purchasers
• Centralized licensing, billing and contracting
• Sustainable funding source
Increased efficiency through coordination
• Statewide marketing of programs
• Online systems to streamline registration
Increased program reach and access
Lessons learned to date
Partner involvement is crucial
– The new system needs to work for them
• Listen - they ask great questions
– Change and ambiguity are scary, so:
• Expect angst: normalize and frame it
• (Over)communicate, even when there isn’t progress
• Be as transparent as possible
• Be patient and stay positive
• Help partners feel appreciated and understand their roles
• Connect individual tasks to the overall goal
• Celebrate successes, no matter how small
• “Walk with intent”
Lessons learned to date
Slow progress is frustrating but ultimately
positive
• Steep learning curve, new vocabulary
• Partners need time and tools to communicate with
their partners and leaders
• Slower process allows dialogue
Sometimes the best messenger is someone else
• Cultivate allies who “walk between the worlds”
• It’s OK to not be the expert, as long as you have some
you can call on
• Translate business language, provide specific examples
Questions? Comments? Insights? Advice?
For more information
Laura Chisholm, MPH, MCHES
Self-Management Technical Lead
Oregon Health Authority – Public Health Division
(971) 673-0987
www.healthoregon.org/livingwell
