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Community governed health care: Oregon's coordinated care model
Upper Lobby
Community governed health care: Oregon's coordinated care model
Oregon Health Authority
The State of Oregon developed the Coordinated Care Model in 2011 as a new way to deliver healthcare services to its nearly 1.1 million Medicaid members. As a result of state legislation and a federal waiver... Read more

Description

The State of Oregon developed the Coordinated Care Model in 2011 as a new way to deliver healthcare services to its nearly 1.1 million Medicaid members. As a result of state legislation and a federal waiver from the Centers for Medicare and Medicaid Services, Oregon called for the creation of legal entities known as Coordinated Care Organizations (CCOs). The 16 CCO’s in the state now serve essentially as Medicaid managed care plans in the traditional sense. However, these organizations are much more than health plans.

Unlike traditional health plans, CCO’s pay for medical, behavioral and dental health care services under one fixed global budget. Additionally, these plans are governed by members of the community they serve. Their board of directors are required to have leadership from local hospitals, behavioral health organizations, government, providers and most importantly members served by the plan.

The Yamhill Community Care Organization is one of Oregon’s CCOs which has been incredibly successful in delivering community governed healthcare. The healthcare providers and Medicaid members of this community played an active role in the development of the organization, realizing the potential benefits of a health plan which was actually governed by the providers for the plan and the members served by the plan.

A Community Advisory Council (CAC) composed of health plan members and their families is one of three main governing bodies in the organization. The CAC has produced a large amount of meaningful work such as a Community Health Improvement Plan which serves as a blueprint for improving the health not just of the Medicaid population served by the plan, but also the broader community. The Clinical Advisory Panel (CAP) is another of the main governing bodies comprised of local providers including physicians, dentist’s and behavioral health providers. They have produced work such as the development of a Persistent Pain Program to serve as a multidisciplinary approach to hep manage chronic pain and reduce opioid use.

The Yamhill CCO now serves as a platform for coordinating care in the community as well as fostering healthcare innovation and transformation . New relationships between providers have been developed such as between public health and primary care providers which allow them to collaborate on community initiatives, track outcomes with a common set of metrics, and pay for care using a value based alternative payment model.

Additionally, the organization allows for rapid deployment of novel services. An example is a primary care clinic based tele-dermatology program. In this program, iPads were placed in primary care clinics allowing for consultations to be performed virtually during an already scheduled visit. Prior to this, only a single dermatologist was available with limited access. Another novel program has funded placement of behavioral health providers in primary care clinics to address behavioral health determinants.

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