UID:
almahu_9949232527802882
Format:
1 online resource (363 pages)
ISBN:
0-12-809828-7
,
0-12-809827-9
Note:
Front Cover -- Health Reform Policy to Practice -- Copyright Page -- Contents -- List of Contributors -- Acknowledgments -- Introduction -- I. Origins of Oregon Health Reform -- 1 The Oregon Narrative: History of Health Reform in Oregon -- 1980s-Statewide Dialog, Mobilization, and Action -- Hard Choices and the Death of a Boy -- Goal Setting and the Oregon Health Plan -- Oregon's Controversial Prioritized List of Services -- Other Kinds of Insurance Expansion -- Employer Mandate -- The Oregon Medical Insurance Pool -- Small Employer Health Insurance -- 1990s-OHP Implementation-Challenges and Benefits -- Explicit Versus Implicit Rationing -- Oregon Health Plan Goes Live -- Managed Care and Cost Containment -- The Family Health Insurance Assistance Program -- 2000s-Policy Refinement and the Quest for Sustainability -- Creation of OHP2 -- The Surprising Impact of Cost-Sharing and Premium Requirements -- Expanded Access to OHP Standard -- Covering More Children: The Healthy Kids Initiative -- 2010-12-The Perfect Storm for Delivery System Reform -- The Evolution of a Burning Platform -- A Gifted Leader Takes Charge -- Immediate Budget Implications -- Early Political Discussions and Negotiations -- Oregon-Style Collaboration -- CMS Waiver Approval and Funding -- Conclusion -- References -- 2 State-Level Design: The Coordinated Care Model -- Background -- The Fourth Path-Changing How Health Care Is Delivered -- Elements of the Coordinated Care Model -- Local Accountability and Governance -- Global Budget With Per Capita Growth -- Integrated and Coordinated Care -- At Risk for Quality (Metrics) -- Flexibility -- Implementation: Oregon's 1115 Waiver and Supports -- Supports for Change -- Progress to Date -- Lessons Learned -- References -- 3 The Politics of Creating the Coordinated Care Organizations -- Introduction -- Background.
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Oregon Legislative Politics -- Federal Politics -- Lessons Learned -- 4 Strategic Communication and Engaging the Public -- Introduction -- #1: Meet People Where They Are -- Messaging for Where People Are -- Message Strategies -- Keep Language Simple and Relevant -- Focus on People, Not Systems -- #2: Show What's Possible-The Story Bank -- #3: Be Disciplined and Tenacious -- Special Note About Communications With Oregon Health Plan Clients -- Communications Channels -- Mass Media-Earned Communications -- Owned Communications -- Get Feedback and Communicate About Communicating -- Agency Partnerships -- Internal Communications to Agency Staff -- Lessons Learned -- II. Implementation of the Coordinated Care Model: Key Components -- 5 Delivering Health Care Through the Coordinated Care Organization Model -- The CCO Background Story -- The Regional Health Authority Concept -- Considering Other Delivery Models -- The Emergence of the CCO Model -- Risk and Funding Arrangements -- Service Areas -- Legislation Drives CCO Development -- CCO Successes and Failures -- Conclusion -- 6 Primary Care as a Cornerstone of Reform -- Policy Drivers and Landscape -- A History of Primary Care Reform -- The Coordinated Care Model and PCPCH -- From Legislation to Practice -- Patient-Centered Primary Care Home Model Development -- Statewide Implementation -- The Outreach and Engagement Strategy -- Technical Assistance Partnerships -- Sustainability of Primary Care Transformation -- Evaluation Results -- Looking Back and Moving Forward -- Challenges -- Synergies -- Conclusion -- References -- 7 The Path to Integrating Medical, Behavioral, and Oral Health Care: Oregon's Experience With Change -- Evidence Supports Integration -- Oregon's Evolution of Change -- Delivering Care in Separate Silos -- Pockets of Innovation -- Steps Toward Integration -- Oregon Integration Efforts.
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State-Led Integration Efforts -- OHA Reorganization -- Metrics -- Technical Assistance and Resources -- Legislation -- CCO-Led Integration Efforts -- Governance Structure -- Experiments and Pilots in Practices -- Training and Education -- CCO Collaborations -- Future Opportunities -- Conclusion -- References -- 8 Aligning Financial Models With Health Care Delivery -- State Government and Medicaid Landscape Prior to Coordinated Care Organizations -- Funding for Transformation -- Global Budget -- Quality Measurement Strategy -- Impacts of the Affordable Care Act -- Establishing Payment Rates to CCOs -- Financial Reserves, Solvency, and Risk -- Alternative Payment Models -- Implementation -- Results -- Legacy Payment Models -- Flexible Services -- Conclusion -- 9 Engaging the Community to Promote Health -- Community Advisory Councils -- The Community Health Improvement Plan -- The Community Health Improvement Plan Development Process -- Community Health Improvement Plan Priorities -- Value of the Community Advisory Council: New Partnerships -- Community Advisory Council Successes -- Characteristics of Effective Community Advisory Councils -- Payment Incentives for Community Engagement -- Health-Related Services -- Barriers to Using Health-related Services -- Incentive Metrics -- Looking Toward the Future -- Conclusion -- References -- 10 Promoting Health Equity -- Introduction -- Background -- Defining Health Equity -- Historical Considerations -- Addressing Equity in Health System Change -- Structural Support for Health Equity -- Community Engagement -- Health Care Interpreter Council -- Community Health Worker Advisory Committee -- Regional Health Equity Coalitions -- Health Equity Policy Changes -- Health Equity in Coordinated Care Organizations -- CCO Transformation Plans -- Health Literacy: Equity in Communication.
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Supplementary Policy Development -- Doulas -- Race and Ethnicity Data -- Civil Rights Implementation -- Lessons Learned -- Conclusion -- References -- 11 Measuring Success: Metrics and Incentive Payments -- Introduction -- History -- Foundational Work -- Establishing Accountability -- State Accountability: Quality and Access Test -- Making Metrics Matter: Putting CCOs at Risk for Quality -- Developing a Quality Pool Methodology -- The Metrics -- Benchmarks and Performance Targets -- The Methodology -- Stage 1 Distribution -- Stage 2 Distribution -- Retiring and Refreshing the Measure Set -- Implementing the Program -- Reporting and Transparency -- Story of a Metric -- Developing Capacity for EHR-Based Measurement -- Results -- Lessons Learned -- The Future -- References -- 12 The Oregon Transformation Center: How and Why a State Agency Can Support Change -- Why a Transformation Center? -- Building the New Transformation Center -- Staffing Structure -- Innovator Agents -- Internal Transformation: Supporting Culture Change Within the Agency -- Building a Network of Learning and Support for Transformation -- Learning Collaboratives -- Coordinated Care Model Summit -- Council of Clinical Innovator Fellows Program -- Transformation Fund Projects -- Transformation Plan Oversight and Support -- Community Health Improvement Plan Review and Implementation Support -- Technical Assistance Bank -- Online Resources -- Transformation Center 2.0 -- Key Lessons Learned -- Conclusion -- References -- 13 Supporting the Coordinated Care Model Through Technology -- History: A 10-Year Evolution of Oregon's HIT Efforts -- Legislative Action and Federal Investment -- Challenges to HIT Efforts -- Developing Oregon's Path Toward a HIT Strategy -- Oregon's Current HIT Strategic Plan -- Implementing the HIT Strategy: Successes, Opportunities, and Challenges.
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Leveraging State Transformation Funds -- Taking a Chance on EDIE -- Sustaining the Oregon HIT Program -- State Office of HIT Structure -- Future of HIT in Oregon -- References -- 14 Emerging Models to Prepare the Workforce for Health System Change -- Clinician Supply and Demand -- Competency Training for a New System of Care -- Policy -- Education -- Practice -- Promising Models of Training -- The Clinical Innovation Fellows Program -- Fellows and Innovation Projects -- Faculty -- Curriculum -- Lessons Learned -- The Fellows' Experience -- Reflections on Program Effectiveness -- Impact on Oregon's Health System Transformation -- Training the Traditional Health Worker in a New Model of Care -- The Traditional Health Worker Training Program -- Implementing Traditional Health Worker Training Programs -- Successes and Challenges: Integrating the Traditional Health Worker Into Health Systems -- Patient-Centered Primary Care Home Program-A Strategy to Promote On-the-Ground Primary Care Transformation -- Lessons Learned -- Reflections on Program Effectiveness -- Experience of Clinics Receiving Site Visits -- Experience of Peer-Mentor Clinical Transformation Consultant Clinicians -- Impact on Oregon's Health System Transformation -- References -- III. Future Implications for State and National Health Reform -- 15 Evaluating Medicaid: Moving Beyond Coverage to Understanding Program Design -- Underlying Financing, Economics, and Feasibility of the Oregon Transition -- Capitalizing on the Research Opportunity -- Confronting the Challenges of Medicaid Research and Evaluation -- Lessons Learned -- Conclusion -- References -- 16 Expanding Beyond Oregon - Lessons for Other States -- Challenges -- Challenge 1: Medicaid Sustainability -- Challenge 2: Acting on the Social Determinants of Health -- Challenge 3: Weak State Administrative Capacity -- Lessons Learned.
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Conclusion.
Language:
English
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