Transcript Data Summary - Columbia Pacific CCO

Columbia Pacific Coordinated Care
Organization (CCO) –
Columbia County Data Summary
Changes in Oregon Health Plan
Coordinated Care Organizations
Healthcare Coordination &
Integration
Community Advisory Councils
OHP Client
Physical Health
• Assessment
• Diagnosis
• Treatment
Plan (EBP)
• Pre-set rate
per service
• Monitor /
Update
Mental Health
• Assessment
• Diagnosis
• Treatment
Plan (EBP)
• Pre-set rate
per service
• Monitor /
Update
Addictions TX
• Assessment
• Diagnosis
• Treatment
Plan (EBP)
• Pre-set rate
per service
• Monitor /
Update
Oral Health
• Assessment
• Diagnosis
• Treatment
Plan (EBP)
• Pre-set rate
per service
• Monitor /
Update
• Local Control (different
CCO models)
Coordinated
Care
Organizations
• Coordination – Integrate
Physical health, mental
health, dental health–
single point of
accountability
• Metrics / Performance Measures –
Operate under contracted
performance standards with clinical,
financial and operational metrics
• Global Budget And Shared Saving
– More flexibility to manage dollars
Primary Care
Health Homes –
Center of patients’
coordinated care.
Includes a team
that works on
keeping patients
at their healthiest.
Community Advisory Council –
Each CCO convenes a CAC to
ensure that the health care needs
of consumers are being addressed
CCO created a culture which allowed
providers to bring these local activities
into the next generation of integration
Why This Why Now?
Better Health Care System
Better Health Outcomes
Cost Savings
Improve Health System, Improve Health Outcomes, Lower Costs
All OHP Clients
Early Assessment &
Identification of High
Risk For Chronic
Disease
At High Risk Chronic Disease
Chronic
Disease
Coordinated case
management – Reduce
likelihood become chronic
Coordinated case
management – Reduce high
end costs
All OHP Clients
Early Assessment &
Identification of High
Risk For Chronic
Disease
At High Risk Chronic Disease
Chronic
Disease
Coordinated case
management – reduce
likelihood become chronic
Coordinated case
management – Reduce high
end costs
All OHP Clients
Early Assessment &
Identification of High
Risk For Chronic
Disease
At High Risk Chronic Disease
Chronic
Disease
Coordinated case
management – reduce
likelihood become chronic
Coordinated case
management – Reduce high
end costs
All OHP Clients
Early Assessment &
Identification of High
Risk For Chronic
Disease
At High Risk Chronic Disease
Chronic
Disease
Coordinated case
management – reduce
likelihood become chronic
Coordinated case
management – Reduce high
end costs
Savings = reinvestment into system – incentive, etc.
Cost Impact
Sample – Using Diabetes for A Single Oregon County:
Number of Persons:
Number of Deaths:
Costs:
If you can prevent 4.67% of people from
getting Diabetes:
9,300
531
$42.6M
If you can prevent 20% of people from
getting Diabetes:
Number Prevented:
437
1,860
Lives Saved:
32
121
Financial Cost Savings: $2 M
$8.52 M
Cost Impact
Sample – Using Diabetes for Douglas County:
The risk of Type 2 Diabetes
can be reduced by
50-70% by control of obesity
And by
30-50% by increasing physical activity
$8.52 Million Question:
What is the likelihood of preventing 5%, 10%, 20% of population from getting
Diabetes?
If you can prevent 4.67% of people from
getting Diabetes:
If you can prevent 20% of people from
getting Diabetes:
Number Prevented:
437
1,860
Lives Saved:
32
121
Financial Cost Savings: $2 M
$8.52 M
• Personal impact cannot be quantified
• Can apply model to other chronic diseases – Each has risk
factors which increase the likelihood of illness:
Heart Disease and Stroke Prevention:
• No tobacco
• Physically active
• Healthy weight
• Healthy food choices
• Preventing / controlling high blood
pressure
• 12 – 13 point reduction in average
systolic blood pressure over 4 years
reduces heart disease risk by 21%,
stroke risk by 37%
Cancer Prevention:
• No tobacco
• Limiting alcohol
• Limited exposure to ultraviolet rays
• Diet rich in fruits and vegetables
• Maintaining a health weight
• Being physically active
• Seeking regular medical care
PCP
Oral Health
Addictions
Mental Health
Health Integration System
Family
Behavioral Health
Mental Health
Spiritual
Community
Patients
Dental Health
Peers
Providers
Physical Health
Neighborhood Health
• 15 CCO management areas
Community Advisory Councils – Ensure health care needs of
consumers are being met. Community / consumer focus within CCO’s
work to accomplish vision – Improve Health Care System, Improve
Health Outcomes, Lower Costs
Current Goal – Identify 3 priority areas to improve health then
identify strategies to reach that goal
18
Summary of Findings
National / State Studies:
Higher death rates related to:
• Heart disease
Slightly higher rates of:
• Smoking
• Heavy drinking - female
Higher percentage of reporting of
depression/anxiety and high blood
pressure (CP CCO Medicaid data)
Community Responses (Not in specific
Order)
Conditions create a healthy community:
• Jobs
• Education / schools
• Drug / alcohol prevention
Health problems in community:
• Alcohol and drug addiction
• Obesity
• Tobacco use
3 things to improve community health:
• Later in day doctor appointments
• More doctors
• More health education services
Poor Or Fair Health
18%
16%
17%
14%
14%
12%
10%
10%
8%
6%
4%
2%
0%
Columbia Co.
Oregon
National Benchmark
Premature Death
,400
6,342
,200
6,076
,000
,800
,600
,400
5,317
,200
,000
,800
Columbia Co.
Oregon
National Benchmark
Poor Physical Health Days
0
3.9
3.7
5
0
2.6
5
0
5
0
5
0
Columbia Co.
Oregon
National Benchmark
Chronic Condition Diagnoses – Medicaid-eligible Population (CPCCO Service Area
Chronic Health
Conditions
Percent told they have
it by a physician (N=
1,486)
Of those percent
currently taking RX for
it
Diabetes
9.7
62.4
High cholesterol
19.1
45
High blood pressure
29.6
57.8
Depression / anxiety
44.2
51.8
Asthma
18.2
51.9
Emphysema / COPD
8.2
50.4
Heart attack / Angina
6.6
50
2
69
Kidney problem
5.1
33.3
Cancer
3.7
50
Congestive heart failure
Poor Mental Health Days
4.5
4.0
4.1
3.5
3.2
3.0
2.5
2.3
2.0
1.5
1.0
0.5
0.0
Columbia
Oregon
National Benchmark
Low Birthweight
6.1%
6.1%
6.1%
6.1%
6.0%
6.0%
6.0%
6.0%
6.0%
6.0%
6.0%
5.9%
Columbia
Oregon
National Benchmark
Leading Cause of Death - Rate Per 100,000
(5 year average) 2007 – 2011
Cause
Heart Disease
Stroke
Columbia County
175.0
Oregon
163.1
40
47.9
Unintentional Injuries
49.2
41.9
Suicide
15.2
16.2
Health Behaviors
Adult Smoking
20.0%
20.0%
18.0%
17.0%
16.0%
14.0%
13.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
Columbia Co.
Oregon
National Benchmark
2%
Tobacco Use Smokeless (By Males)
7.2%
0%
8%
6%
4%
6.3%
2%
0%
8%
Columbia Co.
Oregon
Excessive Drinking
16.0%
14.0%
16.0%
15.0%
12.0%
10.0%
8.0%
7.0%
6.0%
4.0%
2.0%
0.0%
Columbia Co.
Oregon
National Benchmark
Binge Drinking
20.0%
18.7%
18.0%
16.0%
14.0%
14.9%
13.2%
12.0%
10.8%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
Male Columbia Male Statewide
Co.
Female
Columbia Co.
Female
Statewide
Heavy Drinking
9.0%
8.9%
8.0%
7.0%
6.1%
6.0%
5.0%
5.6%
5.4%
4.0%
3.0%
2.0%
1.0%
0.0%
Male Columbia
Co.
Male Statewide
Female
Columbia Co.
Female
Statewide
DUI Rates Per 100,000
20.0
506.0
00.0
80.0
60.0
40.0
20.0
425.1
00.0
80.0
Columbia Co.
Oregon
Percent Motor Vehicle Fatalities Involving Alcohol
Oregon
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
38
48.0
37
39.0
37
37
41.0
38
45.0
38
38
40.0
35.0
38.0
Columbia
00 - '4
01 - '05
02-'06
03-'07
04-'08
05-'09
06-'10
Death Rate from Alcohol-Induced Diseases per 100,000
13
13
14
13
13
13
12
10
10
8
10
13
13
11
11
05-'09
06-'10
14
C
13
10
9
9
Columbia
6
4
2
0
00 - '4
01 - '05
02-'06
03-'07
04-'08
07-'11
Percent of Youth Who Had Drank Alcohol Past 30 Days (11th Grade)
70
62
60
50
44
45
48
46
44
42
36
40
30
20
10
34
37
36
35
Percent of Youth Who Binge Drink in the Past 30 Days (11th Grade)
60
51
50
Columbia
40
29
30
31
25
25
27
26
30
21
21
22
2010
2012
20
10
0
2002
2004
2006
2008
21
Percent of Youth Who Drove When Drinking Alcohol (11th Grade)
25
22
Columbia
20
15
10
8
8
10
8
8
7
5
7
7
6
6
0
2002
2004
2006
2008
2010
2012
5
Death Rate from Drug-Induced Causes per 100,000
15
16
14
14
13
14
14
14 14
12
12
11
12
10
10
8
14
10
9
9
9
6
4
2
Columbia
0
00 - '4
01 - '05
02-'06
03-'07
04-'08
05-'09
06-'10
07-'11
Percent Who Used Illicit Drug(s) Other Than Marijuana in Past 30 Days
12
11
10
10
8
Columbi
a
6
6
6
4
4
4
2
0
12 to 17 yrs
18 - 25 yrs
26 or older
Percent of Youth Who Used Marijuana In Past 30 Days (11th Grade)
30
29
24
24
25
25
20
24
19
19
20
17
17
2006
2008
19
15
10
Columbi
5
0
2002
2004
2010
2012
24
Death Rate from Suicide per 100,000
20
18
19
17
19
15
16
15
17
15
17
15
16
15
15
15
16 16
15
14
12
Columbia
10
8
6
4
2
0
00 - '4
01 - '05
02-'06
03-'07
04-'08
05-'09
06-'10
07-'11
Percent of Youth Who Attempted Suicide in the Past Year (11th Grade)
7
7
6
6
6
Columbi
6
5
5
5
5
4
4
4
4
4
3
3
2
1
0
2002
2004
2006
2008
2010
2012
Percent of Youth Who Had Depressive Episode in the Past Year (11th Grade)
28
30
27
25
21
20
25
24
21
20
23
20
19
15
10
Columbia
5
0
2002
2006
2008
2010
2012
Obesity and Access to
Recreation
7.0%
Obesity
27.0%
6.5%
6.0%
5.5%
5.0%
24.5%
4.5%
4.0%
3.5%
3.0%
Columbia Co.
Oregon
Physical Inactivity
21.0%
21.0%
20.5%
20.0%
19.5%
19.0%
19.0%
18.5%
18.0%
18.0%
17.5%
17.0%
16.5%
Columbia Co.
Oregon
National
Benchmark
Access To Recreational Facilities
16.0
14.0
16.0
14.0
12.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
Columbia Co.
Oregon
National Benchmark
Limited Access To Healthy Foods
5.0%
5.0%
4.5%
4.0%
4.0%
3.5%
3.0%
2.5%
2.0%
1.5%
1.0%
1.0%
0.5%
0.0%
Columbia Co.
Oregon
National Benchmark
Fast Food Restaurants
45.0%
43.0%
40.0%
41.0%
35.0%
30.0%
27.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Columbia Co.
Oregon
National Benchmark
Clinical Care
Uninsured
20%
20%
18%
16%
16%
14%
12%
11%
10%
8%
6%
4%
2%
0%
Columbia Co.
Oregon
National Benchmark
Preventable Hospital Stays
47.0
47.0
47.0
46.0
45.0
44.0
43.0
43.0
42.0
41.0
Columbia Co.
Oregon
National Benchmark
Diabetic Screening
90.0%
90.0%
89.0%
88.0%
87.0%
86.0%
86.0%
85.0%
84.0%
84.0%
83.0%
82.0%
81.0%
Columbia Co.
Oregon
National Benchmark
Mammography Screening
74.0%
73.0%
72.0%
70.0%
68.0%
67.0%
66.0%
66.0%
64.0%
62.0%
Columbia Co.
Oregon
National
Benchmark
Up-to-date Immunizations Among Two-year Olds
72.5%
72.0%
72.1%
71.5%
71.0%
70.5%
70.0%
69.5%
69.4%
69.0%
68.5%
68.0%
Columbia Co.
Oregon
Mothers Receiving Inadequate Prenatal Care
6.0%
5.5%
5.0%
4.0%
4.2%
3.0%
2.0%
1.0%
0.0%
Columbia Co.
Oregon
Percent Age 20+ with Diabetes
8.5%
8.5%
8.4%
8.3%
8.2%
8.1%
8.0%
7.9%
7.9%
7.8%
7.7%
7.6%
Columbia Co.
Oregon
Social, Economic, and Physical
Environment
High School Graduation
68.0%
8.0%
7.5%
7.0%
6.5%
6.0%
5.5%
5.0%
65.0%
4.5%
4.0%
3.5%
Columbia Co.
Oregon
Some College
0.0%
70.0%
65.0%
0.0%
57.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
Columbia Co.
Oregon
National Benchmark
Unemployment
0.0%
9.0%
9.4%
8.7%
8.0%
7.0%
6.0%
5.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Columbia Co.
Oregon
National Benchmark
Children In Poverty
Inadequate Social Support
Children in Single-parent households
Teen Birth Rate
Violent Crime Rate
A Look At Who We Are…
Average Age?
Oregon = 38.1
Columbia County = 40.8
Age 60 +
Under Age 18
Percent White / Caucasian
Percent African American
Percent Indian or Alaskan Native
Percent Asian or Pacific Islander
Percent Other Race
Percent Two or More Races
Percent Male
Percent Who Speak Language Other than English At
Home
Housing Vacancy Rate
Percent Households With Retirement Income
Percent Households with Social Security Income
Community Survey
Preliminary Data:
• 350 Community Surveys
1. In the past year, have you or anyone living in your home used
health services at any of the following locations? Please select
all that apply:
Percent
Number
Hospital
24.3%
85
Urgent care
50.3%
176
Doctor’s office or other outpatient medical clinic
79.7%
279
Veterans health Administration hospital or clinic
6.3%
22
Addictions treatment center
5.1%
18
Dental services
68.3%
239
Public health department
20.6%
72
Mental health / behavioral health or other counseling
23.1%
81
911
13.4%
47
2.
What conditions exist now in your community to help create or foster good
health? Please select all that apply:
We have good doctors
(They care about patients, provide good health
care, etc.)
63.7%
223
We have local access to specialty services
(A focus on specific area of care like a heart
doctor)
15.4%
54
There are good prevention services that help
reduce health problems
(Services that help people quit smoking or to eat
healthy)
38%
133
Citizens make use of recreational activities
(Helps with exercising and stress reduction, etc.)
34%
119
3. What do you think are the three (3) most important ways to create a
healthier community? Please select only 3
A clean environment
23.7%
83
Mental health treatment
20.3%
71
Access to healthy
foods
25.1%
88
Food banks/hunger programs
12.6%
44
Affordable housing
22.6%
79
Low crime/safe neighborhoods
18.3%
64
Cultural acceptance
4.3%
15
Sports and recreation activities
21.1%
74
Education / Schools
34.3%
120
27
Drug/alcohol
prevention and
treatment
Health prevention and
wellness education
28.6%
100
Tobacco prevention / treatment 7.7%
services
Job opportunities and a healthy 42.9%
economy
23.7%
83
Better access to health care
services
23.7%
150
83
4. What do you think are the three (3) most critical health problems in your
community? (those problems which have the greatest impact on overall
community health)
Cancer
17.4%
61
Lack of mental health treatment
10.3%
facilities
High crime rates
4.9%
High cost of mental health services 2.9%
36
Respiratory/lung disease
HIV/AIDS
6%
1.4%
21
5
Diabetes
Heart disease / stroke
24%
14.9%
84
52
8.9%
18%
31
63
7.1%
25
14.6%
4.9%
3.1%
5.1%
51
17
11
18
50
Not enough doctors and clinics
High cost of health care / lack of
health insurance
Too few recreational and exercise
facilities
Poor eating habits
Lack of access to healthy foods
Domestic violence
Lack of transportation to medical
facilities
Too little affordable housing
High blood pressure
15.1%
53
Tobacco use
Obesity
Mental Illness
Alcohol/drug addiction
23.4%
33.7%
20.6%
45.1%
82
118
72
158
Dental problems
14.3%
11.1%
39
Sexually transmitted
diseases
Suicide
5.1%
18
Child abuse
5.1%
18
3.7%
13
Too few educational opportunities 11.4%
after high school (college, trade
schools, et.)
17
10
40
5. If you could pick just three (3) things to improve your community's access to health
care, what would they be? Please pick only 3 boxes:
More health education services
34.4%
120
More doctors
40.3%
141
More illness prevention services
17.1%
60
More alcohol and drug treatment
21.4%
75
14%
49
Doctor appointments after 5 pm or on weekends
49.1%
172
More culturally sensitive care
3.1%
11
Transportation assistance
15.7%
55
More mental health services
19.7
69
Alternative health care
17.7%
62
Expand the OHP (Medicaid)
30.9%
108
More tobacco cessation programs
6.9%
24
More dentists
6. Think about the most recent time when you or a family member living in your
home went without needed health care. What were the reasons why? Please
check all that apply
It costs too much
53.7%
188
Don’t know where to go to get care
5.4%
19
Don’t have insurance
36.3%
127
Afraid of what they might find wrong
with me
8%
28
Childcare issues
3.1%
11
Do not have a regular doctor
8.9%
31
Transportation
problems
12%
42
Couldn’t get appointment quickly
enough
17.7%
62
Don’t like doctors
5.1%
18
11
Waited for the health
problem to go away
19.1%
67
On the Oregon Health Plan, but do not 3.1%
have a doctor
Doctor’s office not open not open
19.4%
when needed
68
7. Age
8. Gender
Income
Race / Ethnicity:
Less than $5,000
16.6%
58
American Indian or Alaska
Native
2.6%
9
$5,000 - $15,000
20.6%
72
Asian
.6%
2
$16,000 - $25,000
25.7%
90
Black or African American
.3%
1
$26,000 - $40,000
26%
91
Latino / Hispanic
3.1%
11
$41,000 - $70,000
29.4%
103
Native Hawaiian or Other
Pacific Islander
.6%
2
$71,000 - $100,000
8.6%
30
White
80.9%
283
More than $100,000
7.7%
27
Other:
.3%
1
Summary of Findings
National / State Studies:
Higher death rates related to:
• Heart disease
Slightly higher rates of:
• Smoking
• Heavy drinking - female
Higher percentage of reporting of
depression/anxiety and high blood
pressure (CP CCO Medicaid data)
Community Responses (Not in specific
Order)
Conditions create a healthy community:
• Jobs
• Education / schools
• Drug / alcohol prevention
Health problems in community:
• Alcohol and drug addiction
• Obesity
• Tobacco use
3 things to improve community health:
• Later in day doctor appointments
• More doctors
• More health education services
“Community Health Needs Survey, - Columbia County” 2013. Columbia
Pacific Coordinated Care Organization : Community Advisory Council.
Oregon.
“County Health Calculator,” 2013. Robert Wood Johnson Foundation and the
Virginia Commonwealth University Center on Human Needs.
“County Health Rankings and Roadmaps – a Healthier Nation County by
County,” 2013. Robert Wood Johnson Foundation and University of
Wisconsin – Population Health Institute.
“Data Elements for CCOs Reports,” 2013. Oregon Health and Science
University. Office of Rural Health.
“Columbia County’s Epidemiological Data on Alcohol, Drugs and
Mental Health. 2000 to 2012. Oregon Health Authority. Office of
Health Analytics and Addictions and Mental health Division.
“Columbia Pacific CCO Service Area. Health & Care Profile for Newly Eligible
Oregonians Under the ACA”
“Prevention Chronic Diseases and Reducing Health Risk Factors,” 2013.
Centers for Disease Control and Prevention. CDC 24/7 : Saving Lives.
Protecting People.
“Quick Facts,” January 2013. Oregon Department of Human Services;
Children, Adults and Families Division. Office of Business Intelligence and
the Office of Forecasting, Research and Analysis.