Transcript Data Summary - Columbia Pacific CCO

Clatsop Pacific Coordinated Care
Organization (CCO) –
Clatsop 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
National / State Studies:
Summary of Findings
Higher death rates related to:
• Heart disease
• Stroke
• Unintentional injuries
Higher death rate from drug induced
causes
Slightly higher death rates related to
alcohol induced diseases
Higher rates of:
• DUII rates
• Heavy drinking – female
• Youth who use marijuana
Limited access to health foods
Higher rates of preventable hospital stays
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
• Clean environment / Access to
healthy foods
• Affordable housing / Education –
Schools
Health problems in community:
• Alcohol / drug addiction
• Obesity
• Cancer
3 things to improve community health:
• Health education
• Expand OHP
• More doctors
Poor Or Fair Health
Poor Physical Health Days
4.0
3.5
3.7
3.7
3.0
2.6
2.5
2.0
1.5
1.0
0.5
0.0
Clatsop
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
3.5
3.2
3.0
3.0
2.5
2.3
2.0
1.5
1.0
0.5
0.0
Clatsop
Oregon
National Benchmark
Low Birthweight
6.1%
6.1%
6.1%
6.0%
6.0%
6.0%
5.9%
5.9%
5.9%
5.8%
Clatsop
Oregon
National Benchmark
Leading Cause of Death - Rate Per 100,000
(5 year average) 2007 – 2011
Cause
Clatsop County
Oregon
Heart Disease
222.1
163.1
Stroke
67.4
47.9
57
41.9
14.3
16.2
Unintentional Injuries
Suicide
Health Behaviors
Adult Smoking
25.0%
20.0%
21.0%
17.0%
15.0%
13.0%
10.0%
5.0%
0.0%
Clatsop
Oregon
National Benchmark
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%
Clatsop
Oregon
National
Benchmark
Binge Drinking
20.0%
18.7%
18.0%
16.0%
16.3%
14.0%
10.8%
12.0%
10.0%
9.8%
8.0%
6.0%
4.0%
2.0%
0.0%
Male Clatsop
Co.
Male Statewide Female Clatsop
Co.
Female
Statewide
Heavy Drinking
10.0%
9.7%
9.0%
8.0%
7.0%
6.1%
6.0%
5.4%
5.0%
4.0%
4.8%
3.0%
2.0%
1.0%
0.0%
Male Clatsop
Co.
Male Statewide
Female
Clatsop Co.
Female
Statewide
DUI Rates Per 100,000
900.0
800.0
836.6
700.0
600.0
502.1
500.0
400.0
300.0
200.0
100.0
0.0
Clatsop
Oregon
Percent Motor Vehicle Fatalities Involving Alcohol
38
37
37
40.0
36
37
38
40.0
36.0
35.0
38
Oregon
38.0
33.0
30.0
33.0
31.0
25.0
32.0
20.0
15.0
10.0
5.0
Clatsop
0.0
00 - '4
01 - '05
02-'06
03-'07
04-'08
05-'09
06-'10
Death Rate from Alcohol-Induced - Diseases per 100,000
20
C
19
18
17
18
17
18
16
16
16
14
13
13
13
13
14 13
13
13
14
12
10
Clatsop
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 Had Drank Alcohol Past 30 Days (11th Grade)
70
63
60
52
50
44
51
45
44
46
43
40
36
45
36
27
30
20
10
0
2002
2004
2006
2008
2010
2012
Percent of Youth Who Binge Drink in the Past 30 Days (11th Grade)
38
40
36
35
31
29
Clatsop
30
26
25
25
26
25
21
21
25
20
17
15
10
5
0
2002
2004
2006
2008
2010
2012
Percent of Youth Who Drove When Drinking Alcohol (11th Grade)
12
11
10
Clatsop
10
8
8
8
8
7
8
8
7
6
6
5
6
4
2
0
2002
2004
2006
2008
2010
2012
Death Rate from Drug-Induced Causes per 100,000
25
25
24
24
24
23
22
22
20
19
15
13
15
14
14
14
14
12
11
10
5
Clatsop
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
Clatsop
6
6
6
4
4
2
0
12 to 17 yrs
18 - 25 yrs
26 or older
4
Percent of Youth Who Used Marijuana In Past 30 Days (11th Grade)
35
35
33
30
29
29
27
24
24
24
25
20
24
19
19
20
15
10
Clatsop
5
0
2002
2004
2006
2008
2010
2012
Death Rate from Suicide per 100,000
25
22
20
21
22
18
15
15
15
17
15
18
15
16
16
15
15
Clatsop
13
12
10
5
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)
10
10
9
Clatsop
8
8
7
7
7
7
6
6
6
6
5
6
5
5
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)
35
31
30
27
23
25
21
20
15
20
19
20
17
17
10Clatsop
5
0
2002
2006
2008
2010
2012
28
Obesity and Access to
Recreation
Obesity
25.0%
25.0%
24.9%
24.8%
24.7%
24.6%
24.5%
24.5%
24.4%
24.3%
24.2%
Clatsop
Oregon
Physical Inactivity
21.0%
21.0%
20.5%
20.0%
20.0%
19.5%
19.0%
18.5%
18.0%
17.5%
17.0%
16.5%
18.0%
Access To Recreational Facilities
16.0
16.0
14.0
12.0
10.0
12.0
11.0
8.0
6.0
4.0
2.0
0.0
Clatsop
Oregon
National Benchmark
Limited Access To Healthy Foods
12.0%
11.0%
10.0%
8.0%
6.0%
5.0%
4.0%
2.0%
1.0%
0.0%
Clatsop
Oregon
National Benchmark
Fast Food Restaurants
45.0%
43.0%
40.0%
35.0%
30.0%
25.0%
27.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Clatsop
Oregon
National
Benchmark
Clinical Care
Uninsured
25%
20%
21%
20%
15%
11%
10%
5%
0%
Clatsop
Oregon
National Benchmark
Preventable Hospital Stays
70.0
66.0
60.0
50.0
47.0
43.0
40.0
30.0
20.0
10.0
0.0
Clatsop
Oregon
National Benchmark
Diabetic Screening
90.0%
90.0%
89.0%
88.0%
87.0%
87.0%
86.0%
86.0%
85.0%
84.0%
Clatsop
Oregon
National Benchmark
Mammography Screening
74.0%
73.0%
72.0%
70.0%
68.0%
66.0%
64.0%
62.0%
60.0%
58.0%
66.0%
64.0%
Up-to-date Immunizations Among Two-year Olds
69.5%
69.4%
69.0%
68.5%
68.0%
67.5%
67.6%
67.0%
66.5%
Clatsop
Oregon
Mothers Receiving Inadequate Prenatal Care
5.5%
5.5%
5.4%
5.3%
5.2%
5.1%
5.0%
4.9%
4.9%
4.8%
4.7%
4.6%
Clatsop
Oregon
Percent Age 20+ with Diabetes
9.0%
9.0%
8.8%
8.6%
8.4%
8.2%
8.0%
7.9%
7.8%
7.6%
7.4%
7.2%
Clatsop
Oregon
Social, Economic, and Physical
Environment
High School Graduation
68.0%
68.0%
67.5%
67.0%
66.5%
66.0%
66.0%
65.5%
65.0%
Clatsop
Oregon
Some College
70.0%
70.0%
68.0%
66.0%
65.0%
64.0%
62.0%
60.0%
58.0%
59.0%
56.0%
54.0%
52.0%
Clatsop
Oregon
National
Benchmark
Unemployment
9.0%
8.0%
8.5%
8.7%
7.0%
6.0%
5.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Clatsop
Oregon
National Benchmark
Children In Poverty
30.0%
28.0%
25.0%
23.0%
20.0%
15.0%
14.0%
10.0%
5.0%
0.0%
Clatsop
Oregon
National
Benchmark
Inadequate Social Support
16.0%
16.0%
16.0%
15.5%
15.0%
14.5%
14.0%
14.0%
13.5%
13.0%
Clatsop
Oregon
National
Benchmark
Children in Single-parent households
40.0%
35.0%
37.0%
30.0%
30.0%
25.0%
20.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Clatsop
Oregon
National
Benchmark
Teen Birth Rate
35.0
33.0
30.0
31.0
25.0
21.0
20.0
15.0
10.0
5.0
0.0
Clatsop
Oregon
National
Benchmark
Violent Crime Rate
300.0
257.0
250.0
200.0
150.0
159.0
100.0
66.0
50.0
0.0
Clatsop
Oregon
National
Benchmark
A Look At Who We Are…
Average Age?
Oregon = 38.1
Clatsop County =
42.7
Age 60 +
25.0%
23.4%
20.0%
19.1%
15.0%
10.0%
5.0%
0.0%
Clatsop
Oregon
Under Age 18
23.0%
23.0%
22.5%
22.0%
21.5%
21.0%
20.9%
20.5%
20.0%
19.5%
Clatsop
Oregon
Percent White / Caucasian
88.0%
87.8%
86.0%
84.0%
82.0%
80.0%
79.3%
78.0%
76.0%
74.0%
Clatsop
Oregon
Percent African American
1.8%
1.7%
1.6%
1.4%
1.2%
1.0%
0.8%
0.6%
0.6%
0.4%
0.2%
0.0%
Clatsop
Oregon
Percent Indian or Alaskan Native
1.0%
1.0%
0.9%
0.8%
0.7%
0.6%
0.5%
0.4%
0.3%
0.3%
0.2%
0.1%
0.0%
Clatsop
Oregon
Percent Asian or Pacific Islander
4.0%
3.9%
3.5%
3.0%
2.5%
2.0%
1.5%
1.0%
0.9%
0.5%
0.0%
Clatsop
Oregon
Percent Other Race
0.3%
0.3%
0.3%
0.2%
0.2%
0.1%
0.1%
0.1%
0.0%
Clatsop
Oregon
Percent Two or More Races
3.0%
2.8%
2.8%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Clatsop
Oregon
Percent Male
49.6%
49.6%
49.6%
49.6%
49.5%
49.5%
49.5%
49.5%
49.5%
49.5%
49.4%
Clatsop
Oregon
Percent Who Speak Language Other than English At
Home
16.0%
14.3%
14.0%
12.0%
10.0%
8.0%
7.8%
6.0%
4.0%
2.0%
0.0%
Clatsop
Oregon
Housing Vacancy Rate
25.0%
23.7%
20.0%
15.0%
10.0%
9.2%
5.0%
0.0%
Clatsop
Oregon
Percent Households With Retirement Income
25.0%
21.9%
20.0%
17.9%
15.0%
10.0%
5.0%
0.0%
Clatsop
Oregon
Percent Households with Social Security Income
34.0%
33.0%
33.3%
32.0%
31.0%
30.0%
29.0%
28.2%
28.0%
27.0%
26.0%
25.0%
Clatsop
Oregon
Community Survey
Preliminary Data:
• 189 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
54%
102
Urgent care
44.4%
84
Doctor’s office or other outpatient medical clinic
70.9%
134
Veterans health Administration hospital or clinic
5.3%
10
Addictions treatment center
1.1%
2
Dental services
61.4%
116
Public health department
20.1%
38
Mental health / behavioral health or other counseling
19.6%
37
911
9.5%
18
2.
What conditions exist now in your community to help create or foster good
health? Please select all that apply:
68.8%
130
37%
70
There are good prevention services that help
reduce health problems
(Services that help people quit smoking or to eat
healthy)
39.7%
75
Citizens make use of recreational activities
(Helps with exercising and stress reduction, etc.)
47.6%
90
We have good doctors
(They care about patients, provide good health
care, etc.)
We have local access to specialty services
(A focus on specific area of care like a heart
doctor)
3. What do you think are the three (3) most important ways to create a
healthier community? Please select only 3
A clean environment
37.6%
71
Mental health treatment
21.2%
40
Access to healthy
foods
37%
70
Food banks/hunger programs
17.5%
33
Affordable housing
32.8%
62
Low crime/safe neighborhoods
14.8%
28
Cultural acceptance
7.9%
15
Sports and recreation activities
18%
34
Education / Schools
31.2%
59
15
Drug/alcohol
prevention and
treatment
Health prevention and
wellness education
21.2%
42
Tobacco prevention / treatment 7.9%
services
Job opportunities and a healthy 45%
economy
22.2%
42
Better access to health care
services
45
23.8%
85
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
21.7%
41
Respiratory/lung disease
HIV/AIDS
4.2%
2.6%
8
5
Diabetes
Heart disease / stroke
18%
6.9%
34
13
9%
17
Tobacco use
Obesity
Mental Illness
Alcohol/drug addiction
15.9%
29.1%
15.3%
36%
30
55
29
68
Dental problems
9.5%
Sexually transmitted
diseases
Suicide
High blood pressure
Lack of mental health treatment
3.7%
facilities
High crime rates
4.2%
High cost of mental health services 3.7%
7
9%
6.3%
17
12
2.6%
5
14.8%
5.8%
3.7%
4.2%
28
11
7
8
18
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
6.9%
13
3.7%
7
Child abuse
6.3%
12
3.2%
6
Too few educational opportunities 6.3%
after high school (college, trade
schools, et.)
12
8
7
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
30.7%
58
More doctors
31.7%
60
More illness prevention services
5.3%
10
More alcohol and drug treatment
36%
68
13.2%
25
Doctor appointments after 5 pm or on weekends
27%
51
More culturally sensitive care
4.2%
8
Transportation assistance
13.8%
26
More mental health services
26.5%
50
Alternative health care
18.5%
35
Expand the OHP (Medicaid)
37.6%
71
More tobacco cessation programs
8.5%
16
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
46.6%
88
Don’t know where to go to get care
3.2%
6
Don’t have insurance
30.2%
57
Afraid of what they might find wrong
with me
7.4%
14
Childcare issues
2.6%
5
Do not have a regular doctor
14.3%
27
Transportation
problems
9.5%
18
Couldn’t get appointment quickly
enough
11.6%
22
Don’t like doctors
10.1%
19
28%
53
On the Oregon Health Plan, but do not 1.6%
have a doctor
Doctor’s office not open not open
15.3%
when needed
Waited for the health
problem to go away
3
29
7. Age
8. Gender
Income
Race / Ethnicity:
Less than $5,000
15.9%
30
American Indian or Alaska
Native
5.3%
10
$5,000 - $15,000
19.6%
37
Asian
1.1%
2
$16,000 - $25,000
13.8%
26
Black or African American
1.6%
3
$26,000 - $40,000
16.9%
32
Latino / Hispanic
6.3%
3
$41,000 - $70,000
13.8%
26
Native Hawaiian or Other
Pacific Islander
1.1%
2
$71,000 - $100,000
8.5%
16
White
79.9%
151
More than $100,000
6.9%
13
Other:
4.2%
8
National / State Studies:
Summary of Findings
Higher death rates related to:
• Heart disease
• Stroke
• Unintentional injuries
Higher death rate from drug induced
causes
Slightly higher death rates related to
alcohol induced diseases
Higher rates of:
• DUII rates
• Heavy drinking – female
• Youth who use marijuana
Limited access to health foods
Higher rates of preventable hospital stays
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
• Clean environment / Access to
healthy foods
• Affordable housing / Education –
Schools
Health problems in community:
• Alcohol / drug addiction
• Obesity
• Cancer
3 things to improve community health:
• Health education
• Expand OHP
• More doctors
“Community Health Needs Survey, - Clatsop County” 2013. Clatsop 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.
“Clatsop 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.
“Clatsop 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.