[row][column]Effective … equitable … efficient. These are more than just quality buzzwords for Yamhill Community Care Organization (Yamhill CCO). Yamhill CCO is extending the scope of health care delivery to include non-traditional partners, in order to improve attainment of health and overall wellness for its entire community, including some of Oregon’s most vulnerable patients. This commitment to collaboration and exploration of mechanisms to invest in non-clinical determinants of health account for Yamhill’s selection as an initial site in Bridging for Health: Improving Community Health Through Innovations in Financing, supported by the Robert Wood Johnson Foundation.
Current Standing: Yamhill County ranks 8 healthiest of 34 counties in Oregon, according to the County Health Rankings
Leader of the Initiative: Coordinated care organization
Collaborative: Complex adaptive system of a payer, physical and behavioral health providers, plus public health and community members
Potential Financing Mechanism Being Explored: Upstream reinvestment of captured savings
Community Goals: Triple Aim of improving health outcomes, improving patient care and experience, and decreasing the cost of physical, behavioral and, eventually, dental care
“We know that social determinants, poverty and education among them, have a tremendous impact on health,” says Jim Carlough, president and CEO of Yamhill CCO. “Being selected as a Bridging for Health site gives us the opportunity to have access to national resources and consultation to help us move forward to address social determinants of health and how we pay for doing things together as a community. It’s also an opportunity to share what we’re doing here with other communities across the country.”
CCOs, a National Model
Under the Oregon Health Plan (the state’s Medicaid program), local CCOs deliver health care for a geographically-defined service area and population of patients. CCOs, like accountable care organizations nationally, are given a fixed budget for providing care with defined outcomes and quality measures. With this charge, comes financial responsibility—savings generated from efficient care and the improving health status of a population yields a financial reward (performance-based incentive payments), while uncoordinated or excessive care needs resulting from an unhealthy population spells appreciable financial risk for the organization and providers.
In Oregon a statewide network of 17 CCOs are charged with providing comprehensive services—physical, mental, and oral health care—to covered populations. The CCOs are given flexibility to create new models of care that juggle improving the quality of care while containing costs and ultimately reducing health disparities. This is largely accomplished through coordinated, team-focused care.
Yamhill CCO takes this approach one step further. Recognizing that its Medicaid population faces high risk for psychosocial challenges that impact health outcomes, Yamhill CCO sees incorporating non-traditional health partners and services (like those early childhood education) as an opportunity to significantly improve the health of its population.
Community Focus from the Start
Despite receiving state funds, CCOs in Oregon are essentially community driven. Yamhill relies upon community-based partnerships of county public health agencies, health care administrative partners, providers, and local organizations; a community board to make strategic decisions for the CCO; and community stakeholders to help conduct a health needs assessment to ensure the CCO’s work addresses its community’s priority needs.
The overarching goal of the Yamhill CCO is to achieve the “Triple Aim” to improve health outcomes, improve patient experience, and decrease the cost of care—physical, behavioral and, dental. Yamhill CCO’s 2013 Transformation Plan, a blueprint towards achieving the lofty Triple Aim, identified eight area of focus that remain priorities. They include:
- Develop and implement a delivery model that integrates mental health and physical health care.
- Expand implementation of the Patient-Centered Primary Care Home. (One hundred percent of patients were assigned to physicians in the first two months of the CCOs operation.)
- Implement alternative payment methodologies that align payment with health outcomes.
- Develop a community health assessment and adopt an annual community health improvement plan.
- Encourage electronic health records; health information exchange; and meaningful use.
- Assure communications, outreach, member engagement, and services are tailored to cultural, health literacy, and linguistic needs.
- Address cultural diversity by providing cultural competence training and ensuring provider composition reflects community diversity.
- Develop a quality improvement plan to eliminate disparities in access to care, quality of care, experience of care, and health outcomes.
Central to achieving these transformations is having the right players at the table. Since its inception, Yamhill CCO has uniquely focused on including community organizations, even those outside of health care, with a common vision towards community wellness improvement.
“Yamhill CCO was really a grass-roots organization based on a community need to address access to health care and wellness opportunities,” Carlough said. “We started a brand new organization that really does have a diverse community board that makes the decisions about establishing and carrying out a new model of health care, and we carry the financial risk for those decisions.”
Inherent in the CCO model is the assumption of financial risk for the delivery of care. Yamhill CCO believes that operational savings are attainable with better service integration and care management and organizational leaders are currently exploring how to capture and reinvest those anticipated savings into upstream determinants of health, like early childhood education. (Evidence shows educational attainment is one of the greatest determinants of future health.)
Yamhill is the only CCO in the state with an early learning hub. The Yamhill CCO leadership believes the close alignment of the health care delivery system and the early learning hub will allow the county to synchronize care for children and families in an unprecedented manner.
“The capture and reinvestment of savings from invested state and federal dollars is an intriguing model to watch over time,” says Chris Parker, associate project director at the Georgia Health Policy Center, the national coordinating center for Bridging for Health. “Yamhill is a great opportunity for other communities and policymakers to learn from. They have a strong collaboration with a diversity of non-traditional health sector partners, innovations in financing, and a goal of improving health equity. The health impact of these factors coming together may have the greatest impact on the Medicaid population, where the burden is greatest.”