SEASIDE, OR—Shauna Chilinski has a new outlook on her life, business and health because of the Oregon Health Plan (OHP) and Columbia Pacific Coordinated Care Organization.
“I was born with hip dysplasia,” said Chilinski, owner of Java Reef Coffee Shop in Seaside and member of Columbia Pacific CCO. “My leg bone would literally fall out of my hip joint, which made walking painful and quite difficult. But since I became eligible for OHP in January, I was able to have hip surgery that has allowed me to walk without pain for the first time in my life.”
Life hasn’t been easy for the Seaside woman. As a small-business owner with a life-long disability, she was unable to find affordable health insurance. She applied to every hospital in Oregon and several outside of the state for charity care to cover the corrective surgery and was repeatedly turned down. In the recent recession, she lost almost everything, including her house and her husband’s business, before qualifying for OHP. Under the Affordable Care Act, many more people became eligible for the Medicaid program in January 2014. After getting OHP through Columbia Pacific CCO, Chilinski had hip replacement surgery at Providence Seaside Hospital. She went in on a Friday afternoon and was discharged the following Sunday, able to walk out of the hospital without pain.
“This is why quality matters,” said Mimi Haley, regional executive for Columbia Pacific CCO. “Our partnership with the health care providers in our CCO allows them to do their very best in caring for our members, like Shauna. Our clinical advisory panel has been very dedicated to improving patient outcomes and meeting our quality metrics, which will allow us to help our members even more.”
“Columbia Pacific CCO is one of the higher performing CCOs in the state, meeting 100 percent of the incentive measures for 2013 and three of the challenge pool measures for a total incentive payout of more than $1.4 million,” Haley continued. “I have to credit our great partnerships with CareOregon, Greater Oregon Behavioral Health and each of the clinics in our CCO network that help us meet our triple aim goals of improving quality of care, lowering overall costs and improving patient care experiences.”
Oregon Health Authority set 17 CCO incentive measures for 2013. Of those, Columbia Pacific met or exceeded 13.8 of the measures.. The following measures are an example of those where the CCO met or exceeded the incentive targets:
- Colorectal cancer screenings
- Developmental screenings for infants and toddlers (0-36 months)
- Electronic health record adoption
- Reductions in emergency room utilization
- Enrollment of members in a patient-centered primary care medical home
- Reduction in early elective deliveries
- Follow-up after hospitalization for mental illness
- Follow up care for children prescribed ADHD medications
- Mental and physical health assessment with 60 days for children in DHS custody
Rather than keep the whole payout, as some CCOs plan to do, Columbia Pacific CCO will reward the clinics that are recognized as patient-centered primary care homes and include all of the participating partners (including behavioral health providers) that served 500 or more CPCC members. Columbia Pacific CCO plans to give 50 percent of the payout to partner clinics up front, then share the other 50 percent based on clinics’ willingness to increase access to members or for performance in meeting specific metrics.
In addition to meeting the 2013 quality measures, Columbia Pacific grew membership more than 68 percent in 2013 and accomplished the following heath care transformation projects:
- Opened the North Coast Pain Clinic in Astoria
- Assigned 80 percent of all CCO members to a patient-centered primary care medical home
- Created four local community advisory councils and a CCO-wide community advisory council
- Developed a CCO-wide Community Health Improvement Plan
- Collected more than 300 narrative stories about health and well-being from across the service area that will be used to help define future service needs
- Funded seven local organizations for local health improvement projects, from a new clinic start up to suicide prevention training and mentoring for school-aged children