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Serving State Governments

Attune Healthcare brings value to state governments through its expertise in integration.

 Integrating delivery systems, for better care at lower costs

Background

True Transformation Led by States (click to enlarge)

With an eye towards the end of full federal government coverage for expanded health insurance population costs in 2020, some state agencies are looking for an effective model as the basis of a value-based purchasing economy, beginning with Medicaid. The best of these models integrate medical, behavioral, and oral healthcare, with community resources. Oregon has successfully implemented this integrated model, and patients, providers, communities and the state are reaping the rewards.

In Oregon, private health plans called Coordinated Care Organizations (CCOs) contract with the state to deliver medical, behavioral, and oral health services to Medicaid members through a global budget. CCOs are required to incorporate the needs of the community by performing a community needs assessment, engaging community representatives in decisions on CCO services, and integrating with public and private community resource organizations.

Since 2013, Oregon has held Medicaid spending rate increases to less than 3.4% annually through CCO programs that promote preventive care, use lower-cost care settings, reduce preventable emergency room visits and readmissions, and eliminate duplicate services. This 3.4% rate includes state incentive bonuses paid to CCOs for meeting quality and performance benchmarks.

Challenges

The Oregon results shown in the Appendix are compelling in and of themselves, but state agencies can still benefit from hands-on experience to implement this transformation model. Essential steps forward to the Oregon model include:

  • Development of a state-wide Transformation Plan
  • Definition of a persuasive case for legislators and providers to garner political backing and provider endorsements for the Plan
  • Application of lessons learned in developing a state-wide provider learning network, and
  • Adaptation of the transformative Medicaid model to state employee health coverage.
Services

Provider Training Overview (click to enlarge)

Attune Healthcare is skilled in the creation and implementation of Transformation Plans for the Coordinated Care Organization model. We begin by evaluating the funding streams and relationships between the state and its currently contracted Medicaid network. A state-wide Transformation Plan from Attune will incorporate the eight domains included in the Oregon model:

  1.  Behavioral and Physical Health Integration
  2. Advanced Patient Centered Medical Homes
  3. Alternative Payment Models
  4. Community Health Needs Assessment and Improvement
  5. Electronic Data Efficiency and Telehealth
  6. Workforce Development
  7. Health Equity and Access, and
  8. Improvement in Care Quality, Cost and Outcomes

We apply experience in integration in the private and public health sectors to a comprehensive approach for each unique state environment and incorporate community resource organizations into its Transformation Plan.

Attune supports agencies with state-specific analyses and position statements to aid in building political support and healthcare provider endorsements. Our resources include access to advisory services from the primary negotiator of the state-CMS relationship during Oregon’s transformation, as well as counsel on strategies and lessons learned.

The Attune team is also expert in developing programs and content for provider learning networks, and helps state agencies develop their criteria for public bids for technical assistance. Our experience in primary care and behavioral health provider training, and our successes in developing and implementing Alternative Payment Models for facilities, specialists, primary care, oral care and behavioral health care providers are a source of valuable advice for agency leaders and staff who wish to streamline transformation of their delivery system.

Attune has successfully adapted the Oregon Medicaid model to state public employee populations. We’re able to support state authorities through the process to negotiate the political demands and address the performance standards for state employee health coverage.

Anticipated Outcomes

With Attune’s guidance, state agencies can expect the development of a state-wide Transformation Plan built on the accumulated knowledge from Oregon’s journey, and a process designed to build consensus among key stakeholders.

We provide the benefit of experience in successful governmental coordination with the private healthcare sector. Integration models from Attune support the healthcare system’s needs as its sophistication grows in managing populations and risk. And our integrated models of care incorporate research in the effect of the social determinants of health on public programs and health outcomes.

We are experts in transformative education for practitioners, and skilled in best practices for APM design. Our experience in facilitating collaboration between agency staff, healthcare providers, and communities, supports the spread of a rapid transition to a value-based healthcare economy.

Oregon Results
Measure DescriptionImprovement
(Oregon Health Authority Data: through 2017)
Admissions for COPD and Asthma (Adults)53% Down from 2011
Admissions for Young Adults with Asthma55% Down from 2011
Admissions for Congestive Heart Failure15% Down from 2011
Readmissions within 30 days27% Down from 2014
Avoidable Emergency Room Visits52% Down from 2011
All Emergency Room Visits23% Down from 2011
Depression Screening & Follow Up+109% Up from 2014
Developmental Screening in 1st 36 Months+230% Up from 2011
Early Elective Delivery86% Down from 2011
Childhood Immunization+7% Up from 2011
Prenatal Care: Timeliness +85% Up from 2011
Reporting Good-Excellent Health+23% Up from 2011