Trailblazing Oregon’s Alternative Payment Model Frontier: A multi-stakeholder, tri-county school-based health center innovation project
ABSTRACT SUMMARY
Panelists will describe the effort in Oregon to develop SBHC-specific Alternative Payment Methodology (APM) models in conjunction with Coordinated Care Organizations. They will 1) Describe the process of partnering with ACOs to develop alternative models; 2) Describe viable APM models for SBHCs; and 3) Share lessons learned including expected and unexpected challenges, successes, and strategies for adapting the work to other SBHCs in Oregon and nationally.
ABSTRACT DESCRIPTION
Health care transformation is rapidly innovating systems that incentivize value-based, outcomes-focused, and sustainable services. Alternative Payment Models (APMs) are a solution to the challenges of fee-for-service structures that undervalue traditionally non-billable, prevention-oriented services. At present, traditional payment structures do not compensate for the unique aspects of SBHC specific work despite the fact that these activities provide significant long-term health related cost savings. It’s crucial to develop APMs that support the various roles the SBHC may play based on student or student family needs. The ongoing sustainability of SBHCs is dependent upon successful integration with APMs that are specifically suited for the SBHC environment. Through the 1115 waiver process, Oregon was able to implement its ACOs/coordinated care organizations (CCOs). CCOs are locally governed networks of providers ranging from primary to tertiary care that have agreed to work together within the confines of a global budget to ensure the delivery of quality health care for the covered Medicaid lives in their defined region. CCOs are required to include school health in its community needs assessment and work collaboratively with the education community to improve health outcomes for school-aged children and adolescents. With the development of CCOs, there are new opportunities for SHBCs to partner with these organizations to address and improve the health outcomes of school-aged youth in Oregon.
In July of 2014, Multnomah County Health Department was awarded a grant from the Public Health Division of the Oregon Health Authority to coordinate a SBHC Alternative Payment Innovation Project. In coordination with the Oregon School Based Health Alliance (OSBHA), Multnomah County convened a collaborative workgroup to address the unique needs of SBHC care coordination and effectiveness of the delivery of health services. This large stakeholder workgroup was tasked with identifying various alternative payment models that are compatible with the unique way in which SBHCs deliver care. Stakeholders participating in this workgroup included representatives from three County SBHC programs, OSBHA, the Oregon Health Authority and Oregon Public Health Division, Oregon Primary Care Association, CareOregon as well as representatives from the two CCOs operating within the region. During these meetings stakeholders identified various barriers to school based health center sustainability, to what degree APMs address needs, and learned about the current APMs being utilized throughout the Country. Of the different payment models identified, the workgroup singled out those that would operate best within a SBHC center, giving special consideration to the fact that all SBHC centers do not have FQHC status, have different PCPCH recognition and varying levels of infrastructure and capacity.
Throughout the course of the project period each County was tasked with creating their own internal workgroup and applying the different APMs to their specific SBHC programs to see which payment model would work best within their program and identify any barriers that would inhibit the implementation of that model. Along with the internal county workgroups, there were workgroups created for finance, model of care and operations to help work through the technical aspects of the identified APMs as needed throughout the project. To help ensure that all stakeholders were kept up to date as to the progress of the workgroup, OSBHA created a webpage that provided access to project information and all documents created throughout the process.
PRESENTER(S)
NAME: Courtney Kappes MPA ORGANIZATION: Multnomah County School-Based Health Center Program NAME: Sarah Knipper MSW ORGANIZATION: Oregon Health Authority NAME: Maureen Hinman BS ORGANIZATION: Oregon School-Based Health Alliance NAME: Alexandra Lowell MPH ORGANIZATION: Multnomah County Health Department
AUDIENCE
ADMINISTRATORS: Y
PRIMARY HEALTH: Y
MENTALHEALTH: N
ORGANIZATIONAL: Y
PUBLIC HEALTH: Y
EDUCATION: N
YOUTH: N
Technical
issues should be directed to Deirdre Taylor via email: dtaylor@sbh4all.org
or Telephone: (202) 638-5872, ext. 204
