Redesigning a care model for better health. CareOregon's MEDS (My Easy Drug System), Health Resilience program, and human-centered design programs are leading the way.

1. CareOregon
Opportunities and Challenges
Redesigning a Care Model
Patrick Curran
President and CEO
®
®

2. Agenda
 Demographic and clinical profile
 Program examples
• Health Resilience program
• MEDS (My Easy Drug System)
 Moving upstream
 Challenges with current system
 Discussion

3. • Formed in 1994
• 501(c)(3)
• 240,000 Medicaid
members
• 11,000 Medicare
members
• $1B annual revenue
• 510 employees
• SNP since 2006
• 3.5 Star Rating

4. Mission
Cultivating individual
well-being and
community health
through shared learning
and innovation
Vision
Healthy
communities for all
individuals
regardless of
income or social
circumstances

5. Member Demographics
47.0
1.0
10.9
41.2
65+ Under 65
Percent of total Medicare members
with disabilities, by age band
Not Disabled Disabled
0.0
10.0
20.0
30.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Current Medicare membership's first
year on CareOregon Advantage
Not Disabled Disabled
%
21.4 20.8
36.2
21.6
Female Male
Medicare age/gender demographics (%)
Under 65 65+
5.7%
6.2%
6.4%
6.8%
7.6%
8.9%
9.4%
11.7%
12.0%
14.2%
16.2%
Drug/Alcohol Dependence
Vascular Disease
Morbid Obesity
Seizure Disorders and Convulsions
Specified Heart Arrhythmias
Schizophrenia
Congestive Heart Failure
Major Depressive, Bipolar, and…
Diabetes with Chronic…
Chronic Obstructive Pulmonary…
Diabetes without Complication
Medicare membership with chronic
conditions

6. 41%
28%
26%
13%
12%
11% 11%
8%
6%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Depression Diabetes Asthma COPD CHF Heart Schizophrenia Chronic Renal
Failure
Bipolar
Percentage of CareOregon Advantage D-SNP
members with various chronic conditions

7. Program No. 1: Health Resilience
 Highest-cost, most-complex
members were not getting needs
met with previous approaches.
• Telephonic case management
• Clinic-based care
management
 Because they contribute as much
as 60% to our annual health care
expense, largely driven by ED and
hospital admissions, some of
which are avoidable.
 Social values
Curtis Peterson, Health Resilience Specialist
and Gordon Rasmussen, Client
Charlie Kloppenburg, photographer

8. New Primary Care Workforce
Health Resilience Specialists (master’s level social workers) are embedded
with primary health homes and specialty practices to enhance the practices’
ability to provide community-oriented individualized “high touch” support to
high risk/high cost patients.
Social Behavioral
Medical
• Health risk behaviors
• Cognitive / coping
skills
• Health literacy
• Basic needs: food,
shelter, safety,
ADLs
• Supportive
relationships
• Trauma recovery
• Hope and purpose
• Integrated with
primary care team
• Care Coordination
with specialists and
MH providers

9. Clinical Assessment Data:
Health Resilience Clients N= 275
No
36%
Yes
64%
Active behavioral
health challenge
75%
51%
31%
Depression
Anxiety
PTSD
Yes
55%No
3%
Hx of traumatic
experiences
Unknown
42%
Yes
54%
No
30%
Active trauma
Unknown
16%
Yes
42
%
No
58
%
Chronic pain
Current living situation

10. ED Utilization Rates for HRP Cohort

11. Hospital Utilization Rates for HRP cohort

12. Program No. 2: MEDS Chart
• The estimated cost to the
U.S. health care system is
more than $200 billion/year.
• (8% of the country's total
annual healthcare
expenditure)
12
50%
of
Americans
fail to take
medicines
correctly
Brown MT, Bussell JK. Medication Adherence:
WHO Cares? Mayo Clinic Proceedings 2011;
86(4):304-314.
Copyright – all rights reserved

13. V
All prescribers
Pharmacist
PCP/Clinic
Health
Resilience
Specialist
(HRS)
ER
Hospital
Coordinated Care Organization
• Covered benefits/services
• Targeted strategies/programs
Caregiver
Patient
+/-
Caregiver
PTSD
DEPRESSED ANXIOUS
Medication
Trauma
Map
Copyright – all rights reserved
Nurse
Mental
health
support

14. Medication Trauma Cycle
Trauma
Impairment
Risk
behaviors
Diseases
worsen
Medications
increase

15. SNP Medication Trauma
Risk Prevalence
Risk score of 10 or greater (1,000 members)
Monthly average experience
• 3 different pharmacies
• 5 different fill dates
In 12 months
• 30 different drug/dosage/strength combinations
• 12 different prescribers

16. Medication Trauma Treatment
“Fewer medications taken the right way for the right
length of time is better than lots of medications taken
the wrong way and stopped due to side effects, drug
interactions, confusion and fear.”
MEDS Chart helps the care team
take the next step in educating
patients about how they
can simplify, change or reduce
medications.
Copyright – all rights reserved

17. Copyright – all rights reserved

18. MEDS Team Model
 Deploy High-Risk Rx model: Organize network of
pharmacists to screen and manage high-risk
pharmacy patients (~10,000) at risk for medication
trauma.
• Dispensing pharmacist payment model
• Clinical pharmacist payment/staffing/recruitment model
• Transitions coordination (hospital, clinical and dispensing pharmacist
all working together)
• Organize with other touches from multi-disciplinary team
 Measure outcomes in 2016

19. SNP Conservative Cost Savings
 6.7:1 ROI with pharmacist time
• If every actively managed empaneled patient
achieves one point better in risk score.
 If 1 in 6.7 patients succeeds, then it breaks even.
 Somewhere between 1:1 and 7:1 is likely reality.
• Other MTM programs show 3 to 10:1 ROI but have
not focused on high-risk trauma Medicaid and SNP
populations through trauma-informed care
principles.

20. Overall Utilization Strategy
Old Model of Care
• Entire population
• Telephonic
• Regulatory focus
• Health-plan based
New Model of Care
• High-risk population
• Face-to-face
• Clinical focus
• Partnering with delivery
system

22. Housing with Services Model

23. Human-Centered Design
• Field research
• Listening
• Brainstorming
• Prototyping
• Piloting
• Production

24. SNP Model of Care Elements
1. Description of the SNP-specific target population
2. Measurable goals
3. Staff structure and care management goals
4. Interdisciplinary care team
5. Provider network having specialized expertise and use of clinical
practice guidelines and protocols
6. Model of Care training for personnel and provider network
7. Health risk assessment
8. Individualized care plan
9. Communication network
10. Care management for the most-vulnerable subpopulations
11. Performance and health outcome measurement

25. Star Rating: Progress?

26. Thank You
Patrick Curran
President and CEO
CareOregon
curranp@careoregon.org
503-416-1421 (office)