What does a CCO mean to my small practice?
The goal of the CCO is to provide resources to physicians that will enable them to enhance the level of care provided to OHP members. All members, including those who receive care in small practices, will benefit from improved care coordination under the CCO model.
How can I be involved in the CCO administration?
The CCO will work with physicians to help manage and improve the health of their patients. As the individual provider, you may need different things from the CCO than another provider or practice to accomplish this goal. That is why the CCO has physicians representing primary care, psychiatry, pediatrics and high volume Medicaid practices on the clinical advisory board so that specific needs can be voiced and effectively addressed.
How is the CCO going to help my practice improve patient care?
WVCH welcomes input from providers. Physicians have the opportunity to participate in both the Clinical Advisory Board and the Consumer Advocacy Committee, as well as the numerous ad hoc subcommittees that are being created to inform the board of directors. If you are interested, we encourage you to contact WVP Health Authority Quality Improvement.
Will the scope of what specialist physicians are able to do based on their referral approval change?
No, specialty physicians’ scope of practice will not change.
What do I need to do/know for August 1?
There will be a new Pharmacy Benefit Manager, OHP members can stay with their same pharmacy and the new information will be located on their new member ID cards.
Contracts rolling over and are not scheduled to change until January 2013.
Eligibility verification process will remain the same
Authorization numbers are staying the same
How do I learn more about CareAccord?
CareAccord is a direct secure e-mailing system that enables HIPAA covered entities with to communicate with one another electronically, via e-mail. Please visit https://www.careaccord.org/ to learn how to get registered with this free service.
How do I learn more about the health insurance exchange?
The Health Insurance Exchange is a marketplace for consumers to choose individual, family, and small group plans and learn more about access to federal tax credits. To learn more visit https://orhix.org/about_us.html.
How is the CCO planning to decrease cost?
The CCO is planning to decrease cost by focusing on the top 20% of clients who utilize 80% of the resources. Other areas that we are focusing on include: utilizing non-traditional health workers, increasing communication electronically, increasing communication between medical, mental and dental providers, and pushing for an increase in primary care utilization as a way to avoid costly hospital admissions and ER visits.
Do non-traditional health workers actually save money?
Non-traditional health workers (also called community health workers, lay leaders, or peer mentors) are non-clinical individuals, typically supervised by a clinical professional, who engage with clients in order to enable clients to get to their appointments and assist with navigating the health care system. The MOMS Program utilizes peer mentors and has helped Marion County in decreasing children born drug positive significantly decrease from 114 in 2005 to 12 in 2010 and 9 in 2011. None of the babies born positive in 2010 and 2011 were born to mothers who were involved in the MOMS Program. Here are additional articles supporting the use and expansion of community health workers:
How did WVCH select the listed partners?
Willamette Valley Community Health reached out to community stakeholders who share the same vision, in that the primary goal is to provide effective health care to our community. In addition, the Oregon State Legislation also provided a directive in who should be considered as stakeholders, taking into consideration the expenditures of health care services for Oregon Health Plan. The Federally Qualified Health Centers and County Health departments were identified as key participants, primarily based on their classification as “Large Key Risk Takers.”
More questions and answers coming soon…
- How will this process work?
- How will this improve health care?
- How will this save Oregon and taxpayers money?
- What are the benefits?
- Does this make government involved in my health care?