COVID-19 Response

COVID-19 ResponseHow CareOregon is supporting its most vulnerable members

April 2020

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CareOregon is…CareOregon is a nonprofit community benefit organization involved in health plan services, reforms and innovations since 1994. We currently serve more than 375,000 Oregon Health Plan/Medicaid and Medicare members.

By listening to our members and exploring innovative solutions with our providers and communities, we help Oregonians prevent illness and live better lives. Every day, we strengthen our communities by making health care work for everyone. That’s the CareOregon Effect.

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Our statewide footprintHealth Share CCO Columbia Pacific CCO Jackson Care Connect CCO

• CareOregon serves 310,000 Health Share members

• Members live in the Portland metro region

• CareOregon is one of five health plans offered by Health Share. Other plans include: Kaiser Permanente, Legacy Health PacificSource, OHSU Health, and Providence.

• Columbia Pacific CCO is owned by CareOregon

• It serves 25,000 members

• Members live in the northern Oregon coastal counties of Columbia, Clatsop and Tillamook

• Jackson Care Connect is owned by CareOregon

• It serves 45,000 members

• Members live in southern Oregon’s Jackson County

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Responding to COVID-19• COVID-19 has created unprecedented impacts on the health care system and

challenged insurers to think creatively about our role in supporting the overall health of the health care sector.

• As a community benefit organization, we serve the most vulnerable and medically fragile populations in the state.

• We worked quickly to identify ways to assist them in accessing care to minimize the impact of COVID-19 on member health, while simultaneously deploying funds and other supports to ensure our provider network’s stability.

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We believe in whole-person care

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Google mobility report (Oregon, April 11th)

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By mid-April, Oregon’s shelter in place order was impacting travel to frequently visited destinations.

Our high risk outreach support plan


• Technology

• Telehealth (implementation, payment, and platform)

• Collective (tracking report for CO, state, and nation)

• High risk population

• Analytics

• Questionnaire and Resource Guides

• Further focus: Homeless-shelter work, SUD

• Housecall Providers (intensive and vastly different needs)

• Behavioral Health

• High risk medication guidelines

• Resource document for providers and members

• Health-related services

• Increased volume-review for COVID related and BH

• Adapt Policies and Procedures (i.e. bulk purchases)

• Non-emergent Medical Transportation support

• Clinical guidance for exposure, PPE, and prioritization of rides

Leverage existing CCO clinical infrastructure for response

(CAPs, RCT, PHP Analytics)

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Network

• Primary Care, Specialty, Behavioral Health, Dental

Care Coordination

• Unengaged last 24 months

• Additional support for network if no capacity

Customer Service

• Customer Service & Connect to Care- Lowest risk/tiers

• Pharmacy – Most drug complexity or high risk drugs

Create high risk list work flow (empowering providers)Principle: Outreach done by those with closest relationship first

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CareOregon

Care Coordination Framework

Regional Care Teams (RCT)

Panel Coordinators

PharmacyCustomer

Service/Connect to Care


How we prioritized high risk outreach

Priority 1- RCT/Pharmacy/PC

65 and older

More than 3 chronic conditions

Priority 2 – RCT/Pharmacy/PC

2a Hypertension only or asthma only

2b other chronic conditions not in 2a

Priority 3- CSRs/C2C

60 and older

No chronic conditions


CareOregon teams supporting the effort

Pharmacy Panel Coordinators Connect to Care/Customer Service

Outreach to members on high risk medications and infusion drugs (for RCT list/no capacity list)

Support Network and RCTs in:• Medication refills/90 day fills• Assist with mail order

pharmacy • Adherence monitoring

• Offer to support clinics with their lists

• Assist with RCT outreach, they have EMR access

• Focus on members over 60, no chronic conditions

• Connect to Care assist network/RCT with getting people signed up for OHP

• HRAs/HRS- will cross reference list so if doing outreach already, will do assessment as well and connect to RCTs if needs identified


Snapshot of Health Share’s high risk population


High risk populations across CareOregon’s footprint


Applying an equity lens to inform high risk outreach and community giving efforts

The problem:

• Communities of color disproportionately

affected by COVID-19

The intervention:

• Add health disparity data to high risk list

and outreach

• Focus community benefit dollars to support

CBOs focused on communities of color


Data dictionary – leverages ACG


Chronic condition list

• Diabetes

• Hypertension

• Ischemic heart disease

• CHF

• Asthma

• COPD

• Kidney disease

• Liver disease

• Transplant

• HIV

• Cancer

• Frailty


High risk medication list

• Diabetes• Hypertension• Ischemic heart disease• Asthma• COPD• Kidney disease

• Kidney disease

• Liver disease

• Transplant

• HIV

• Cancer


Questions?

Contact

Contact Chief Medical Officer, Amit Shah

[email protected]

mailto:[email protected]

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COVID-19 Response

Documents

Transcript of COVID-19 Response