How

CCOs Are Advancing Health Equity

Innova&on Caf
May 9, 2017
Salem, OR
What Is Health Equity?

Why Is Health Equity Important?

 Health Equity Consulta&ons with CCOs:
Technical Assistance Team

OHA Transforma&on Center sta and

Technical Assistance Bank consultant
OHA Innovator Agents
OHA Oce of Health Analy&cs
OHA Oce of Equity & Inclusion
 Health Equity Consulta&ons with CCOs

CCOs invited sta, board, community

par&cipants (CAC members, regional
health equity coali&ons, etc.)
Technical assistance team had pre-call,
two-hour consulta&on at CCO, debrief call
Shared data and materials with CCO
before consulta&on
Shared wriVen summary with CCO aWer
consulta&on
 Health Equity Consulta&ons with CCOs

Piloted May 2016

All 16 CCOs par&cipated > November 2016
144 total par&cipants
9 CEOs/equivalents, 5 CMOs/equivalents,
5 COOs/equivalents
Quality, data, IT, provider rela&ons sta
7 CAC coordinators/equivalents
5 CCOs had equity sta (full- or part-&me)
 Health Equity Consulta&ons with CCOs:
Data and Materials Reviewed
Data from July 2014 June 2015*
Demographic data about CCO members:
race and ethnicity, household language,
members with disability
Incen&ve measure data, stra&ed by
member demographics, when available
CCO Transforma&on Plan
CCO Community Health Improvement
Plan
 Health Equity Consulta&ons with CCOs:
Data and Materials Reviewed
Data from July 2014 June 2015
Demographic data about CCO members:
race and ethnicity, household language,
members with disability
Incen&ve measure data, stra&ed by
member demographics, when available
CCO Transforma&on Plan
CCO Community Health Improvement
Plan
Members with disability is dened as:
people who qualify for Medicaid based on an impairment
that has prevented them from performing substan<al
gainful ac<vity for at least one year, or is expected to
prevent them from performing substan<al gainful ac<vity
for at least one year;
this may include physical, mental, emo<onal, learning,
developmental or other disabili<es;
these individuals may or may not also be qualied for
Medicare
 Health Equity Consulta&ons with CCOs:
Data and Materials Reviewed
Data from July 2014 June 2015
Demographic data about CCO members:
race and ethnicity, household language,
members with disability
Incen&ve measure data, stra&ed by
member demographics, when available
CCO Transforma&on Plan
CCO Community Health Improvement
Plan
Medicaid Behavioral Risk Factor Surveillance Survey

Oversampled for each CCO in 2014

 Ensure Pa&ent-Centered Primary Care
Homes (PCPCHs)
Use holis&c approach, e.g., rou&ne
primary care, improving overall health
Recognize cultural/linguis&c barriers for
members; marke&ng by tobacco
companies
Review smoking cessa&on programs for
cultural/linguis&c appropriateness
Engage diverse members/communi&es/
Indian tribes to develop interven&ons
 Ensure Pa&ent-Centered Primary Care
Homes (PCPCHs)
Use holis&c approach, e.g. rou&ne
primary care, preven&ve services
generally
One Key Ques&on
Recognize cultural/linguis&c barriers for
members AND providers (s&gma, shame)
Review member educa&on/engagement
materials
Engage diverse members/communi&es
 Ensure Pa&ent-Centered Primary Care
Homes (PCPCHs)
Review access to aWer-hours and urgent
care services
Address eligibility issues for American
Indians, access barriers for members
with disability
Review member educa&on/
engagement materials
Engage diverse members/communi&es
 Improve coordina&on and integra&on of
oral and behavioral health services
Improve coordina&on and integra&on
with school-based health, early learning
programs
Bundle preven&ve services/screenings
for families in member educa&on/
engagement materials/communica&ons
 Health Equity Consulta&ons with CCOs:
Data and Materials Reviewed
Data from July 2014 June 2015
Demographic data about CCO members:
race and ethnicity, household language,
members with disability
Incen&ve measure data, stra&ed by
member demographics, when available
CCO Transforma&on Plan
CCO Community Health Improvement
Plan
CCO Transforma&on Plan Elements
 Improve informa&on about language
assistance services available
Translate member communica&ons into
Spanish and other languages
Review member communica&ons for
health literacy and for members with
disability
 Ensure access to interpreters, including
sign language interpreters
Test CCO mul6lingual sta for second
language prociency
Specic outreach to/engagement with
culturally/linguis6cally diverse members/
communi6es
 Conduct sta and provider trainings on
cultural competency, health literacy,
adverse childhood events/trauma-
informed care, culture of poverty
Review cultural competency policies of
providers
Support training and use of CHWs,
THWs, health care interpreters
Review CCO sta hiring policies
 Review provider networks to reect
diverse members/communi6es served
Improve informa6on in provider
directories
Increase sta trainings
Increase trainings on equity in clinical
care processes and outcomes
Engage Clinical Advisory Panels on equity
Leverage CHWs and THWs to support
equity
 Assign sta/work groups on health
equity
Analyze quality data stra&ed by
member demographic characteris&cs
Review member experiences of care,
complaints/appeals by diverse members
Implement interven&ons for reducing
iden&ed dispari&es
Par&cipate in/support regional health
equity coali&ons
 Rene health equity objec6ves (and
benchmarks)
Link health equity objec6ves to incen6ve
measures
Improve data collec6on and analy6cs to
support equity
Share data about equity with
community stakeholders, e.g. CACs,
governing boards
 Health Equity Consulta&ons with CCOs:
Data and Materials Reviewed
Data from July 2014 June 2015
Demographic data about CCO members:
race and ethnicity, household language,
members with disability
Incen&ve measure data, stra&ed by
member demographics, when available
CCO Transforma&on Plan
CCO Community Health Improvement
Plan
 Community Health Improvement Plans

Iden&fy needs of diverse communi&es in

Community Needs Assessment
Collect public health, rural health, other
data
Conduct focus groups, surveys of diverse
members/communi&es
Make explicit references, integra&ng
health equity, use an equity lens
 Community Health Improvement Plans

Recruit and retain diverse CAC members

Support training on health equity, social
determinants of health, etc.
CHP investments, pilots, projects focused
on health equity
Address social determinants of health
(transporta&on, early learning, etc.)
Follow-up Health Equity Technical Assistance

10 CCOs: September 2016 > April 2017

Up to 10 hours of tailored technical
assistance
Strategic planning/CCO-wide equity plan
Revise Transforma&on Plan objec&ves
CCO sta training
Engage providers serving La&no members
Tailor interven&on for La&no members
Review website with equity lens
How CCOs Are Advancing Health Equity:
Lessons Learned
Advancing Health Equity: Lessons Learned

Create a plan
Use your own data
Partner with diverse members/
communi&es
Engage providers
Build a diverse health workforce
Integrate into health system
transforma&on
Be accountable
 Advancing Health Equity: Create a Plan

LOTS of opportuni&es at every CCO:

connect the dots, develop a plan,
measure progress
Iden&fy an organiza&onal champion/
sponsor AND a lead implementer
Use incremental, achievable benchmarks
and objec&ves (not eliminate dispari&es
this year)
 Advancing Health Equity:
Partner with Diverse Members/Communi&es
Engage diverse members and communi&es
(dont do anything about me without me)
Find community gatekeepers/leaders, build
trust and long-term partnerships
Sustain at big-picture level (Community
Needs Assessment) and every day, every
encounter (every clinical visit, every
contact with CCO)
Leverage CACs as asset/entry point
 Advancing Health Equity: Use Your Own Data

Look at your own data; and keep

looking
Improve completeness of demographic
data from OHA, providers, members
Support collec&on and use of addi&onal
data (disability, sexual orienta&on,
gender iden&ty, social risk factors, etc.)
Use public health, rural health, other
data
 Advancing Health Equity: Use Your Own Data

Collect addi&onal data from sta,

providers, community stakeholders and
members
Support quality data from electronic
health records (will be the best data)
Leverage health informa&on exchange
(stra&fy by member demographics)
Advancing Health Equity: Engage Providers

Start with ensuring Pa&ent-Centered

Primary Care Homes (PCPCHs) for all
members
Help providers meet needs of culturally
and linguis&cally diverse members
(technical assistance, payment
incen&ves)
Integrate into quality improvement/
alterna&ve payment models
 Advancing Health Equity:
Build a Diverse Health Workforce

Support mul&lingual/mul&cultural health

workforce development (educa&on/
training, recruitment, reten&on,
promo&on) among CCO sta and
providers
Support training of CHWs, THWs, health
care interpreters
Support integra&on of CHWs, THWs into
team-based care
 Advancing Health Equity:
Integrate into Health System Transforma&on

Health equity is not separate or extra

Integrate health equity into
Transforma&on Plan objec&ves
Integrate health equity into Community
Needs Assessment, Community Health
Improvement Plan
Integrate into strategic and business
planning
Advancing Health Equity: Be Accountable

Stra&fy and report member, quality and

other data by member demographics
Collaborate with Oce of Health
Analy&cs on beVer measures of member
experience
Share progress on health equity ac&vi&es
with sta, board, providers and
community stakeholders
How CCOs Are Advancing Health Equity:
Your Ques&ons?
 Upcoming Webinar

How CCOs are advancing health equity through

health system transforma&on
Presenter: Igna<us Bau
May 16, 2017, 11 a.m.-noon
Register here:
hLps://aLendee.gotowebinar.com/register/
7552151027747260931