CAC 101: An Introduction to Community Advisory Councils Jessica Coshatt Peer Wellness Specialist II FamilyCare CAC Member

Welcome! Oregon is a national leader in health system transformation. By working together to improve how coordinated care organizations (CCOs) manage and deliver care, we are changing the face – and function – of health care in Oregon. We are the bridge between our communities and the entire health system. We are agents of change. We won’t get the outcomes we need if we’re not at the table asking for them. That’s where the Community Advisory Councils (CACs) come in.

Presentation Overview 1. Health System Transformation 2. Coordinated Care Organizations (CCOs) 3. Community Advisory Councils (CACs), Part I 4. Community Health Assessments (CHAs) 5. Community Health Improvement Plans (CHIPs) 6. Community Advisory Councils, Part II 7. Community Advisory Council Supports 8. Community Advisory Council Events 9. Resources and References

HEALTH SYSTEM TRANSFORMATION The Changing Face of Oregon’s Health System

Affordable Care Act: Overview The Affordable Care Act (ACA) encompasses the largest changes to American health care in 50 years. Increase of 454,000 covered patients since the ACA took effect in January 2014 Total Oregon Health Plan (OHP – state Medicaid) enrollment: 1,064,000 as of April 2015 …and this is just here in Oregon.

Health System Transformation Goals: The Triple Aim The Triple Aim guides all of our work. It simply and clearly states what CCOs and CACs are all here for:

COORDINATED CARE ORGANIZATIONS Pulling It All Together

Coordinated Care Organizations: Overview Most people receiving care under the Oregon Health Plan are enrolled in a CCO. CCOs are local health care networks focused on: Comprehensive patient-centered care Communication between all types of care providers Preventive care Chronic disease management Early intervention Addressing regional, cultural, socioeconomic, and racial disparities in health care Reducing waste and inefficiencies

Before CCOsWith CCOs Fragmented careCoordinated, patient-centered care Disconnected funding streams with unsustainable rates of growth One global budget with a fixed rate of growth No incentives for improving health (Payment for volume not value) Metrics with incentives Limits on servicesFlexible services Health care delivery disconnected from population health CCO Community Health Assessments and Improvement Plans Limited community voice & local area partnerships Local accountability and governance, including a Community Advisory Council Before and After CCOs

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CACs Around the State AllCare Health Plan: 3 Cascade Health Alliance: 1 Columbia Pacific CCO: 3 Eastern Oregon CCO: 13 FamilyCare, Inc: 1 HealthShare of Oregon: 1 Intercommunity Health Network: 3 Jackson Care Connect: 1 PacificSource Central Oregon: 1 PacificSource Columbia Gorge: 1 PrimaryHealth of Josephine County: 1 Trillium Community Health Plan: 2 Umpqua Health Alliance: 1 Western Oregon Advanced Health: 2 Willamette Valley Community Health: 1 Yamhill County Care Organization: 1

Source: Oregon Health Authority Narrow Focus = Deficient Results

For Your Consideration… What is unique about your CCO? What are some of the basic and specific needs of your community? How is information best shared in your community? How can you use common venues to raise awareness of community health issues? What are some ways to collect information and opinions from your community?

COMMUNITY ADVISORY COUNCILS, PART I Who We Are and What We Do

Community Advisory Councils: Overview Oregon Revised Statute (ORS) requires CCOs to create Community Advisory Councils (CACs), which must: meet regularly to ensure the CCO is addressing the health care needs of CCO members and the community. include representatives of the community of each county served by the CCO. Consumer representatives must constitute a majority of the membership (at least 51%). include a representative from each county government in the service area.

CAC Duties Oregon Revised Statute (ORS) describes the responsibilities of CACs: identifying and advocating for preventive care practices to be used by the CCO. overseeing a community health assessment (CHA). adopting a community health improvement plan (CHIP) to serve as a strategic plan for addressing health disparities and meeting health needs of the communities in the service area. annually publishing a report on the progress of the CHIP.

COMMUNITY HEALTH ASSESSMENTS Unearthing Community Priorities

Community Health Assessments: Overview A CHA: is a process of collecting, analyzing, and interpreting information about a community’s health assets and needs. helps to identify and prioritize areas needing improvement. informs policy formulation, implementation, and evaluation. must be overseen by each CAC every five years.

Commonly Prioritized Health Issues Access to health care Mental health Chronic disease Substance abuse Culturally competent data and care Oral health Domestic violence Cancer Maternal and child health Sexual health

COMMUNITY HEALTH IMPROVEMENT PLANS Where The Rubber Meets the Road

Community Health Improvement Plans: Overview A CHIP is based on data from the CHA. It is a detailed working outline used to: identify priority issues. develop strategies for action. ensure accountability for creation of measurable health outcome improvement. guide our work as CAC members.

Helping people quit tobacco Providing youth with access to confidential health services Supporting access to healthy foods Encouraging physical activity Helping families be healthy Improving oral health Connecting to community resources Source: Oregon Public Health Division

COMMUNITY ADVISORY COUNCILS, PART II Getting Better at What We Do Best

Creating a High-Impact Community Advisory Council Effective CAC members: understand the basic requirements of the CAC and help the CAC to fulfill them. recognize their individual role within the CAC, and the function of the CAC group within the CCO. are creative and enjoy bringing new ideas to the table. work together to help the CAC function efficiently. have a commitment to serving their communities. look for new ways to become a high-impact group. ask questions and listen to learn.

Above...and Beyond: Engaging projects, good membership mix, excellent communication, community events, outside learning Moving Toward High-Impact: Recruiting new members, clear roles, good time and meeting management Basic Requirements Being Met: Following state laws and CCO policies and procedures, completing projects High-Impact CAC Model Material created by Vanessa Becker, V Consulting & Associates Inc., 2014

How Do We Strengthen the Community Voice? Recruiting, selecting, and retaining CAC members Sharing and hearing about ideas and projects happening around the state Learning more about how CCOs operate Networking at CAC meetings, presentations, and summits Using available resources to find more information about CHAs and CHIPs Using both successes and failures as learning experiences to guide our work in establishing clear objectives and creating measurable outcomes

For Your Consideration… What motivates you to stay engaged as a CAC member? How would you describe your role as a CAC member? What is one change that the CAC could make to engage you more fully? What is one thing you can change to increase the impact of the CAC? Would these changes invite new people to get involved? How can you ensure that your CAC meetings are as accessible, accountable, and transparent as possible?

CONSUMER ADVISORY COUNCIL SUPPORTS Where We Turn for Information and Ideas

CAC Supports: Oregon Health Authority OHA offers resources and shared experience to support the work of CCOs and their CACs. Resources include: Innovator Agents provide support to CCOs. statistical data and performance reports (metrics). funding information and opportunities. a Technical Assistance Bank, where CACs can get consultation to keep things running smoothly. access to the CAC Learning Collaborative, among others. a Transformation Center to help get ideas moving between CCOs.

What is the Transformation Center? Oregon Health Authority’s Transformation Center: is OHA’s hub for health system innovation and improvement. helps increase the rate and reach of transformation and the coordinated care model in Oregon’s health system. provides targeted technical assistance to help CCOs and other health plans and providers achieve results. offers support to CACs to help them achieve their mission of promoting the health of their CCOs' members and communities. ​

CAC Supports: OHA’s Public Health Division The OHA Public Health Division can help CACs: connect to local health departments identify community health programs that work find the right data measure success use community health data to inform CHIP strategies

RESOURCES AND REFERENCES For Your Information...

CAC Learning Collaborative collaborative/cac OHA Transformation Center Health System Transformation

CAC Acronym Reference APD Aging and People with Disabilities CAC Community Advisory Council CCO Coordinated Care Organization CHA Community Health Assessment (ref. CHNA) CHIP Community Health Improvement Plan CHNA Community Health Needs Assessment CWS Child Welfare Services DCO Dental Care Organization DHS Department of Human Services EHR Electronic Health Record EMR Electronic Medical Record (ref. EHR)

CAC Acronym Reference, Continued MAP Medical Assistance Program MAPP Mobilizing for Action through Planning and Partnerships OAR Oregon Administrative Rule OHA Oregon Health Authority OHP Oregon Health Plan ORS Oregon Revised Statutes PWS Peer Wellness Specialist SDS Senior and Disability Services SSP Self-Sufficiency Programs TPEP Tobacco Prevention & Education Program THW Traditional Health Worker

Oregon Administrative Rules & Statute Guiding CACs Community Advisory Councils are provided definition, authority, roles and responsibilities from three general areas. 1) Oregon Revised Statute (ORS); 2) Oregon Administrative Rules (OAR); 3) Policies & Procedures of the Coordinated Care Organization, developed and approved by the CCO Board of Directors. ORS (1) (i) Each coordinated care organization convenes a community advisory council that includes representatives of the community and of county government, but with consumers making up a majority of the membership, and that meets regularly to ensure that the health care needs of the consumers and the community are being addressed.

ORS Duties of the CAC include, but are not limited to: Identifying and advocating for preventive care practices to be utilized by the CCO Overseeing a community health assessment (CHA) and adopting a community health improvement plan (CHIP) to serve as strategic guidance for the CCO to address health disparities and meet health needs for the communities in their service area Annually publishing a report on the progress of the CHIP

Oregon Administrative Rules (14) “Community Advisory Council” means the CCO-convened council that meets regularly to ensure the CCO is addressing the health care needs of CCO members and the community, consistent with ORS ” Certification Criteria for Coordinated Care Organizations “(7) Each CCO must convene a community advisory council (CAC) that meets the requirements of ORS The applicant must clearly describe how it meets the requirements for selection and implementation of a CAC consistent with ORS , how the CAC will be administered to achieve the goals of community involvement and the development, adoption and updating of the community health assessment and community health improvement plan.”

Oregon Administrative Rules Operations and Provision of Health Services “(1) CCOs shall establish, maintain and operate with a governance structure and community advisory council that is consistent with the requirements of ORS and applicable health system transformation laws.” Community Health Assessment and Community Health Improvement Plan “(5) The CCO’s Community Advisory Council shall oversee the community health assessment and adopt a plan to serve as a strategic population health and health care system service plan for the community served by the CCO. The Council shall annually publish a report on the progress of the Plan.”

Oregon Administrative Rules Outcome and Quality Measures “(6) CCOs must adopt practice guidelines consistent with 42 CFR that address physical health care, behavioral health treatment or dental care concerns identified by members or their representatives and to implement changes which have a favorable impact on health outcomes and member satisfaction in consultation with its community advisory council or clinical review panel.” Reminder: Your individual CCO will have additional organization policies, procedures and guiding documents for your CAC that are complimentary and additional to the OAR and ORS’s.

Thank You! Alicia Atalla-Mei Brett Hamilton Tom Cogswell Jan Tesch Adrienne Mullock Feedback

This project was supported by Funding Opportunity Number CMS-1G from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services and the content provided is solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. 43