Why CCOs Matter to School Nurses …….and how to become involved.

Beth Baynes, MESD  In partnership with:  Nina Fekaris, Beaverton SD  Paula Hall, WLWV SD

CCO 101  A Coordinated care organization, or CCO, is a network of all types of health care providers (physical health care, addictions and mental health care and sometimes dental care providers) who have agreed to work together in their local communities to serve people who receive health care coverage under the Oregon Health Plan (Medicaid). CCOs are focused on prevention and helping people manage chronic conditions, like diabetes. This helps reduce unnecessary emergency room visits and gives people support to be healthy. 

What Will Stay the Same and What will be Different with Coordinated Care Organizations  Under CCOs, the Oregon Health Plan's medical benefits will not change. Before CCOs, the system separated physical, behavioral and other types of care. That made things more difficult for patients and providers and more expensive for the state.  CCOs have the flexibility to support new models of care that are patient- centered and team-focused, and reduce health disparities. CCOs are be able to better coordinate services and also focus on prevention, chronic illness management and person-centered care. They have flexibility within their budgets to provide services alongside today's OHP medical benefits with the goal of meeting the Triple Aim of better health, better care and lower costs for the population they serve.

How Coordinated Care Organizations Work CCOs are local. They have one budget that grows at a fixed rate for mental, physical and ultimately dental care. CCOs are accountable for health outcomes of the population they serve. They are governed by a partnership among health care providers, community members, and stakeholders in the health systems that have financial responsibility and risk.

Status of Coordinated Care Organizations  Today, there are 15 CCOs operating in communities around Oregon.  Oregon Health Plan benefits will stay the same. Clients' doctors will stay the same.  Reducing costs while improving care Oregon has committed to meet key quality measurements for improved health for OHP clients while reducing the growth in spending by 2 percentage points per member over the next two years. 

Care Coordination  School Nurses conduct care coordination activities frequently and are experts in this intervention.  How are school nurses identified and accounted for in the CCO framework?  Can the community CCO make a difference in the school nurse’s practice?

School Nurse Engagement Step 1 Awareness: Monitor the Environment Step 2 Identify Allies Step 3 Make the Introduction Step 4 Promote SN Role Step 5 Start the work

Step 1 Awareness: Monitor the Environment  Read the website.  Watch for meeting announcements.  Identify the CCO (s) in your community.

What We Did  Attended community meetings by OHA designed to generate awareness and solicit community input to CCO design and development.  Reviewed work committee membership, and contacted partners. Example: Dr. Oxman (MCHD) and Mary Rita Hurley (Ex Director OCN).

Step 2 Identify Allies  Identify your CCO.  Initiate contact with:  CCO staff  CCO Governing Board

What We Did  Identified the 2 CCOs approved for the Tri-County area:  Health Share of Oregon (Tri-County CCO)  Covers Multnomah, Clackamas, Washington Counties  FamilyCare  Covers Multnomah, Clackamas, Washington and part of Marion County.

Step 3 Make the Introduction  Use phone, , other relationships to connect with CCO staff.  Keep at it until contact has been made.  Identify yourself as a school nurse, and voice your desire to meet with the CCO to discuss how you/school nurses in the area can work collaboratively in order to coordinate the care of school-age members.  Follow up after the meeting or contact with a request for further conversation.

What We Did  Identified HSO key staff were scheduled to attend the local HKLB meeting.  Attended the meeting.  Came prepared to provide a quick summary and description of school nurse role.  Brought lots of business cards to distribute.

Step 4 Promote School Nurse Role: The Meeting  Describe the role of the school nurse.  Describe the types of nursing procedures that are conducted in your schools.  Use data to describe your population.

What We Did  Success! Invitation to meet with Chief Policy Officer, Chief Medicaid Officer, and other key staff.  Invite one nurse from each county for initial meeting: Paula and Nina.  Prepared one notebook of resource documents for the CCO.  Prepared 2 page document with condensed, key information as the talking points.

Step 5 Start the work  Review goals and outcome metrics of your CCO.  Leverage CCO payment metrics to accomplish school nurse goals.

What We Did  Following the initial meeting, we were invited to establish a monthly standing meeting.  Became familiar, and discussed

Expected Outcomes  Increased efficiency in care coordination activities  Increased awareness of school nurse role by medical community  EHR coordination  Blended funding

Student Outcomes  Improved health status of students  Research links school nurse involvement with increased attendance.  Schools are accountable for attendance and achievement:  Funding  Achievement Compacts  Maughan, E. (2003). The impact of school nursing on school performance: A research synthesis. Journal of School Nursing, 19(3)

Discussion with Administrators  Inform your districts about your activities with community CCOs and potential for increased student achievement.  Review district achievement compact, and potential link to health outcomes and student achievement.  Be prepared to think about your role in a different way.  ADHD and performance measures example.

Ultimate Outcome  Working with CCOs in your community will provide you an opportunity to describe, demonstrate, and increase the visibility of your school nurse role.

The End.  Any questions?  The Power Point and materials will be posted on the OSNA website.