1. The Indiana Family and Social Services Administration Oregon and CCOs October 2009

2. Definition of a CCO CCOs are local health entities that deliver care and coverage to Medicaid and potentially state employees. They include: –Community level accountability for better health, better care, and lower costs –A focus on elimination of health disparities –New models of integrated care that are patient-centered and team focused with an emphasis on prevention

3. Definition of CCOs continued –A global budget that grows at a fixed rate for behavioral, physical, and dental care –Flexibility within the budget to deliver the outcomes expected –Incentives for improved care –Governed by a partnership between providers of care, community members, and the stakeholders in the health system who have financial responsibility and risk

4. Impetus For Change Budget issues and business community reaction Resulting reduction in funding State Direction Provider response

5. Managed care penetration Lack of substance abuse penetration Three to four plans for everyone Carved out populations Background

6. Provider Reaction Disbelief to action Some will lead others will follow Change on the table Jury still out

7. The “Deal” $1.9 Billion Detail negotiations complete and available Replication possible, but not guaranteed

8. Applicability To Indiana Are we ready for Community wide? Smaller geography? Everyone covered? Non health care outcomes? Reduced requirements for more risk on outcomes?