Oregon CCO’s –
Passing Fad or A Model for the Future
Changing How we Provide Care
David Schlactus, CEO, Hope Orthopedics
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David Schlactus - None
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CCO’s v. ACO’s
How they Came About
Why CCO’s
A Driving Force for Change?
Preparing for CCO’s
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CCO’s in Portland v. other parts of Oregon
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A Passing Fad or the Future?
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“The definition of insanity is doing the same
thing over and over again and expecting a
different outcome”
- Albert Einstein
“Americans can always be counted on to do the
right thing….after they have exhausted all
other possibilities.”
- Winston Churchill
“In the absence of a compelling reason to
change, people don’t”
- Phillip Kotter, Leading Change
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Healthcare on it’s current course is
unsustainable as a percent of the GDP
10,000 baby boomers turn 65 EVERY day
More than 50 million Americans are
uninsured
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In short:
More people are without healthcare
The cost curve has not yet been bent
Access to healthcare is rapidly decreasing due
to flatline reimbursement from Medicare &
Medicaid
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Conceived by Don Berwick, MD, former head
of CMS:
Improve Access
Decrease Costs
Improve outcomes / patient experience
But seriously - you can’t really do all three
right? Well – maybe we can.
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Hello ACO’s – the new Capitation, albeit, “risk
adjusted capitation”
All money for the hospital and physician
component are put in a basket and the
participants fight over who gets how much.
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“Quality” must be demonstrated
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65 demonstration projects in the US
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Coordinated Care Organization
◦ Includes all revenue for:
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Hospitals
Physicians
Behavioral / Mental Health
Dental Care
◦ This is NOT a theoretical exercise – they became
effective August 1, 2012
◦ (Mental Health and Dental $$ to be added in 2013
or 2014)
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Plan to have 60% of ALL Medicaid / OHP
patients enrolled by January 1, 2013
Plan to add PEBB and OEBB in 2014
Plan to add Healthcare Exchange patients in
2014
By 2014 – could be as many as 25% of ALL
Oregonians in a CCO
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As of September 15, 2012
13 CCO’s statewide
75% of all OHP patients enrolled
Over 500,000 Oregonians!
Fixed budget limits upside cost to state
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Why this is BAD math?
◦ Medicare
◦ OHP
◦ Commercial
$36
$28 – 30
$60 - $72
CF
CF
CF
◦ PEBB and OEBB =
15% of our volume
◦ Once in the CCO – the CCO will control these funds
– ah, sorry but mental health and dental are
underfunded so we need some of this money
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No problem – we just won’t participate
Nope – SB 158 allows a CCO to MANDATE
participation of providers if they provide
critically needed services
Arbitration for reimbursement rates
Who can afford to drop out if it includes
roughly 15% of your best paying commercial
business?
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Oh- by the way – did we tell you that OHP
rates are slated to go down by 10% on
January 1, 2013?
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What’s a group to do?
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Change how care is delivered!
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The goal of Hope Orthopedics is to lower the
cost of care (per unit) by 20%.
You can not do this by cutting staff
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Meaningful use
E-Rx
PQRI
QRUR
Etc…..
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We have to redefine how care is provided
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Two groups working on this:
◦ Physicians and PA’s at Hope Orthopedics
◦ Clinic Administrators in Salem
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17 physicians
10 PA’s
17 Therapists
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6 ATC’s at 6 local HS
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= 42 providers
2 Clinics + 2 Satellites
Staff spread between 4 buildings
Buying 2 more buildings
MRI, Brace Shop, Therapy, DEXA, ASC, ultrasound
coming
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Don’t just think outside the box – break the
box
We forced ourselves to think different by
creating wild and crazy scenario’s
Some of our scenarios included:
◦ MA’s are illegal in the state of Oregon – now what?
◦ Each MD gets only ONE room for the entire day
◦ Everything has to be done by the close of day – no
work can be carried over to the next day
◦ Our clinic no longer has a waiting room
◦ Our clinic no longer has any receptionists
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Some of our ideas include:
◦ Patients Register from home or on I-pads in the
lobby
◦ Express line for patients who pre-register
◦ MA Swarm
◦ RN triage
◦ Group pre-op classes
◦ Group physical therapy
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Some of our ideas include:
◦ New patients seen by a PA first – goal is to keep the
MD in the OR three days a week
◦ Do totals at our ASC’s with same day discharge
(have successfully completed 7 – with 2 more
scheduled)
◦ Rapid Access Clinic run by PA’s and they get 50% of
the net income
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1 hospital
1 IPA
450 physicians
1 Main EMR funded by IPA
4 EMR’s total in community
50 Administrators that have known each
other and worked together for as much as 20
years, in short
We have established some trust
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Some of our ideas include:
◦ The specialists “stake” the PCP’s with extra $$
◦ The $$ are used to hire navigators who call patients
to insure they take their meds, comply with care
plans and stay out of the ER.
◦ If we save money – savings go 1st to specialists and
then are split in the physician community
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Some of our ideas include:
◦ Establish a one day per week afternoon clinic for
low income / high complication patients, staffed by
the PCP’s and PA’s from all the specialists.
◦ Rather than force these people to travel all over
town by bus, they come to one clinic and can see all
of their care providers in one afternoon.
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Some of our ideas include:
◦ Pay our patients for compliance / results.
◦ $5 gift cards for showing up to the afternoon care
clinics.
◦ Collaboration between all of the PCP and specialty
clinics.
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CCO’s v. ACO’s
How they Came About
Why CCO’s
A Driving Force for Change?
Preparing for CCO’s

CCO’s in Portland v. other parts of Oregon

A Passing Fad or the Future?
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Your options:
◦ Put your head in the sand and hope this will all go
away
◦ Retire early – like at 44
◦ Wait until it is forced upon you, i.e., Oregon
◦ Get ahead of the curve
◦ Learn how to change how you deliver care and
reduce your per unit cost now. Experiment with
ideas but don’t make global changes quite yet.
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Think of it this way – if you could lower your
cost by 15%, you could afford to:
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see Medicaid patients
see more patients (improve access)
Spend more time with your patients (improve care)
And still make the income you do now
◦ At least that’s our premise and what we at Hope
Orthopedics are striving to achieve
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Who knows
But think of it this way – if we succeed and
lower our costs by 15% and the CCO’s fizzle –
have we wasted our time?
But if they are here to stay and we have not
changed how we deliver care, at all……..