Coordinated Care Organization

Vineyards in Jackson County, Ore.  Jackson Care Connect serves many low-income agricultural workers.

It took considerable courage and enthusiasm three years ago to launch Jackson Care Connect (JCC), a Coordinated Care Organization in Oregon created to serve mostly low-income people on Medicaid.

In the past year, Cambridge Management Group (CMG) has participated in a nationally watched project to help JCC accelerate its mission to improve care and medical outcomes for its population while saving money as the U.S. healthcare system moves toward payment for value from fee for service.

Jackson Care Connect has brought together many organizations and other constituencies – some of them economic rivals of each other — to improve how it uses its limited resources.

A key part of Cambridge Management’s JCC engagement,  which included Bob Harrington, Marc Pierson, M.D.,  and Annie Merkle, was to study the individual parts of the healthcare-related environment in which Jackson Care Connect operates and then to explain, in part through mapping, the linkages among providers and a wide range of other community players — many not healthcare institutions per se — and the social determinants of health. CMG’s research is richly presented in graphics and a report.

(Biographical sketches of the CMG team may be found at this link to the “Professional Staff” page of CMG’s Web site.)

CMG had to understand the function of each part of the JCC universe before it could propose ways to make all players mesh their operations for the benefit of the entire population being served.

Cambridge Management suggested how JCC could best coordinate all these moving parts to meet the Triple Aim of improving the individual patient experience (including quality and satisfaction); improving the health of populations — of particular importance to an organization like Jackson Care Connect — and cutting the per-capita cost of healthcare.

Informing all this work has been the need to address the social determinants of health (which experts consider account for up to 90 percent of health, with direct contact with the healthcare system accounting for the rest). These determinants include, among many other factors, family income, family stability or lack thereof, environment, transportation and education.

Dr. Pierson, we should note, is a former emergency physician and hospital executive who is longtime expert on the social determinants of health and how to reform the healthcare system to address them. His work on addressing these determinants of health in Washington State has drawn national attention.

Jackson Care Connect’s chief executive, Jennifer Lind, said that the CMG team found “areas where things didn’t work,’’ helped determine where operations and attitudes could be most quickly improved, and then facilitated more efficient “interactions between the moving parts.’’

“Cambridge Management broke down what everyone was doing and then convened different constituencies together to try to fulfill larger vision. They worked with us to align the different groups to create a community vision of improving outcomes and capturing savings – not just adding more services upstream.’’

“Bob and Marc as conveners got excitement for change going in the various groups by helping them see what they could do better individually and, especially, together.’’

Cambridge Management’s engagement with JCC — informed by CMG’s decades of working with physicians to align their interests and work with their institutions — sparked new thinking about how clinicians and others could make the new value-based payment systems work better. Ms. Lind said that “clinicians, especially, were inspired by Bob {Harrington} and Marc {Pierson} to help develop new initiatives.’’ These included, Ms. Lind said, “improving care transitions between hospitals and nursing homes and between primary-care physicians and specialists.’’

She noted the complexity of the move to fee for value. “We asked people to do really complex stuff. Some people just don’t like being thrown into complex projects.’

But of course transforming American healthcare is complex stuff: The U.S. system is by far the world’s most complicated and among the most inefficient.

Further, she said, improving Medicaid at the provider and user end is particularly difficult because it doesn’t have the much more powerful economic and political constituencies of Medicare and private insurers. Further, there’s no central authority with statutory power to impose the sort of coordination that Jackson Care Connect and similar regional groups seek to help their populations.

Still, that JCC’s initiatives so far have shown all its constituencies the value of care coordination, and that a wide range of important constituencies are represented on its board, should over time increase its ability to implement new clinical and payment models.

Ms. Lind said: “With Cambridge Management’s help, we’ve been showing the system how to deal with the new payer world.’’

By explaining the linkages through a “system and process lens,’’ CMG helped them make order out of the seeming “chaos’’ of the community health environment.

Here’s a poster describing the linkages of Jackson County’s healthcare entities and related information: OHA Summit 2015 Jackson Poster am.ppt (PowerPoint file will download).

A report, with graphics, on the findings and recommendations of the CMG engagement is linked here (PDF) and appendix here. (PDF)

Read the description by Marc Pierson, M.D., of Cambridge Management Group’s convening and mapping process.