Supporting Meaningful Engagement through Community Advisory Councils LESSONS FROM THE OREGON HEALTH AUTHORITY CASE STUDY AUGUST 2020 Renée Markus Hodin and Madison Tallant e WS Milbank > Memorial Fund Using evidence to improve population health LS OMMUNITY CATALYST CONTENTS ADSTraCt ......... ccc ccsesessneereccccsccecessesseseesecceeeeceessssesessssceeeeecssesceseseeseeeeeeeseeccssesessssuseseseeeeesons 3 INTFOCUCTION ..............csscccsssececsreeccseccessccssssceceseseessseecesseecesnecnsseesenseecessseseesescoesneceeseesceseeeoesneeee 3 Methods. ................eccccsssscceceesssccceesssscceseesencesenscssecesensossceeeeescseeeesesscseesessssceeeesssceeseeeersoseeeessnenes 5 Oregon Health Authority Support for CACS ............. eee eeecccssssrrcsccseseecceecestcccesscscsceesesssseeeesees 7 1. Transformation Center Staff ...............::eesseeceeeesceceeeesesceeesenecneeeeneseeeeeeeseseeeeesensees 7 2. INNOVatOr AGENTS .............ccccccccccssssssssssssrsccccccscssssssssnsnsesecceceeseesessssssnacecesecsesssseesees 7 3. In-Person EVeNtS .............scccccessseecccsssseecessessceceesssseecesssessecessssseeecessssssecessssseseeeseenes 7 4. Monthly Technical Assistance Calls .................::cccsssccccssssseceeesssccceresssceesessneeereees 7 5. 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State agencies and health care systems are increasingly seeing the value in engaging consumers not only in direct patient care, but also to guide organizational decisions about that care to drive progress on improving health outcomes and stabilizing health costs. Oregon has made substantial investments in this type of engagement. About a decade ago, the state embarked on an ambitious transformation initiative that established coordinated care organizations (CCOs), local networks of health care providers that receive a global budget to serve Oregon Health Plan (OHP)/Medicaid enrollees. The legislation that created CCOs also required these networks to create at least one community advisory council (CAC) to integrate community and OHP member voices in their work. Since the law's passage, the Oregon Health Authority (OHA), which oversees OHP, has devoted significant time and resources to these councils. This case study takes a look at what has made CACs, and the resulting consumer engagement, so successful. Key takeaways include: devoting state-level staff and financial resources to the program; creating strong lines of communication between OHA, CCOs, and CACs; and providing opportunities, including in-person events, for councils to learn from one another. Background Following the adoption of the Affordable Care Act, the Oregon legislature passed biparti- san, enabling legislation establishing coordinated care organizations (CCOs). In 2011, the legislature enacted HB 3650, which directed the Oregon Health Authority (QHA) to create a plan for a "Coordinated Care Delivery System for Medicaid." After a year of gathering public input-including at more than 75 public meetings or tribal consultations-the legislature passed SB 1580 in 2012. That law formally established CCQs as local networks of health care providers (including physical, mental health and addiction, and dental) that serve approxi- mately 600,000 enrollees in the Oregon Health Plan(OHP), the state's Medicaid program.'In addition to delivering a comprehensive suite of medical and related services, CCOs focus on prevention and community health. The state pays each CCO under a global budget, providing a risk-adjusted, prospective payment intended to cover total expected spending of the CCO''s patient population over a broad continuum of care for a defined period.* SB 1580 also required each CCO to create at least one community advisory council (CAC), an advisory body made up of OHP members and community representatives. CACs are respon- sible for overseeing a community health assessment and developing a community health improvement plan.' This requirement is consistent with growing recognition among policy- makers and health care organizations that consumer engagement is an important contribu- tor to the success of accountable care entities.' Milbank Memorial Fund ¢ www.milbank.org 3 Coordinated Care Organization 2.0 Service Areas (ealth --_-_- - CLATSOP COLUMBIA a, Columbia Pacific COLL} ( pre ay J Overlapping coverage areas. TILLAMOOK 5 InterCommunity Health Plans WHEELER OO dba InterCommunity Health work Coordinated Care Organizations PacificSource Community Solutions - Central Oregon 6R aX ve Eastern Oregon Coordinated - Care Organization, LLC busses his) | } 7 = Pr | Umpqua Health ] Alliance, LLC : | Dn] | | | Cascade Health | Alliance, LLC / Allcare CCO, Inc. Jackson County cco dba Jackson Care Connect While the legislature provided a solid framework for meaningful consumer engagement, the Oregon Health Authority (OHA) Transformation Center has breathed life into it by devoting significant staff and resources to making CACs work as well as possible-and encouraging participating CCOs to do the same.® The OHA Transformation Center continued its support of CACs as the state entered into the next five-year phase of health system transformation, known as "CCO 2.0." Launched in 2020, CCO 2.0 focuses on: e - improving the behavioral health system, increasing value and pay for performance, e focusing on social determinants of health and health equity, and e maintaining sustainable cost growth. Under the CCO 2.0 framework, OHA strengthened CAC requirements. For example, CCO governing boards are now required to have at least two CAC members,' at least one of whom is an Oregon Health Plan(QHP)/ Medicaid beneficiary.' Milbank Memorial Fund ¢ www.milbankorg 4 Methods Fifteen individuals were interviewed, either in person or by phone, to provide insight into OHA's support for CACs. Interviewees included leadership and staff of the Transformation Center, OHA Innovator Agents, CAC coordinators, and OHP members serving on CACs from three CCOs: Columbia Pacific CCO, Eastern Oregon CCO and PacificSource Com-munity Solutions-Columbia Gorge CCO. These CCOs were selected based on their geographic diversity and experience operating CACs, following discussions with Transformation Center staff and Innovator Agents. In addition to these interviews, this case study was informed by a review of CAC-related materials provided by the Transformation Center and CCQs, as well as content on the Transformation Center website. The interviews were recorded, transcribed and coded. * OHA Staff Member Tey el cel a + Liaison between OHA and CCO's Agents » Provides technical assistance to CCOs, including CAC Coordinators Oregon l h Transformation Coordinators Center - Often, CCO staff members CCOCAC e Coordinates and Supports CACs ¢ Supported primarily by Innovator Agent, but also Transformation Center ¢ Volunteer members of community served by CCO CAC CCO and OHP members Members » Supported primarily by CCO CAC Coordinator, but also Innovator Agent and Transformation Center Milbank Memorial Fund « www.milbankorg 5 Snapshot of Three CCOs' CAC Structures CCO Name Columbia Pacific CCO Eastern Oregon CCO PacificSource Community Solutions-Columbia Gorge cco Region 3 counties in Northwest 12 counties in Eastern Hood River and Wasco Oregon(Clatsop, Columbia | Oregon(Baker, Gilliam, counties and Tillamook) Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler) Number of CACs 3-one for each county 12-one for each county 1 Regional CAC Yes Yes No CAC Meeting Structure Local CACs(LCACs) meet Local CACs(LCACs) meet Monthly meetings monthly; Regional CAC monthly; Regional CAC meets quarterly; chair meets quarterly with LCAC and co-chair from each chairs in attendance LCAC attends the regional meeting CAC Coordinator(s) 2-one is responsible for 12-LCAC coordinators 2 the Clatsop and Tillamook CACs; the second is responsible for the Columbia CAC 4-CCO field staff from behavioral health care organization; each one is responsible for 3 LCACs Milbank Memorial Fund « www.milbank.org Oregon Health Authority Support for CACs In September 2012, OHA was awarded a four-year, $45 million State Innovation Model grant from the Centers for Medicare and Medicaid Services. The state used a portion of these funds to establish the Transformation Center as a "hub for innovation and quality improvement for Oregon's health system transformation efforts to achieve better health, better care and lower costs for all."* Broadly speaking, the Transformation Center "identifies, strategically supports and shares innovation at the system, community and practice levels"*-or, as one interviewee said, "to make good ideas spread faster." Once CCOs were formed, the Transformation Center received outside resources to support CAC development. The Northwest Health Foundation provided a $75,000 grant for start-up activities such as key meetings for all CACs. Oregon Health Authority support for CCO CACs includes: 1. Transformation Center staff; 2. Innovator Agents; 3. in-person events; 4. monthly technical assistance calls; and 5 webinars, training and materials. 1. Transformation Center Staff Since its creation, the Transformation Center has employed between 14 and 30 staff mem- bers, depending on the point in time and organizational structure. Three staff members support CACs with a range of responsibilities including: * strategic planning for CAC technical assistance/supports; « identifying partnership opportunities to support CACs; e - facilitating monthly meetings of the CAC Learning Collaborative and CAC coordinators; ¢ - planning and implementing an annual CAC conference; e regularly updating the CAC Supports webpage of the Transformation Center with relevant resources; e developing targeted technical assistance in response to feedback from CACs; e responding to requests for information from CCOs and CACs; and e developing policies to strengthen CACs. 2. Innovator Agents The Innovator Agent role was created by CCO enabling legislation as a resource for CCOs and a bridge between CCOs and OHA to help achieve the goals of health system transformation: better care, better health and lower costs." The five current Innovator Agents have diverse and extensive backgrounds in community development, public health, behavioral health and/ or social work. Milbank Memorial Fund « www.milbankorg 7 Among the Innovator Agents' responsibilities is supporting the formation and ongoing role of CACs, including attendance at every CAC meeting." They provide updates, as needed, from OHA; answer questions that arise on topics such as quality improvement projects; share information from other communities across the state; and field (and resolve) individual OHP member issues. Between meetings, Innovator Agents communicate primarily through CCO CAC coordinators" to share relevant information, answer questions, review document drafts, develop CAC meeting agendas, and help with special projects. 35. In-Person Events The Transformation Center has held an annual, in-person CAC conference since 2014. It brings together representatives from all CCOs and their CACs for one to two days to discuss strategies for their work. The events are planned by Transformation Center staff, with input from Innovator Agents, CAC coordinators, CAC members who participate in monthly CAC Learning Collaborative meetings and, typically, several consultants. Transformation Center staff also process all travel reimbursements for CAC members attending the events and cover hotel lodging expenses for these members. Almost uniformly, interviewees named these face-to-face events as the single most use- ful type of CAC-related technical assistance. As one interviewee observed, "for consumer members, that consumer conference, to be able to be around other consumers and hear their stories and share their experiences, is really, really helpful." The Transformation Center measures the impact of their in-person events using an online, immediate post-event survey and a six-month retrospective survey. In 2019, the six-month retrospective survey asked attendees to look back over the past six months to assess: e how helpful the support/technical assistance provided at this conference was in meeting CAC's needs (54% reported the assistance was either extremely helpful or very helpful); e how helpful the support/technical assistance provided at the conference was in improv- ing their knowledge, skills or abilities (nearly 60% reported the assistance was either extremely helpful or very helpful); and ¢ the session/type of information/experience from the conference they found to be the most useful in their role (common responses included: network- ing with others in the same role, sharing best prac- tices across CACs, learning strategies for engaging people in rural areas and learning about CCO 2.0). "[The CAC conference] started a conversation about how we can better launch efforts to involve more non-English speakers, and inspired us to create [meeting ground rules], as well as have acronym abbreviations on the . . ; 4. Monthly Technical Assistance Calls back of the monthly agendas. The Transformation Center facilitates the CAC ~ CAC Conference Attendee Learning Collaborative, a monthly conference call among CAC coordinators and members. This call Milbank Memorial Fund « www.milbankorg 8 serves as a forum for peer-to-peer sharing among participants and gives Transformation Center staff an opportunity to tailor support to CAC needs. Staff also facilitate a monthly meeting with CAC coordinators for similar purposes. In addition to these monthly calls, Transformation Center staff periodically conduct one- on-one telephone calls with CAC coordinators and periodically send out an online (or paper) needs-assessment survey to CAC members. 5. Webinars, Training and Materials The Transformation Center offers webinars throughout the year on topics related to CAC meeting management, CAC member recruitment and engagement, and other best practices. Many interviewees knew about and utilized these webinars, but others did not. Identified bar- riers to webinar use include finding time to watch them, making sure that all CAC members received notice about them, and perceptions that the content is irrelevant to their role. Staff and consultant-led, in-person training sessions are available to CCOs on issues such as the Commu- nity Health Assessment (CHA) and the Community Health Improvement Plan (CHP), areas for which CACs are responsible. In addition, the Transformation Center maintains an online resource library of webinar recordings, edit- able templates and presentations on topics such as planning effective CAC meetings and onboarding CAC Members. One of the most valuable and fre- quently used resources in the library is the CCO Community Advisory Councils: Handbook of Best Practices. This is a "living document' of recom- mendations and specific examples relevant to recruiting and engaging OHP members as active CAC mem- bers. This handbook reflects the vari- ation across CCOs in their approach to recruiting and selecting OHP CHAs and CHPs CCOs are required, by law and state contract, to complete a Community Health Improvement Plan(CHP) based ona Community Health Needs Assessment (CHA) at least every five years. Community Health Needs Assessments (CHA) identify key health needs and issues through systematic, comprehensive data collection and analysis. CCOs must develop a CHA in collaboration with local public health authorities, hospitals, tribes and other CCOs that share the service area. Community Health Improvement Plans (CHP) are long-term, systematic efforts to address community health issues, needs and priorities. CCOs must develop a shared CHP using the findings documented in their CHA, including any health disparities data. The CHP serves as a strategic plan for pop- ulation health and health care systems to serve the commu- nities within the CCO's service area. CACs are responsible for overseeing a CHA, adopting a CHP and publishing an annual report on the progress of the CHP. Sources: 2020 ORS 414.575 (community advisory councils); CCO Guidance: Community Health Assessments and Cam- munity Health Improvement Plans. members-for example, using fliers, hosting booths at health fairs and relying on referrals from community partners-and providing OHP members with an array of supports, such as transportation, stipends, meals and child care reimbursement, to enable them to participate meaningfully. Milbank Memorial Fund ¢ www.milbankorg Observations Positive Outcomes Health and Wellness Resources When asked about their CAC successes, interviewees were most likely to cite their admin- istration of tens of millions of dollars in community reinvestment funds paid by the state to CCOs for reaching quality targets.% CCOs then allow CACs to make decisions about how these payouts will be reinvested to address community health priorities, as identified in the CHP. Interviewees pointed to programs that provide fresh vegetable "prescriptions," initia- tives aimed at promoting adolescent well-care visits, and gym memberships that encourage wellness. CACs have approved funding to create a life jacket station at a local lake, cleats for walking on snow and ice, and walking poles to promote exercise among older adults while preventing falls. Collaborative Health Planning "After attending the conference, one of our [CAC] members initiated a strategy, with the help of our staff, to outreach and recruit from areas of our county where there are more transportation and distance barri- ers. We have since conducted three informational sessions in those more rural areas and are doing a fourth one this month. It has helped raise awareness of the CAC and the overall work of the CCO in these areas and helped strengthen connections with various partners (schools, churches, community-based organizations) in outlying areas, allowing the CAC and staff to hear regularly the different strengths and barriers to health that people living there experience." ~ CAC Conference Attendee The CAC creates a space where people from many community entities, such as schools or churches, can come together to have conversations about the health system. As one CCO representative put it, "our CAC has become the one place in the region where all these partners meet. There's not really another regular meeting where all these various cross-sector organizations meet, and....look to get more information on how to best serve our clientele." This point was illustrated by an example in which the executive director of alocal health clinic sought the CAC's opinion on its priorities for a planned new building. Improving CCO Policies and Procedures By including OHP members in the CAC, CCOs have an important avenue to learn how their policies and procedures are impacting members and make any necessary adjustments. For instance, nonemer- gency medical transportation (NEMT) services are a covered Medicaid benefit for Columbia Pacific CCO members who, depending on their needs, can receive rides, bus passes or help paying for gas. The Tillamook CAC began hearing that those who were receiving help paying for gas had to complete a complex process for reimbursement, thereby making it difficult for OHP members to pay for other necessities. As a result of the CAC's recommendation, the CCO changed the procedure to streamline the reimbursement process. Milbank Memorial Fund « www.milbankorg Making Health Planning More Inclusive Another area of success has been making materials and meetings more accessible to community members. The Columbia Gorge CAC strongly influenced the regional CHA's development by creating an 11-page "plain language," more accessible and visual summary that provides key highlights of the 63-page assessment. Its members also advocated successfully for translating the summary document into Spanish, the region's dominant non-English language. Finally, OHP members of the Columbia Gorge CAC were able to get the CCO to invest in simultaneous Spanish-English translation, making meetings fully accessible to Spanish-speaking residents. The Transformation Center also found examples where outreach was improved to better understand the experience of CCO members in outlying areas. For instance, one CAC started holding monthly meetings in outlying areas of its county. Other CACs adopted new meeting tools and approaches to help OHP members participate in more meaningful ways. Challenges Recruiting and Supporting OHP Members Recruiting and supporting OHP members to serve on CACs were by far the most common barriers. Challenges related to outreach and recruitment included: varying level of in- terest across CCO regions, ensuring CACs have the sup- ports needed to meaningfully include members once they join CACs, and properly funding supports for CAC member attendance. "[It's important to ] have those 'mover and shaker' people that are community partners sitting in the same room with and building good relationships with and friendships with people that we're serving on our health plan, because they're equals, and frankly, if anybody should be in the hierarchy it should be our members, because they're the ones that are being impacted directly, and they should be the ones voting on those things." ~ CAC Coordinator Several interviewees said it was challenging to identify specific and meaningful ways for CAC members to help CCOs reach their two key outcomes: limiting increases in per capita spending and improving health care access and quality." Additionally, some interviewees said cultivating an environment in which member voices were respected was an ongoing challenge. Representing the Diversity of Communities Served While progress has been made to create more language access for individuals whose first language is not English, translation and interpretation still remain a barrier to full member participation. In addition, CAC staff said there are not sufficient supports for meeting CAC diversity requirements. CAC members and staff both mentioned that CAC operating practices (meeting times, location, etc.) may hinder more diverse membership. Measuring Impact The OHA has a sophisticated and widely published approach to evaluate the CCO program's progress in achieving its outcomes." To date, however, with the exception of capturing the structure and process outcomes noted above, the OHA has not otherwise measured the Milbank Memorial Fund ¢ www.milbankorg impact of the CACs in achieving these outcomes. That said, as of the publication of this case study, the OHA was developing a CCO 2.0 evaluation plan that will include measuring CACs' impact. Acknowledging Differences Among Regions Some interviewees mentioned a lack of flexibility in how CACs and their activities are implemented and acknowledged that the differences between CCO regions could influence a councils efficacy. Others identified challenges in staffing CACs, procuring space for CAC meetings, and identifying the best communication methods for CAC members (in-person meetings or phone meetings). An OHA staff member said one of the biggest internal challenges is traveling to all regions of the state to interact in-person with all CACs. Best Practices OHA's approach to prioritizing and supporting meaningful consumer and community engage- ment through CAC structures offers several lessons for other state agencies, health plans and accountable care entities seeking to better engage their Medicaid beneficiaries in health system transformation. Many of these best practices reflect current thought leaders' views on key elements of successful engagement initiatives. Prioritize Engagement The years of careful and thoughtful work that OHA put into empowering CACs, and making them relevant and visible, have paid off. As a result, when planning CCO 2.0 was underway, stakeholders prioritized CACs and assigned them a more significant role in achieving the overall aims of the statewide CCO initiative. Invest Staff Time and Financial Resources Creating and sustaining meaningful consumer engagement takes significant time and resources. A key part of the CACs' success is the staff dedicated to their operation. This includes OHA Transformation Staff, Innovator Agents and consultants. Additionally, it could not be successful without the network of CCO CAC coordinators, whose job it is to recruit and support members, guide them in executing their responsibilities and handle meeting logistics. "You give people meaningful work to do. Give Beneficiaries Meaningful Work They have a real role. Often times, with The single most effective way to engage Medic- these [advisory groups], it's 'come on in, have some lunch with us, we'll show you some marketing materials that are two seconds from going to print. You tell us what you think and we'll say we consulted the community.' By statute and by rule, [CACs] have real important work to do, and | think that's empowering." ~ Innovator Agent Milbank Memorial Fund « www.milbankorg aid beneficiaries in health system transforma- tion efforts is to provide them with meaningful and important work. Advisors can readily tell if they are just "window dressing" or a means to satisfy externally imposed requirements for consumer engagement. They can also tell if they are being asked for input on issues that have already been decided upon or communi- cations materials that are about to go to print. CACs' roles in developing CHPs and in deciding how to allocate community reinvestment funds are examples of "co-design," in which benefi- ciary advisors are equal partners in tackling complex challenges." Measure and Communicate Outcomes It is essential to communicate CACs' success to a broader audience to underscore their importance. Although OHA collects data from CCOs on a wide variety of measures, it does not collect information on outcomes related to CAC activity. That said, individual CACs collect some information-e.g., how many people have been helped, what changes were made-about projects supported by their CCOs' community reinvestment funds. OHA has used its quarterly e-newsletter, among other communication vehicles, to highlight these and other results of CAC activities. Support an Inclusive Environment Several interviewees identified inclusive approaches to engaging CAC members-especially those that are OHP members-as a key reason CACs are so successful. This engagement is not only cultivated through member participation on CACs, but also by their establishment and operations. Some CACs make space in their agendas for members to bring up new business or comment on old business, and some employ popular education techniques to make sure everyone's voice is heard and respected. Despite challenges in reaching this level of meaning- ful consumer engagement, it is seen as a critical component of the CAC program's success. Share "What Works" Whether through in-person events, conference calls, webinars or online materials, the Transformation Center has prioritized sharing best practices across CACs on topics ranging from recruitment and retention techniques to successful meeting habits. This allows CACs to learn from one another and to avoid spending limited time creating approaches from scratch. Looking Ahead CCO 2.0 was launched in early 2020" to meet new CAC requirements designed to ensure that CACs better represent the communities served by CCOs, and that CCO spending to address social determinants of health is consumer-informed. (See Appendix 1- New CAC Requirements Under CCO 2.0). CAC members and CAC coordinators identified needs to fulfill the new requirements, and Transformation Center staff have begun developing CAC-related supports." They are also creating (or updating) templates specific to CCO 2.0 reporting, including an Annual CAC Demographic Report Template and a CAC Member Diversity Assess- ment Worksheet. CACs Role in Addressing Disparities Under CCO 2.0, CACs have an essential role in addressing disparities in histori- cally excluded communities. By contract, CCOs are required to increase their strategic investments in activities aimed at addressing the social determinants of health, health equity, and health dispar- ities. And, CACs will have a distinct role in determining how those investments are made. (See Appendix | for additional detail.) Milbank Memorial Fund « www.milbankorg 13 Conclusion The Oregon Health Authority works in varied and intentional ways to ensure CCOs not only meets the law's minimum community engagement requirements, but also that their engage- ment is meaningful, inclusive and transparent. With a deeper understanding of OHA' infra- structure and supports, state agencies-as well as managed care plans, accountable care organizations and other health care organizations-can adopt similar engagement strategies to drive progress on improving health outcomes and stabilizing health costs. Acknowledgements The authors wish to thank leadership and staff of the Oregon Health Authority Transforma- tion Center-Chris DeMars, Alissa Robbins, Tom Cogswell and Adrienne Mullock-for gen- erously sharing their time and insights in the development of this case study. We are also grateful for the perspectives offered by Innovator Agents Joell Archibald, Estela Gomez and Dustin Zimmerman. Finally, many thanks to CAC coordinators and CAC members* for Co- lumbia Pacific CCO (Jody Bell, Romy Carver and Margot Huffman), Eastern Oregon CCO (Taj Hambleton and Troy Soenen) and PacificSource Community Solutions-Columbia Gorge CCO (Suzanne Cross, Joel Pelayo, and Mayra Rosales). * CAC Members were all members of OHP (Medicaid) and received a modest stipend in consid- eration of their time and effort associated with the project. Milbank Memorial Fund « www.milbankorg 14 APPENDIX 1 - New CAC Requirements Under CCO 2.0 Topic Details CAC Membership CAC Selection Committee: CCO must convene a CAC Selection Committee comprised of (in equal numbers): (a) individuals who sit on the CCO's Governing Board; and (b) individuals who are represen- tatives of each county within the CCO's service area. The Selection Committee is responsible for selecting members of the CAC and will ensure the CAC includes representatives from the community, including, but not limited to consumer representatives (at least 51%) and is representative of the diversity of populations within CCO's service area. Definition of Consumer Representative: A Consumer Representa- tive must be at least 16 years old and either (a) a person serving on a CAC who is on(or was within the previous six months} the Oregon Health Plan (OHP), or(b)a parent, guardian or primary caregiver of an individual who is on (or was within the previous six months) the OHP. Tribal Participation: In CCO service areas where only one tribe exists, the tribe will be responsible for choosing one tribal repre- sentative to serve on the CAC; in CCO service areas where more than one tribe exists, each tribe will choose a tribal representative to serve on the CAC; in the Portland tri-county metropolitan area, CCOs shall also reach out to the Urban Indian Health Program to identify a representative to serve on the CAC. CAC Member Repre- sentation CCO Governing Body: Each CCO''s governing body must include at least two members of the CAC. At least one of the CAC representatives on the CCO's governing body must be a current CAC consumer representative. Annual CAC Demo- The report (due 6/30/21) will show how CAC membership is Goal: CCOs have a representative CAC. This builds trust and relationship with members. Systems are designed with the OHP member in mind. Supporting Health for All through Reinvestment (SHARE) Initiative. They will also have a role in determining how Health-related Services (HRS) Community-Benefit Initiative Investments are made. graphic Report representative of the communities in a CCO's service area. CAC Duties: CCO CAC members will have a role in reviewing Social Determinants Goal: Increased Spending Decisions | of Health and Equity (SDOH-E) spending under the future (2021) strategic spending by CCOs on social determinants of health and health equity/dis- parities. Decision-mak- ing is inclusive and consumer-informed. Asked Questions Sources: Transformation Center, CCO 2.0 Policies Impacting CCO Community Advisory Councils (CACs) - Pulled from Ap- pendix A: CCO 2.0 recommended policies and implementation expectations; Transformation Center, CCO 2.0 and CACs: What's New for CAC Members?; Transformation Center, CCO 2.0 & Community Advisory Councils (CACs) v4: Frequently Milbank Memorial Fund « www.milbankorg Notes 'The passage of the CCO law was the culmination of several years of work by then Governor Kitzhaber, key legislators and the Oregon Health Reform Collaborative, a multi-stakeholder group of over 25 organizations representing providers, insurers, underserved populations, businesses, consumers and faith-based communities. Consumer representatives were the driving force behind the inclusion of CAC provisions in the law. 2 In 2014, the state awarded contracts to 16 organizations to serve as CCOs for a period of five years. Those contracts were extended for an additional year, to December 31, 2019, to allow the state to develop the new, five-year CCO 2.0 contracts. 32020 ORS 414.575 community advisory councils 4 See e.g., White R, Kocot SL, Mostashari F, McClellan MB. Improving the Medicare ACO Program: The Top Eight Policy Issues. Brookings Issue Brief. June 2014. https://www.brookings.edu/blog/up- front/2014/06/17/improving-the-medicare-aco-program-the-top-eight-policy-issues/. Accessed July 29, 2020. 5 Picture from https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/|e8116. pdf. 82017 ORS 414.625(2)( 0) D)-(E) 72017 ORS 414.625(2)(o)(E) as amended by Chapter 529 Oregon Laws 2019 (HB 2267). https://www. oregonlegislature.gov/bills_laws/lawsstatutes/20190rLaw0529. pdf. 8 About the Transformation Center. Oregon Health Authority website. https://www.oregon.gov/oha/ HPA/dsi-tc/Pages/About-Us.aspx. Accessed July 29, 2020. § About the Transformation Center. Oregon Health Authority website. https://www.oregon.gov/oha/ HPA/dsi-tc/Pages/About-Us.aspx. Accessed July 29, 2020. The Innovator Agent role was modeled on the role of agricultural extension workers, as described Gawande A. Testing, Testing. The New Yorker. Dec. 7, 2009. Available at https://www.newyorker.com/ magazine/2009/12/14/testing-testing-2. Accessed July 29, 2020. 2017 ORS 414.628(2) ® CAC-related issues are only one part of the CAC coordinator's job. Estimates of how much of their time is spent on CAC issues ranged from 40 to 70%. CAC coordinators' have a wide array of respon- sibilities that include: recruiting CAC members, helping to develop meeting agendas and organize meeting logistics, writing the meeting minutes, and writing applications for community reinvestment funds. % While the reinvestment funds come almost entirely from CCOs themselves, in 2016, OHA provided CHP implementation grants of up to $30,000 to each CCO to implement strategies identified in their CHPs. "4 See e.g., OHSU Center for Health Systems Effectiveness. Evaluation of Oregon's 2012-2017 Medicaid Waiver. December 2017. https://www.oregon.gov/oha/HPA/ANALYTICS/Evaluation% 20docs/Summa- tive%20Medicaid%20Waiver% 20Evaluation%20-%20Final%20Report.pdf. Accessed July 29, 2020. Milbank Memorial Fund « www.milbankorg 16 ® See e.g., OHSU Center for Health Systems Effectiveness. Evaluation of Oregon's 2012-2017 Medicaid Waiver. December 2017. https://www.oregon.gov/oha/HPA/ANALYTICS/Evaluation%20docs/ Summative%20Medicaid% 20Waiver% 20Evaluation%20-%20Final%20Report.pdf. Accessed July 29, 2020. ® The National Academy of Medicine, in its Guiding Framework for Patient and Family Engage Care, points to making engagement a strategic priority, allocating appropriate resources to engagement efforts, creating an inclusive culture and creating feedback loops as key criteria for successful initiatives. Frampton SB, Guastello S, Hoy L, Naylor M, Sheridan S, Johnston-Fleece M. Harnessing evidence and experience to change culture: A guiding framework for patient and family engaged care. NAM Perspect. National Academy of Medicine, Washington, DC. doi:10.31478/201701f. Similarly, the American Institutes for Research referred to engagement as "the blockbuster drug of the century" and emphasized the importance of using inclusive, collaborative engagement strategies. American Institutes for Research and The Gordon and Betty Moore Foundation. A Roadmap for Patient and Family Engagement in Healthcare: Practice and Research. https://www.air.org/sites/default/files/ Roadmap-Patient-Family-Engagement.pdf. Accessed July 29, 2020. " See e.g., Fucile B, Bridge E, Duliban C, Law MP. Experience-based co-design: A method for pa- tient and family engagement in system-level quality improvement. Patient Exp. J. 2017;4{2):53-60. doi:10.35680/2372-0247.1209 8 OHA sought the views of CACs while developing CCO 2.0 policies. 8 New materials on CAC requirements under CCO 2.0 are available at the Transformation Center's CAC Supports webpage. https://www.oregon.gov/oha/HPA/dsi-tc/Pages/CAC-Learning-Community.aspx. Milbank Memorial Fund ¢ www.milbankorg 7 The Authors Renée Markus Hodin, JD, is deputy director of Community Catalyst's Center for Consumer Engagement in Health Innovation. In this role, she works to establish a powerful and effective consumer voice at all levels of the health care system in order to make it more responsive to consumers, particularly those who are most vulnerable. Prior to joining the Center, Ms. Hodin served as the director of the Voices for Better Health project, which brought a consumer voice to the design and implementation of new programs aimed at providing better coordinated, comprehensive, high-quality care to Medicare-Medic- aid beneficiaries ("dual eligibles"). Her expertise extends to other areas of health care including hospital free care and community benefits and health care conversions. Before joining Community Catalyst in 1998, Ms. Hodin served as a special assistant attorney general in the civil litigation department of the Vermont Attorney General's Office. She holds a bachelor's degree from the State University of New York at Binghamton and a Juris Doctor degree from the University of Maryland School of Law. Madison Tallant, MSW, joined Community Catalyst's Center for Consumer Engagement in Health Innovation in 2018 as a program associate. In this role, she provides research and project management support for the Center's policy and client-based work. Ms. Tallant recently graduated from the Boston College School of Social Work where she studied health and mental health policy and programming. While a graduate student, Madison interned with the National Alliance on Mental Illness of Massachu- setts and the Technical Assistance Collaborative, Inc. She holds a bachelor's degree in psychology from Rhodes College. About Community Catalyst Community Catalyst is a national, non-profit consumer advocacy organization founded in 1998 with the belief that affordable, quality health care should be accessible to everyone. We work in partnership with national, state and local organizations, policymakers, and philanthropic foundations to ensure consumer interests are represented wherever important decisions about health and the health system are made: in communities, courtrooms, statehouses and on Capitol Hill. For more information, visit communitycatalyst.org. Follow us on Twitter @healthpolicyhub. About The Center for Consumer Engagement in Health Innovation The Center for Consumer Engagement in Health Innovation (CCEHI) at Community Catalyst is a hub devoted to teaching, learning and sharing knowledge to bring the consumer experience to the forefront of health innovation in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center engages in investments in state and local advocacy, leadership development, research and evaluation, and consultative services to delivery systems and health plans. For more information visit healthinnovation.org. Follow us on Twitter @CCEHI. Milbank Memorial Fund « www.milbankorg 18 About the Milbank Memorial Fund The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evi- dence and experience. Founded in 1905, the Fund engages in nonpartisan analysis, collabora- tion, and communication on significant issues in health policy. It does this work by publishing high-quality, evidence-based reports, books, and The Milbank Quarterly, a peer-reviewed journal of population health and health policy; convening state health policy decision makers on issues they identify as important to population health; and building communities of health policymakers to enhance their effectiveness. The Milbank Memorial Fund is an endowed operating foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in healthpolicy. In the Fund's own publications, in reports, films, or books it publishes with other organizations, and in articles it commissions for publication by other organizations, the Fund endeavors to maintain the highest standards for accuracy and fairness. Statements by individual authors, however, do not necessarily reflect opinions or factual determinations of the Fund. © 2020 Milbank Memorial Fund. All rights reserved. This publication may be redistributed digitally for noncommercial purposes only as long as it remains wholly intact, including this copyright notice and disclaimer. Milbank Memorial Fund 645 Madison Avenue New York, NY 10022 www.milbank.org Milbank Memorial Fund « www.milbankorg 19