Healthcare Innovation Awards: Redesigning Service Delivery through the Tri-County Health Commons

Publication Year: 2019
Patient Need Addressed: Care Coordination/Management
Population Focus: Complex care, Medicaid beneficiaries
Intervention Type: Education, Service redesign, Staff design and care management
Type of Literature: Grey

The Providence Portland Medical Center, on behalf of Health Share of Oregon, received an award to launch the delivery system transformation of Oregon’s largest Medicaid Coordinated Care Organization (CCO). As a CCO, Health Share is integrating care delivery for Medicaid beneficiaries through an unprecedented level of cooperation among traditional competitors. Known as the Health Commons Project, this work aims to create an integrated patient-centered system to improve care coordination, care quality, and health outcomes among high-cost, high-acuity Medicaid patients while reducing overall healthcare costs. Through the implementation or expansion of five complementary care model interventions, including the hiring of new community outreach workers and patient guides and the development of a member registry, care will be coordinated more efficiently and effectively across multiple organizations. Additionally, enhanced systems for learning, collaboration, and workforce development are being created. The goal is to develop a sustainable system of care delivery across our community, which will reduce emergency department visits and avoidable hospital readmissions and improve the health of the population. Over a three-year period, this project will create an estimated 67 jobs.

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