Delivery System Transformation Workgroups

Workgroups Make Headway Toward Common Goals

The Delivery System Transformation Committee utilizes workgroups, groups of people working toward a common agenda, to help develop and support transformational work efforts. The number of workgroups changes as the Committee’s strategic goals change. The workgroups focus on the cross-sector collaboration between Patient Centered Primary Care Homes and community efforts and services, to achieve better health and access, and to reduce costs.  

Please contact the Committee if you are interested in joining the workgroups, or if you would like more information.

Workgroup summaries:

Workgroup Purpose

Community driver of Connect Oregon in Benton, Lincoln and Linn counties, the Oregon network of Unite Us, and to explore connections with other systems, particularly referral platforms used in the region. Unite Us is a community driven, participation required, and locally sustained tool for social determinants of health screening and referrals. The Connect Oregon Workgroup is focused on improving individual and community health while keeping the individual at the center. 

Short Term Goals

  1. Understand the current state of Connect Oregon.
  2. Build networking opportunities by sharing successes and discussing limitations.
  3. Strategize ways to engage end users with the Unite Us platform.
  4. Identify and overcome barriers to implementing Connect Oregon.
  5. Identify areas of opportunity to increase usage and better support community health.

Long Term Goals

  1. Demonstrate the value of the network through data gathering and evaluation.

  2.  Standardize screenings for use throughout the health care and social service system.

  3. Support and facilitate training opportunities with Connect Oregon.

  4. Provide community awareness and education to the resources within Unite Us.

  5. Support ease of use and integration/interoperability for all sectors with the focus on full bi-directional integration.

  6. Communicate and liaise with Unite Us on community needs and improvements.

  7. Review and improve understanding of workflow particularly for organizations that are not clinical or social need focused.

  8. Integrate with other communication technology including electronic health records and screening and referral platforms.

Meeting Frequency

Quarterly

Workgroup Purpose

The IHN-CCO Health Equity Workgroup supports delivery system transformation that identifies and reduces inequities and advances health equity by: supporting the diverse needs of members; supporting quality improvement focused on eliminating inequities in access, quality of care, experience of care and outcomes; building a workforce that reflects IHN-CCO membership; supporting the equitable implementation of the quadruple aim; and supporting IHN-CCO’s Community Health Needs Assessment and Community Health Improvement Plan.

Short Term Goals

  1. DATA: Support and monitor quantitative and qualitative data to inform, prioritize and monitor strategies to meet the needs of culturally diverse members and to reduce health disparities. 
  2. TRAINING: Support health equity trainings for the IHN-CCO Health Equity Workgroup, IHN-CCO staff, IHN-CCO providers and other community stakeholders. 
  3. REAL D: Inform Race, Ethnicity, Language and Disability conversations as they relate to community partners.
     

Long Term Goals

  1. Support the Health Equity goals of community partners.
  2. Support and retain IHN-CCO provider and staff composition that reflects member diversity including removing barriers to participation.
  3. Informing and addressing health equity services, access, trainings, scope of practice and supports for Traditional Health Workers to address health disparities across IHN-CCO services and in Benton, Lincoln and Linn counties.
  4. Ensure regular communication between the IHN-CCO Health Equity Workgroup, IHN-CCO staff, IHN-CCO DST Steering Committee, IHN-CCO CAC and IHN-CCO workgroups about health disparities and health equity activities in the community.  
     

Meeting Frequency

Fourth Thursday of the month from 3 to 4 p.m.
Annual joint meeting with Traditional Health Worker Workgroup.

Workgroup Purpose

To develop and promote the transformational integration of Social Determinants of Health (SDoH) into the health care delivery setting. The focus of this work will be at two levels; 1) identify and promote strategies within IHN-CCO to support awareness and positively impact SDoH, and 2) promote identification of SDoH, create connections to community resources, and foster agency relationships.

Short Term Goals

  1. Building on the framework to develop strategies/goals for the community, to IHN-CCO, practice, community and policy level. 
  2. Present recommendations to the Delivery System Transformation (DST) Committee (who reports to the Regional Planning Council) to act on recommendations for desired IHN-CCO initiatives and service level pilots.  
  3. Utilize tools and resources to ensure recommendations/goals are data driven. 
     

Long Term Goals

  1. Increase awareness in the community regarding what is being done to address SDoH through initiatives and pilots within the region. 
  2. Influence the direction and provide input to IHN-CCO for the 5-year CCO application, SHARE Initiative, DST pilots, community-based organizations, CMS waivers and any other pertinent project or initiative 
  3. Identify and act on structural and policy barriers to recommendations/goal.
  4. Assessing the social needs impact of health interventions and how that affects community and healthcare providers’ job satisfaction.  
     

Meeting Frequency

Second Thursday of the month from 3 to 4 p.m.

Workgroup Purpose

The Sustainability Workgroup’s purpose is to identify best practices and solutions for billing, staffing, funding, data collection, replicability and overall sustainability. Support and collaborate with community partners for advancement into sustainable practices and organizations to better the community’s available resources, providers and services. 

Strategic Goals

  1. Understand, document and address current and past Pilots’ challenges, successes and areas for opportunity. 
  2. Create and inform integrated and streamlined pathways for sustainable community-led support services.
  3. Identify simplified, affordable and effective data collection and reporting tools and how to leverage data for additional funding opportunities. 
  4. Build a strong community partner network to support great alignment of resources.
     

Short Term Actions

  1. Improve the process for pilot analysis to understand challenges, successes and areas for opportunity. 
  2. Ensure access to IHN-CCO supports especially billing and provider credentialing.
  3. Develop tools to educate and inform community partners about IHN-CCO’s current funding mechanisms.  
  4. Identify tools useful for community partners’ collecting, reporting and tracking. 
  5. Explore developing forums for networking, sharing best practices and resource sharing.  
  6. Improving the process for engaging and contracting with DST pilots.
     

Long Term Actions

  1. Increasing sustainability of the DST Pilots in the community to extend resource, provider and service access within the Benton, Lincoln and Linn counties. 
  2. Creating a sustainability resource guide informed by community partners for newly funded DST Pilots to include best practices and support services for billing, staffing, funding and data collection.
  3. Implement tools identified as useful for required reporting and tracking outcomes. 
     

Meeting Frequency

Fourth Wednesday of the month from 3 to 4 p.m.

Workgroup Purpose

The Traditional Health Workers (THW) Workgroup aims to advance the development of THWs in the transformation of health care to advance the Triple Aim. Promote utilization of THWs to address social determinants of health.

Short Term Goals

  1. Implement the THW training hub in the Benton, Lincoln and Linn area that will serve the mid-Willamette area.
  2. Work with the Health Equity Workgroup on an ongoing an annual basis to align goals and strategies.

Long Term Goals

Improve the THW delivery system, allowing THWs to better support and educate members in navigating the health care system and ensure appropriate, timely care.

Meeting Frequency

Second Wednesday of the month from 3 to 4 p.m.
Annual joint meeting with Health Equity Workgroup.

Traditional Health Worker Toolkit