The Office of Clinical Services Improvement (CSI) aligns medical management practices and coordinates clinical and system innovation, programs, and policies across coordinated care organizations (CCOs), communities, other plans and payers, and the Oregon Health Authority divisions. The goals of the CMO-CSI Office are to:
- Integrate clinical policies and resources to support the coordinated care model;
- Align and coordinate health care delivery strategies and systems throughout the Oregon Health Authority;
- Pursue further integration of behavioral, physical, and oral health care;
- Establish and maintain effective working relationships with Oregon's providers and health care delivery system representatives; and
- Coordinate quality improvement efforts across OHA, PEBB- and OEBB-contracted plans, the CCOs, and other entities involved in quality improvement.
One goal of the CMO is to focus the agency’s clinical knowledge and expertise on achieving performance, quality, and cost containment goals. It will accomplish this in part by assuming direct supervision of several existing positions within the Oregon Health Authority that have historically reported through a variety of chains of command. These include:
- OHA Medicaid Medical Director
- OHA Behavioral Health Director
- OHA Dental Director
- Transformation Center’s Director of Systems Innovation
- Health Evidence Review Commission (HERC) Clinical Directors
- OHA Quality Improvement Director
- Pharmacy & Therapeutics Committee Contracted Clinical Resources
- Oregon Prescription Drug Program
- Patient Centered Primary Care Program
The Office coordinates with the divisions of Public Health and Health Systems to align OHA’s clinical policies and program strategies.
The CMO also oversees the Health Evidence Review Commission (HERC). Among other responsibilities, HERC:
- Conducts comparative effectiveness and benefit design research to inform public and private sector transformation efforts;
- Performs medical technology reviews;
- Develops clinical and coverage guidelines based on clinical evidence;
- Maintains the OHP Prioritized List of Health Services; and
- Disseminates information on the effectiveness and costs of medical treatments and technologies.
A key strategy for the Office of Clinical Services staff is applying HERC research to advance policy development, implementation, and evaluation for OHA, the CCOs, and PEBB/OEBB contracted plans.
The Office of Clinical Services Improvement has a key role in developing and staffing OHA’s internal, cross-agency Quality Council. The Quality Council brings together OHA leadership to coordinate and lead quality improvement efforts for the agency. It provides the structure for: (1) the clinical, behavioral, and population health leadership of OHA to analyze clinical trends in quality, compliance, and system performance; and, (2) the development of integrated strategies to improve quality. The Office is responsible for making sure the Quality Council’s work is integrated and shared with the CCO medical directors, PEBB/OEBB boards and their contracted plans, and other OHA programs.
The Office of Clinical Improvement Services also sponsors performance improvement projects and oversees the Transformation Center to coordinate and support quality efforts based on the Quality Council’s recommendations. Identifying key health care trends will be valuable information to share with our partner agencies, the Department of Human Services, Department of Consumer and Business Services, Insurance Division, Governor’s Office, and the Legislature. The Patient-Centered Primary Care Home Program (PCPCH) is part of Oregon's efforts to fulfill a vision of better health, better care and lower costs for all Oregonians. By recognizing clinics that offer high-quality, patient-centered care, we can begin breaking down the barriers that stand between patients and good health.
The Pharmacy & Therapeutics Committee and Oregon Prescription Drug Program are overseen by the CMO. Evaluating and monitoring pharmacy benefits across Medicaid populations managed by CCO’s and Fee for Service is work within this area. Additionally, working to develop strategies for fiscally sustainable administration of pharmacy benefits is led by the CMO.