Health Share of Oregon Finding Value in Cross-Sector Case Conferencing

A recent Camden Coalition webinar highlighted progress on cross-sector case conferencing to improve care for individuals with complex health and social needs. Speakers from New Jersey, Vermont and Oregon described setting up new initiatives. 

As several speakers during the webinar made clear, patients with complex needs often receive care across several health systems, behavioral health providers and community service organizations, and usually there’s no easy way for care coordinators to see a cross-system picture of all of the care that patient is receiving or to develop a shared care plan. Setting up regular meetings and/or data-sharing opportunities can help alleviate some of that fragmentation.

One of the speakers was Adam Peterson, portfolio manager of healthcare and homeless services integration at Health Share of Oregon, a collaborative of four health plans serving the Medicaid population in the Portland metro region. He described how case conferencing spread across Portland’s tri-county area as it demonstrated value to stakeholders. 

His talk was preceded by a presentation from Andi Broffman, a consultant with Community Solutions, a national-level organization that helps with the integration between homelessness response systems and health systems, who spoke about why it makes sense to build the shared accountability network across health and homelessness. “Cross-sector case conferencing as a practice is a formalized process; it is not ad hoc or as needed, but these meetings are happening on a regular cadence with established workflows and policies and procedures and capacity from both systems,” she said. “They are not just focused on clinical needs or just housing needs, but truly both.”

Peterson began by defining Health Share of Oregon. The collaboration expands across three counties and serves over 450,000 Medicaid members. In Oregon these managed care organizations are labeled Coordinated Care Organizations (CCOs). They fund and coordinate the care for physical, behavioral and dental health for all of their members.

“One of our large focuses of the last few years is the integration between healthcare and homelessness and trying to figure out how we create the best care for people engaging in homeless services and getting and identifying needs before they become exacerbated further,” he explained. 

One of their key interventions was the adoption of cross-sector case conferencing. Partners at the Homeless Services Department in Washington County were the initiators of the program and the pilot site. In 2023, they worked with Community Solutions to start case conferencing between two of the four health systems and the homeless response system. “At that point, they really raised this up to Health Share, saying this is a great thing we've got going, and we think that all of our health systems would really benefit from it,” Peterson said. 

“We realized that this is pretty incredible. What we have is folks from homeless response identifying people with unmet healthcare needs, and bringing in the healthcare care coordination teams on a bi-weekly meeting in order to say we've got this need that this person's identified; how do we collaboratively meet that unmet healthcare need?”

He stressed that this could be a behavioral health need, a physical health need or a dental health need. "The great thing about it is through the partnership with Community Solutions and the different health systems, we were able to work through the data-sharing components of how we do this across systems and who can be in the room,” Peterson said. 

Adoption spreads to Clackamas and Multnomah counties

After it began in Washington County, the practice spread to Clackamas County in March 2024. “Each county that we serve is a little bit different in their demographics and a little bit different in how they how they see case conferencing,” he said. Clackamas County wanted to focus on behavioral health, so they focused on to get behavioral health providers be at the table and talk freely about behavioral health needs and get people into care. 

Then Multnomah County, the largest county in the region, which also has the largest homeless population, began case conferencing in 2024. “We took the good practices that started in Washington County and Clackamas County and spread them to Multnomah County, so that it's really a combination of system-wide data sharing,” Peterson added. Because they started with an aging population focus in Multnomah County’s program, they were able to have behavioral health, physical health, local care coordination staff, as well as Aging and Disabilities involved. 

“We were able to take what was working in one county and spread it to two additional counties,” he said. There are some things that are universal across the system or across the programs. Each one is held twice monthly, and the group of panelists remains consistent in each meeting. 

“Being in the Medicaid payer space, we don't require any insurance type to be a part of this process. This is an insurance-neutral process where folks could have Medicaid, they could have Medicare, they could have no insurance, they could have a different CCO serving them,” Peterson said.  “We allow for anyone who has these unmet healthcare needs in the space, because we see it as a community benefit, not just a Health Share benefit.” 

An important aspect of the program is that they are allowing the staff from the homeless response system to say who has an unmet healthcare need in their system. “The pathway we've established is from housing to health, and not the other way around, which is a real change in power dynamics, and we've seen it be highly successful, because the folks from the homeless response system have really great relationships with the people that they're serving,” he added. 

In order to spread best practices and data across the community, Health Share hosts a community of practice for all three of the programs, and that includes a shared set of metrics. “We also host the backbone of providing the information for each of the homeless response systems for the clients that they're serving in what we call the regional integration continuum, which is the hub of the coordination between healthcare and homeless services,” he said. 

The programs have served over 400 people in their cross-sector case conferencing work. They also have improved cross-sector knowledge of the practitioners and the homeless response staff who start doing case conferencing and learn how to navigate the health system, “so that eventually they don't need to come to cross-sector case conferencing to get their clients’ needs met. They're able to do that on their own because they've learned how to do it through those relationships built in cross-sector case conferencing,” he said. 

“We've also learned that there are different languages spoken between healthcare and homelessness systems,” Peterson continued. “In order to do a very basic training, we developed a Medicaid 101 about how to get your people the care that they need using Medicaid. We've trained over 350 homeless services providers on how to navigate the Medicaid system.” 

One of the largest cohorts these meetings addresses is people with unintentional overdose, opioid use, stimulant use and psychosis. This is called the high-acuity behavioral health cohort. “These are folks who are historically not getting their needs met in the emergency department and afterwards, but we are able to meet their needs from our cross-sector case conferencing,” he said. 

Early data shows that Health Share of Oregon's cross-sector case conferencing reduced ED visits by 45% for high-acuity behavioral health cohorts, highlighting the effectiveness of integrated care approaches.

“The data on the impact is preliminary,” he said, “but we think the early returns are really promising.”