street roots
4
Aug. 3, 2012
This month the state puts $240 million on the line with coordinated care
BY AM A N D A W ALDROUPE
S T A F F W R IT E R
tarting in September, the Portland
metropolitan area’s largest private and
public health care providers will forge
a new way of delivering health care to some
of the neediest and most vulnerable patients
in the state, and they’ll do it in a way that
seems impossible: by working together.
The organization the providers have
created is called the Tri-County Medicaid
Collaborative. It is one of dozens of
coordinated care organizations, or CCOs,
forming throughout Oregon to change how
patients on the state’s Medicaid program,
the Oregon Health Plan, receive health care.
Coordinated care organizations form the
backbone of ambitious changes to the
Oregon Health Plan pushed by Governor
John Kitzhaber and bipartisan legislation the
Oregon Legislature passed during the 2011
and 2012 sessions—an effort to not only
provide higher quality care, but also to
drastically reduce the state’s Medicaid
expenditures by millions of dollars.
The Collaborative, like the rest of the
state’s CCOs, does not have time to dally.
CCOs are expected to save the state $239
million dollars in 2013 alone; if those
savings are not made, it could be
catastrophic for the state’s budget.
Regional umbrella organizations that
bring together doctors, nurses, mental
health and addictions providers, hospitals,
counties, public health departments and
other health care providers, CCOs are
expected to integrate and coordinate the
physical, mental and dental health care for
the 650,000 Oregonians on the Oregon
Health Plan.
The state’s first seven CCOs became
operational on Aug. 1; by November, the
transition to the new system is expected to
be complete.
The Oregon Health Authority formally
certified the Collaborative to become a CCO
on July 31, and it will begin providing care to
180,000 Oregon Health Plan patients living
in Multnomah, Washington and Clackamas
counties on Sept. 1.
The Tri-County Medicaid Collaborative
will, by far, be the largest CCO in Oregon. It
S
is composed of every major health provider
in Multnomah, Washington and Clackamas
counties: Adventist Health, CareOregon,
Central City Concern, Kaiser, Legacy
Health, Oregon Health & Science
University, Providence Health & Services,
Tuality Healthcare, and representation from
the three metro counties. Its annual budget
is expected to be around $750 million
dollars, and it will provide care for roughly a
third of the state’s Oregon Health Plan
patients.
Janet Meyer, the Collaborative’s interim
CEO, says one of the biggest challenges is
creating a coordinated system of care just as
relevant and effective to patients living in St.
Johns as it is to patients in Sherwood. “We
have a huge area to cover,” she says.
Another is simply learning how to work
together to make the new delivery model
work. “We’re competitors, b u t... the reality
is that we need to be collaborative and
cooperate,” says George Brown, the CEO of
Legacy Health and chairman of the
Collaborative’s board of directors. “It is in
our mutual best interest, and in the best
interest of the community we serve.”
One of the first big tests the Collaborative
will face is submitting an “implementation
plan” to the Oregon Health Authority within
90 days. The plan will spell out exactly how
the Collaborative will coordinate care, with
estimations on how much emergency room
and specialty care use decreases, how care
improves, and most importantly, how much
money the Collaborative expects to save.
And the federal government has its eye
on CCOs: Earlier this summer, the Centers
for Medicare and Medicaid Services (CMS),
which regulates Medicare and Medicaid,
brokered a deal with Kitzhaber to give the
state $1.9 billion dollars over the next five
years to help fund CCOs.
But there are strings attached to the
money. In addition to clearly showing that
preventive care is being utilized, the state
must reduce Medicaid expenditures by
2 percent in two years.
The requirements demand that CCOs get
moving, fast.
“We have to move quickly so that we can
drive transformation, (but) not too quickly
that we disrupt the system of care,” Meyer
says. “This is a very vulnerable population.”
Ed Blackburn, a member of the
Collaborative’s board of directors and
executive director of the social service
agency Central City Concern, thinks the
savings are doable, but difficult.
“One of the things we must absolutely
accomplish is the reduction in utilization in
hospital beds, psychiatric units, and
emergency departments,” Blackburn says.
“We have to drive down those costs, not
simply to help people, but get them into
services that can intervene and prevent
them from getting that far.”
He says the time has passed for the
Collaborative, like the rest of CCOs, to do
nothing. Medical costs continue to rise,
exceeding national inflation rates, and the
strain on state and city budgets means
community services won’t be able to
continue picking up the pieces of a failing
health care system.
“We’ve got a few years to pull this off,”
Blackburn says. “We’re all going to take big
hits if this doesn’t work.”
ne recent development giving those
closely watching the Collaborative’s
development reason for encouragement
the composition of the Collaborative’s
community advisory committee, which was
announced in late July.
The committee is responsible for
representing the perspectives of Oregon
Health Plan patients and the larger
community; in that regard, many view the
advisory committee as an important source
for holding CCOs accountable to their goals
and mission. The committee is also
responsible for developing a community
health improvement plan, designed to
address health disparities and improve
population and public health that the
Collaborative will implement.
The Collaborative’s advisory committee is
made up of 17 people. Nine are current
O
Oregon Health Plan patients. The o th er.
members include representation from a
variety of agencies serving low-income and
vulnerable people — including the Coalition
of Community Health Clinics, the Housing
Authority of Clackamas County and
Multnomah County’s Department of Human
Services.
Steve Weiss, an Oregon Health Plan
patient and active consumer advocate, will
serve as the committee’s chair. His
chairmanship also makes him a voting
member of the Collaborative’s board of
directors.
The selection of committee chair and the
committee’s composition, says Chris
Bouneff, president of Oregon’s chapter of
the National Alliance of Mental Illness says,
shows the Collaborative is intent on
engaging the community and taking its
concerns seriously. “That’s a very
impressive list,” he says. “They put some
people on that committee who are strong
advocates for better health care."
Weiss, 69, has been an Oregon Health
Plan patient since 1991. During that time,
he has received dozens of notifications from
the state telling him that certain health
services would no longer be covered by the
state. And he says the coordination between
physical and mental health care has been
“badly needed” for years.
He hopes he can help the Tri-County
is Medicaid Collaborative function as
effectively as possible for the patients it will
serve. He thinks the biggest challenge the
Collaborative will face is being able to
reduce costs, but still provide effective
service.
He also worries that the Collaborative’s
ability to clearly communicate with patients
may be hampered by the sheer size of the
Collaborative. “The greater number of
middle men you have, the greater likelihood
that you’re going to have complications,” he
says.
See HEALTH CARE, page 5
"Brandy, what did fee tell yon
to convince yoa to come, to
have him come bach?"
Brandy conldidt control her
tears* ""last th at he loved me,
and he was sorry, and he
would never lot
"Bid yon believe him this
tim e?" BBS, Hershfeowlfi
ashed,
"1 believe him every time/"'
Brandy said.
The gravity of abuse
Read all fo u r installments o f this engaging series by
Rosette Roy ale on our website, www.streetroots.org.