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About Street roots. (Portland, OR) 1998-current | View Entire Issue (Aug. 3, 2012)
Street roots 5 Aug. 3, 2012 HEALTH CARE from page 4 FamilyCare forms its own Portland CCO ollaborative members and advocates alike do not expect the Collaborative to hile the Tri-County Medicaid Collaborative fully begin integrating and coordinating care will be the biggest game in town, it won't be in the short term. the only CCO in the Portland metro area. The Centers for Medicare and Medicaid FamilyCare, which has served metro area patients Services is allowing CCOs to be more for decades, is forming its own CCO after flexible with how it spends its Medicaid considering joining the Collaborative, then dollars. Because of that, interim-CEO Janet deciding to strike out on its own. Meyer says the Collaborative, like the rest Jeff Heatherington, FamilyCare's president, of the state s CCOs, will be able invest some decided to leave the Collaborative when the of its dollars in “flexible benefits” - Collaborative's board members were asked to sign methods to help patients maintain their an agreement that they would not be a part of health but not traditionally covered by another CCO in the metro area - essentially, not insurance companies. be a part of an organization that would compete An example often used by Gov. Kitzhaber with the Collaborative. is that of an older person with congestive Heatherington refused to sign the agreement, heart failure, living in an apartment that and left the Collaborative. The CCO FamilyCare is easily becomes hot during the summer. The hot, stuffy air exacerbates the person’s responsiveness: If a patient needs to see illness, which could easily be prevented if their primary care doctor, they can within a the apartment had an air conditioner. couple weeks, if not days. Whether the While some details have yet to be ironed Collaborative can make that sort of access out, Meyer says buying air conditioners for possible remains to be seen. the congestive heart failure patient, or “We need all the (health center) capacity vacuums for patients whose asthma flares as possible,” Blackburn says. “There is not up because of dust, will bring immediate enough access. That is a key issue.” benefit to Oregon Health Plan patients. But what will fundamentally change a patient’s relationship with their provider and their health will be the Collaborative’s he Collaborative might have been off to use across the tri-county area of a a slow start, were it not a three-year, coordinated care model already proven to $17.3 million grant from the Center for work: medical homes. Medicare and Medicaid Innovation (CMMI), A “medical home” employs a team of an offshoot of the Centers for Medicare and multiple health providers, including doctors, Medicaid Services that funds projects nurses, physician assistants, mental health and addiction providers, and various support throughout the nation designed to provide more effective health care at a lower cost. staff who track data and communicate with The money will fund five pilot projects to patients. be launched by September. Each team member has specific The first pilot program will embed up to responsibilities in relation to a patient’s 15 community health workers in existing health. If something is outside the realm of medical home practices. Community health that person’s specialization, he or she workers don’t have medical training, and are communicates with the team member most similar to outreach workers — they work qualified to address that issue. Patients closely with a caseload of up to 30 patients interact with each team member to varying with multiple illnesses and barriers to degrees, depending on the care they need. accessing care. “(Patients are) known and they have “(Patients), are going to be seeing a lot stronger relationships,” says David Labby, more of those people in their lives,” Meyer the Collaborative’s chief medical officer. says. Labby is spearheading the Collaborative’s The workers visit patients at their homes, efforts to create medical homes, and says and communicate with them by e-mail, text every Oregon Health Plan patient will messages, and phone calls to make sure, for eventually belong to one. Within a year, he instance, that the patient does not forget says, the majority of the Collaborative’s about an upcoming doctor visit and that medical homes should be operational. they’re taking medication regularly. Home “We have a lot of practices that are pretty visits can also reveal whether a patient is advanced health home practices,” he says. experiencing other issues, such as social Creating a medical home depends on the isolation or nutrition problems that can providers thinking of their patients as a impact their health. defined group of people for whom they are “In a standard office visit, those things responsible. Identifying who their patients aren’t apparent,” Labby says. are and what their various health needs are Similarly, the second pilot program will determines the providers on the medical place outreach workers in the emergency team. “You design the team around the departments of three hospitals in an effort group you’re taking care of,” Labby says. to decrease the number of patients using Medical homes are touted for their C W T starting is expected to begin on August 1. In some ways, FamilyCare has a head start on the Collaborative in terms of its ability to provide coordinated care. The organization already coordinates the physical and mental health care of its 50,000 patients. And for years, FamilyCare has used patient navigators to work directly with patients and help them find the appropriate care and services they need. FamilyCare and the Collaborative won't necessarily compete, because they have separate patient populations. But it does allow Oregon Health Plan patients a choice — if a member of the Collaborative is unhappy with the care they're receiving, they could enroll in FamilyCare. the emergency department. The workers will help people in the emergency room connect with a primary care doctor, possibly that same day. The third pilot program will create three teams that will work in three separate hospitals to identify people at risk of quickly destabilizing and becoming unhealthy again once they are discharged. The team will work intensively with the patient to appropriate follow up care and related services. The fourth pilot program will create a standardized method of discharging a patient from a hospital. Often, Labby says, primary care doctors may not know for months, if ever, that one of their patients went to the hospital for emergency or specialty care. A standardized “transition document,” to be used by all the Collaborative’s providers, will be created to record each hospital visit. When a patient leaves the hospital, the document is sent to the patient’s primary care provider. The communication between hospital and primary care doctor, via paper trail, will ensure that the doctor is able to “reliably follow up” with the patient in a “timely fashion,” Labby says. The fifth pilot program will embed outreach workers in hospital psychiatric units who will work with patients with acute mental illnesses who can destabilize easily, and help them enter behavioral health treatment and stabilize. The Collaborative expects to save $32.5 million dollars over the three years the pilot programs will be tested, simply by virtue of coordinating care, focusing on prevention, communicating more effectively and often with patients, and focusing more compassionately on their health care. Although the pilot programs are funded by the grant for three years, the Collaborative can decide to fund, expand and standardize a program across the Collaborative before then, if any or all of them prove effective. Connecting the Collaborative’s partners will be a new information sharing system. A digital database containing information about a particular patient — where their medical home is, what physical or mental conditions they have, and a record of care they’ve received. All the Collaborative’s providers will be able to use the database and add information to it. If a patient living in Portland somehow ends up in a Beaverton hospital and is cared for by a doctor who has never met that person before, that doctor will easily be able to access the patient’s information and, for instance, not prescribe medication they may be allergic to, or conflict with other medication they already take. And that doctor can enter information about the visit into the database, which the patient’s primary care doctor can later access. he Collaborative’s success won’t be measured simply by seeing an improvement in Oregon Health Plan patient’s physical health, but will also rely on whether other problems or issues that can impact health are dealt with. Central City Concern’s Blackburn has been using his membership on the Collaborative’s board of directors to help educate others about the importance of developing partnerships with service providers not necessarily related to health, including housing and employment services. He has helped form an informal association of 35 mental health and addiction treatment service providers, all of which could possibly contract with the Collaborative. Blackburn is also working to create a group of housing agencies, which is expected to begin meeting in the next couple weeks. “There’s a lot of people who depend on housing services, social services, employment services,” Labby says. “Those things are really important for people’s health.” “We need to recognize (those services) as part of the care team and intentionally engage with them,” Meyer says But Brown says it is unlikely that the Collaborative will contract directly with social service providers to help Oregon Health Plan patients get housing if they are homeless, for example. The reason, he says, is that the Collaborative would not be able to use its budget — made up of Medicaid dollars, the use of which is regulated by the Centers for Medicare and Medicaid Services - to pay for services not strictly health related. “But within our scope is to find those agencies that do have the dollars ... so that we can achieve the desired end,” Brown says. T
