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
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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.
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