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Questions abound in state health care plans

by: Cover design by Chelsea Tull The Spotlight's Guide To Good Health inside the Feb. 15 issue.

Uncertainties in Gov. Kitzhaber's initiative to convert the state's medical system into a coordinated care model are drawing concern from Columbia County officials and caregivers.

Columbia County Commissioner Earl Fisher convened two meetings with local health care government agencies and private practitioners earlier this year. Across the board, he said, there is uncertainty how the governor's plan for Coordinated Care Organizations, or CCOs, would pan out for those who receive health care assistance in Columbia County.

And one factor above all others is causing some to hit the panic button: Roll-out of the CCO model is expected to start in July.

As it now stands, no organization that qualifies as a coordinated care provider has indicated any interest in providing services to Columbia County.

'We just don't know if anybody wants to include us,' Fisher said. 'We don't know what it means if we're not included.'

There is also mounting consensus among private care organizations and practitioners that the potential for diminished reimbursement funding could serve as a disincentive to offering physical and mental services to Medicaid recipients on the Oregon Health Plan.

'We're finding a lot of doctors and private providers are not willing to take on Oregon Health Plan patients,' he said.

In that case, those who rely on aid programs could be forced into Portland for basic services, Fisher said, versus visiting local practitioners or health clinics such as OSHU or Legacy.

Initially, the CCO model is intended to target Medicaid patients. It is based on the premise health care patients are shifted among many separate health care providers and agencies, resulting in cost inefficiencies and service gaps.

By having one agency coordinate health care, the patient can move through one administrative framework. Also, the CCO provider would manage a lump, 'global' budget, which state officials say works as an efficiency incentive because savings are held as profit. The CCO provider is also accountable for meeting health outcomes for quality and efficiency.

Dr. Bruce Goldberg, head of the Oregon Health Authority, said coordinated care organizations should help the state break free of its 'unsustainable health care system' that has seen costs increase dramatically for employers and employees in the past few years.

'The way we've dealt with (the cost increases) in the past is to do three things: cut people from coverage, cut payments to providers and cut benefits,' Goldberg said. 'What we feel we can do now is create a fourth way, and that is changing the way health care is delivered by focusing on managing chronic illnesses better, deliver robust primary care and give local communities more control.' Goldberg said local organizations should be able to better manage health care and be accountable for services and their costs.

Early sideboards on the coordinated care model indicate Columbia County would be left out of the program, however. One necessary component is that CCOs are connected to hospitals, Fisher said, of which Columbia County has none.

And hospital administrators are hitting the panic button in some instances. The CCO model, as part of statewide health care reform that ultimately is intended to serve as a model for national reform, is prefaced on a preventative care model. With an outcome geared toward considerably fewer emergency room visits, the business model for even large hospitals could be compromised.

Jim Coffee, CEO for Coastal Family Health Center in Clatsop County who has attended the Columbia County meetings, said that's not necessarily a bad thing.

'I think it's a great philosophical model to move to,' Coffee said. Coffee is working with Columbia Community Mental Health administrators on a plan to build a network of community health centers in Columbia County. He said concerns private physicians would be rendered insolvent due to the CCO model are somewhat 'alarmist.'

'The reality is the state doesn't want everybody to go broke,' he said. 'The reality is the state wants everybody to stay whole and provide services.' He did say, however, that the unknowns are driving concern among private care providers. 'It's a big if,' he said.

Coffee said he anticipates community health centers would participate as CCO providers. He also said the community health center model allows for better recruitment of physicians to rural areas because they get to spend more time working as a doctor versus a business owner and because federal student loan repayment options are available.

CCO bill passes Senate

• Sen. Betsy Johnson, of Scappoose, was considered a swing vote after she signed a letter siding with Senate Republicans last week threatening to vote against CCOs because the bill, SB 1580, did not place limits on medical malpractice suits initiated by health plan members. Johnson changed her position in an afternoon vote Tuesday, when CCO formation passed the Senate, 16-14. She said the Republicans' vehicle for tort reform was flawed and posed constitutionality questions upon a Department of Justice review. 'There were huge unintended consequences,' she said. She said medical tort reform will be a top priority for her in the 2013 session.