Bud Laurent, Chair, MVHCA
Among the many acronyms used as shorthand in conversations about health care, we can add a new one beginning in 2012: CCO. That stands for “Coordinated Care Organization” and is a product of recent legislation by state lawmakers responding to the federal Affordable Care Act. (House Bill 3650, if you’re interested: http://www.leg.state.or.us/11reg/measpdf/hb3600.dir/hb3650.intro.pdf )
CCO’s (several have been certified in the state) were created to improve the delivery of health care to Medicaid clients and, it is hoped, make Oregonians healthier. As envisioned, CCOs will coordinate care among a spectrum of providers, from primary care physicians and hospitals to dentists and behavioral health professionals. In our region, the CCO has been organized into the “InterCommunity Health Network” (IHN-CCO), a consortium of Good Samaritan Health Systems, Benton, Linn and Lincoln Counties, and several private providers.
One of the requirements for Coordinated Care Organizations is to hold public meetings at least quarterly to receive and answer questions on the minds of public health clients or supporters of public health care. The IHN-CCO held a quarterly meeting at the Benton County Fairgrounds on November 28th and several representatives of MVHCA attended and asked questions. We also submitted a list of questions from several members for written response, and Ms. Kelley Kaiser, the CEO of Samaritan Health Plans, provided the following answers:
1. Specifically what is being done to help health care practitioners modify how they practice medicine and become part of a TEAM in the patient centered primary care home?
IHN-CCO answers: This is a great question and one we continue to focus on. As we mentioned we have a group of providers that meet every two weeks to discuss clinical transformation and what it entails. There is significant discussion about the PCPCMH [Patient-centered primary care medical home], as well. Each provider group also is working on this internally in terms of educating and communicating with their providers (Samaritan Health Systems, The Corvallis Clinic, the independents etc.)
2. Please explain how community health workers will function and help "activate" Oregon Health Plan members to take responsibility for their health?
IHN-CCO answers: We continue to work with the state on their specific expectations of community health works. We are also working with the local counties who already have many of these workers in place. We will learn and build upon what is already out there and then make sure the pieces are there that the OHA (Oregon Health Authority) wants.
3. How will the CCO hold providers accountable for their performance in the medical home?
IHN-CCO answers: This is part of the metrics and specifics already in place by the OHA. Then as a CCO we would work through our Delivery Systems Transformation team to ensure that appropriate reporting is in place to meet our additional CCO requirements should there be some.
As a CCO we will also have to respond to the OHA metrics and will work with our providers through contract requirements to make sure we are meeting the OHA metrics.
4. How will decisions be made to utilize savings which may result from transforming delivery of care?
IHN-CCO answers: This will work through the Regional Planning Committee and the Finance Committee to make recommendations to the Governing Board.
5. What effort is being made to help the Community Advisory Council members get to know each other, find common ground and work together as a regional advisory body.?
IHN-CCO answers: We continue to meet with them as a group and work on the Charter. We are moving forward with hiring a CAC Coordinator to help keep the group moving forward and educated on their purpose. The meetings we have had so far have started to allow the group to get to know each other.
6. How will the community know if the CCO is doing their job? Will the Oregon Health Authority report their findings to the community?
IHN-CCO answers: The OHA through their Metrics Committee will be reporting out on all CCO’s [about] how they are doing. For us as a CCO we will work collaboratively with the CAC and the Community to continue to communicate our progress.
7. The Transformation bill passed by the Legislature includes language that assures that chiropractors and naturopaths who are qualified to be primary care providers be included -- along with nurse practitioners, doctors of medicine and of osteopathy -- in CCOs and made available to patients who wish their services. This language has been referred to as a "Non-discrimination" clause, meaning that no type of provider who is licensed by the state of Oregon be excluded. Today, many non-Medicaid patients turn to, prefer, and benefit from these providers. So my QUESTION is: Has the IHN CCO included several of these practitioners? Who are they?
IHN-CCO answers: We continue to respond to those providers interested in contracting with us. We will continue to follow our credentialing guidelines that are in place. For those providers who have expressed interest we are working on getting them our credentialing information by the end of the year.
8. Do you have a list of primary care providers, and their training and specialties, that are part of the IHN? We would be interested in knowing who are the auxiliary providers and services (such as physical therapists, etc.) also.
IHN-CCO answers: Our contracted provider panel is available on our website for all providers and specialties currently contracted with us. [The IHN-CCO website can be found at: http://www.samhealth.org/healthplans/members/ihncco/Pages/default.aspx]
MVHCA has requested that future public meetings of the CCO be accompanied by written summaries of presentations and any Q&A session following. This will require more work of the IHN-CCO, but MVHCA feels that records of these important meetings need to be publicly available. We’ll keep you posted.
Bud Laurent, Chair, MVHCA