Mental/Physical Health Patient Advisory Team Volunteers Needed

National Alliance of Mental Illness (NAMI) Oregon is partnering with other organizations to collect patient feedback on the coordination of mental and physical health services.   The group is recruiting for and forming a Patient Advisory Team of individuals who have or are receiving mental health services to share their experiences and act as advisors on this research project. The Patient-Centered Research Outcomes Institute is funding the project.

Contact michelle@namior.org for an application.

March 2015 Cover Oregon Consumer Advisory Committee Report

Cover Oregon and the current Oregon Healthcare Exchange under the Affordable Care Act

by CAC member Roberta Hall

On Friday, Feb. 27, Cover Oregon’s Consumer Advisory Committee (CAC) met for the last time. The place was the Durham headquarters of Cover Oregon, soon to be dissolved, though the space will be used for several more months. The exchange is not by any means abolished, however, as its activities will continue under the Department of Consumer and Business Services, the state’s largest regulatory agency. (This transfer occurred about a week later.) The important points that the public should know appear to be these:
1. Cover Oregon costs have been reduced significantly. In 2014 the budget was 90 million dollars, of which 80 million were spent, whereas this year the budget is 15 million. Last year, the average cost per enrollee was $48, and this year it is $10. Last year, enrollment was done with both paper and online techniques developed under contract to the state of Oregon, whereas 2015 enrollees used technology developed by the federal government (HealthCare.gov).
2. The King v. Burwell case, heard in the Supreme Court on Wed., March 4, is a legal challenge to federal tax credits offered in the 2010 Affordable Care Act (ACA). It applies to states that did not set up their own exchange; however, Oregon is one of 16 that did. Oregon continues to run its own exchange, albeit using technology developed by the federal government. Still, if the plaintiffs win, and tax credits are not provided in the other states, it would change the ACA’s impacts dramatically.  Regardless of the outcome (expected in June of this year), the extension of Medicaid to persons with incomes less than 138% of the federal poverty level is not affected by the suit. Oregon’s Medicaid system, OHP, is now administered by the Oregon Health Authority (OHA).
3. Once again, at the 11th hour, the OHA extended the deadline for OHP fast-track enrollees to renew their coverage; “fast-track” refers to automatic enrollment because of prior income-certification through the food-stamp program. The previous deadline was 2/28, but that has been extended to March 31. It was estimated that the remaining fast-track population who need to act before the 3/31 deadline is about 32,000. There has been a backlog, but the OHA has announced that it is hiring more call center staff to address that serious problem.
4. One of the obligations Cover Oregon staff are working on, in addition to clearing up problems that the technology collapse caused earlier, is getting the small business healthcare insurance program (SHOP) online. Right now, there is a manual process in place until a permanent solution is found.  You can find out more here. Employers with 1-50 employees face no penalty for not providing insurance, but it is my understanding that they can use the program if they wish, and some have been using it.  Starting in 2016, employers with 51-99 employees will be required to provide insurance.  Employers with 100+ employees are supposed to offer coverage to 70% of their employees this year, 2015.
Ten members of Cover Oregon’s CAC attended the Feb. 27 meeting, seven in person, and three online. Much of the meeting was given to a report and Q and A with Director Aaron Patnode.  Alicia Blevins discussed income tax forms pertaining to the individual insurance obligation and Qualified Health Plans (1095-A); next year a tax form (1095-B) will also be sent to people enrolled in a government-sponsored plan like OHP.  Joel Melton and D’Anne Gilmore from the Department of Consumer and Business Services, together with Director Patnode gave an update on the apparently amicable transition process. Cover Oregon staff members Rachael Oh, Kelly Harms, and Cherie Miller ran the meeting and performed recording and online activities. CAC members thanked them and Director Patnode for their work, and expressed regret that these employees had in effect been held accountable for problems that they had no control over.
Please note that Cover Oregon employees are not state employees, so they will not be transferred to other state jobs, nor do they have PERS. The director of the agency where the exchange is now housed did not keep director Patnode on staff after the take-over, and the agency is laying off about 50 more in March; several current Cover Oregon staff will continue, perhaps through June. I, for one, appreciate their service and believe that the successes the exchange has had in extending healthcare coverage to many more Oregonians – perhaps approaching half a million – are due to their efforts and dedication.
Advocacy groups such as Mid-Valley Health Care Advocates need to follow these changes as they unfold in order to advise people correctly as well as to learn more about the complexities of making changes in the structure of the state’s healthcare-related programs.


Roberta Hall, member, Cover Oregon CAC, March, 2015



Oregon Health Plan Terminations

This is a letter from Beth Englander, State Support Unit Attorney at the Oregon Law Center. Please read it and pass the information on to people who may get dropped from their coverage.

Dear community partner : Are you seeing clients who received a notice from the Oregon Health Plan saying their coverage will end soon?

67,000 low income Oregonians were just recently told by the state that they (or their citizen children) will lose their Oregon Health Plan coverage at the end of January or February.  Those people received a notice in the last 6 months telling them they need to go through a renewal or re-determination process in order to keep their OHP coverage.   Many of those people tried to renew or re-determine (some by going to the federal healthcare.gov website, some by trying to call OHP, some by trying to get help from their local self-sufficiency office/case worker) but are still getting a letter from OHP saying something like:

“Your Oregon Health Plan benefits are ending.  We have not received your renewal information.  Your benefits will end on  (date)”. 

Some people are getting notices from OHP in a language they don’t understand and are not sure how to respond to the notices.

The Oregon Law Center and Legal Aid Services of Oregon are trying to help people who tried to renew or didn’t understand that they needed to renew keep their Oregon Health Plan coverage.  If you are providing services to (or assisting) a client/patient who is going to lose their OHP (or their citizen children will lose their OHP coverage) and who tried to “re-determine” or couldn’t understand what to do due to language barriers, please contact Beth Englander at the Oregon Law Center, at 503-473-8321.  

We would like to help people keep their OHP coverage.   If you or others in your organizations talk to people who received an OHP termination notice, would you please have your staff person call me at 503-473-8321?  Or direct the clients themselves to our public benefits hotline at 1-800-520-5292.   Below and attached is a letter on this topic that you could distribute to anyone who might have contact with clients who are being told their OHP coverage is ending. 

Thank you for your time. 

Beth Englander


Information About Signing up for Health Insurance, and Renewing OHP

From the Community Partner Outreach Team, here are some tips to help with your application:

HEALTHCARE.GOV
On the question on HealthCare.gov application about current health coverage, when you fill out an application on HealthCare.gov, one of the questions asks you about your current health coverage. This only refers to private insurance. It does not refer to the Oregon Health Plan
or Healthy Kids. Please put "no" if the only insurance you have is OHP or Healthy Kids. Answering
 "yes" may result in an incorrect eligibility determination.

OHP REMINDER LETTERS

Many OHP members will received or have received a letter reminding them to renew their coverage. Waves of notices were sent to fast-track individuals on Friday, December 12, reminding Oregon Health Plan members to renew their coverage. Please note: Due to the need  to get reminder notices out as soon as possible, the Oregon Health Authority was unable to match renewals already submitted for processing with the reminder mailing list. Therefore, members who have already responded to their initial renewal letter may receive a reminder notice. If they have submitted their application, they have done what they need to do, and their benefits will continue while OHA processes their  application. These members do not need to call Customer Service.

OHP RENEWALS
OHP members will remain covered through January 31, 2015 while their renewal applications
are processed. Members should still submit their renewal applications as soon as  possible. Right now, and through the end of the year, many Oregon Health Plan  members are scheduled to renew their coverage. This means that there is an extremely large number of paper and online renewal applications still being processed for the months of November and December. Not all renewal applications can be processed by the time many members are scheduled to lose their OHP coverage on December 31. This may cause a disruption in a member's care and is counter to our goals of ensuring people have coordinated and continuous care. Therefore, to ensure that members can continue to access care while their renewal applications are processed, their coverage will continue through January 31, 2015.
If they are part of a coordinated care organization, their CCO enrollment will also
continue through January 2015.

* Anyone who received an expedited or full application renewal letter and has not
already taken action should do so immediately so there is no gap in coverage. Members
should follow the directions in their letter for the best way to renew by the end
of the year. OHA will notify them once their application has been processed.

* Members who already submitted a renewal application do not need to call OHP Customer
Service. They will process their application as soon as possible. Their benefits will
remain open while their application is processed. OHA will send them a letter after
we process their renewal application.

NOTE: Not all fast-track members will have their coverage continue. Some fast-track members will still lose benefits on December 31, 2014.
* Fast-track members who already submitted a renewal application and who no longer
qualify for OHP coverage
* People in the MAGI Adult program, and who are also receiving Medicare, per federal
requirements.

DECEMBER 15 DEADLINE EXCEPTION
Exceptions to the December 15 deadline to enroll in a Qualified Health Plan through
HealthCare.gov:
People who are closed or denied OHP have until the end of the month to choose a
Qualified Health Plan that starts on the first of the next month. This is because
they lost their "Minimal Essential Coverage".

Some callers tried to reach HealthCare.gov by phone on December 15 and were given
the option to leave a message due to the high call volume. When these applicants
 get a call back from HealthCare.gov customer service, they will be able to enroll
in a plan effective January 1, 2015.

PROCESSING TIMES
Expect full 45-day processing for applications

As we mentioned above, many Oregon Health Plan members are renewing their coverage.
Due to the volume of applications being submitted, it is appropriate to expect a
 full 45 days for processing. This includes the online PDF or the paper application.
Please keep this in mind as you consider follow up.

More information at Healthcare.gov, Oregon Health Authority, or your county Health Department.

 

 


 

 

 

 

Cover Oregon Advisory Council Report by Roberta Hall of MVHCA

Dec. 9:  CAC meeting, Cover Oregon, Friday Dec. 5, 2014  -- a virtual, by-phone regular meeting. Roberta Hall, MVHCA and CAC member, reporting.

Of course one report from this meeting was about enrollment which started mid-November and ends mid-December for those purchasing commercial products (Qualified Health Plan). As usual, the process has gone more slowly than is desirable. One problem is that if people wait until the last minute, there could be clogging of the website Healthcare.gov – not pleasant.

This week (of Dec.8-on) are the Legislative Days when continuing members of the Legislature meet. The Health care Committee of the house and the Senate’s Health and Human Services committee were meeting. Aaron Patnode, CEO of cover Oregon, told us he would speak to each of them, give an update, and discuss how the errors Cover Oregon (C0) made re: advance tax credits could be corrected, among other topics. On Wed. the Joint interim Committee on Health Care Transition is to meet for the first time, to consider the future of Cover Oregon. The Legislative Concept (the equivalent of a draft bill) LC 1203, now available on line, calls for abolishment of CO—it would also abolish the Board and our CAC – but of course the exchange would continue to exist and its functions would move to Consumer and Business Services, where the Insurance Division is.  Of course the bill could be altered, but in any case it sounds more like a symbolic act than anything that would bring a great deal of change from a user’s point of view; but of course I could be wrong.

Advertising is going on to try to motivate people to enroll in insurance plans through Healthcare.gov.

Insurance companies, we were reminded, are commercial enterprises. They are supposed to remind people to enroll, but sometimes their notices imply that people need to enroll in their plans whereas of course people are free to explore others. There have been workshops to help people, as we noted in the recent MVHCA newsletter, but the one nearest to us is Dec. 10 in Eugene, at Lane Community College Downtown Center, 11 to 3, 101 W 10th st. room 107.

Judy Mohr-Peterson, Oregon’s Medicaid Director, provided useful information. People new to Medicaid can go to healthcare.gov and see if they qualify to enroll, but they also may find helpful information on a new site called Oregonhealtcare.gov, before they go to Healthcare.gov.  It provides screening questions on income and other factors that could help people learn about OHP and if they qualify.

People who qualify and are accepted receive OHP services dating from the date of their application. This is an important point often not stressed. People who were fast-tracked via the SNAP or food-stamp program do need to apply in order to continue to be part of OHP, and some other OHP members will simply be contacted and asked to affirm that their financial situation has not changed, in order to continue. My understanding – I hope it is correct – is that some OHP members will not be contacted but simply will continue on OHP. In any case, if a person is contacted and either does not see the letter, or fails to reply, he or she will be contacted at least twice again, with notices asking them to reply, before being dropped. This is a necessary process, as sometimes letters are lost in the mail, or mislaid. Of course, people with questions about making an OHP application can talk with our Health Dept. Navigators who can be reached at 541-766-2130 or by going to the department office at 27th and Tyler.

One quarter of our Oregon population is on OHP, giving an indication that a very large percentage of our population experiences some degree of poverty. We all have a lot to do to turn this around.

Glimpses of the CCO Summit- Achieving Health Systems Transformation?

December 4, 2014

Report by Lee Mercer, President Health Care for All-Oregon
December 4, 2014

Speaking to 1300 plus attendees at the Coordinated Care Organization Summit in Portland, Susan Johnson, Regional Director, US Department of Health and Human Services (Region 10) said Oregon is “leading the nation like a North Star” towards creating a sustainable model of health care for the future. Nichole Maher, President of the North West Health Foundation sees the key to health in our communities and health outcomes being now defined by zip code, race, income and other social determinants. She thanked Governor Kitzhaber for a budget reflecting dedication to health equity.

Kitzhaber outlined some of the successes of Oregon’s recent initiatives— 95% of Oregonians have health insurance and a million have enrolled in a new health care model. As the CCO’s start covering public employees we are moving towards savings that culminate in a structural budget surplus in 2123.

Building on this theme, keynote speaker Don Berwick, MD, former administrator, Centers for Medicare and Medicaid Services, and Founding CEO, Institute for Healthcare Improvement, praised Oregon and the attendees of the conference. “Bravo! You’re doing something amazing—there is a bright light here.”

But, he noted, there is “a burden of leadership for Oregonians as pioneers.” Pioneers are bound to experience uncertainties. He said Oregon should sense the importance of what we are doing and maintain cooperation—unprecedented levels of cooperation. Everyone must be willing to give up something as we stay focused on the triple aim of better care, better health and lower cost. The cost of health care is inhibiting us from being what we want to be as a nation.

His thesis, illustrated by graphs showing escalating costs, is that health care is “confiscating” opportunity in terms of eating up public finance. As premiums rise faster or through taxes), it is all, sooner or later, coming out of the pockets of the workers. And it means that health care is stealing from all the other programs that government might be providing.

He sees the health care system metaphorically like the Choluteca Bridge, in Honduras. Built well by US engineers, it has weathered every storm for generation, but, over the years, the river has moved and the bridge is no longer relevant.

To make health care relevant and effective, Berwick noted, we must begin treating it as a human right and build a system which is cost effective and sustainable. He sees a need for developing a cooperation index in our work. A focus on transformation and not the finances. He concluded by congratulating Oregon again on its successes, adding “the country needs you!”

Numerous Health Care for All Oregon advocates, proudly wearing their red t-shirts proclaiming health care as a human right, were disappointed that Berwick, an outspoken supporter of single payer as a candidate for Governor in Massachusetts, didn’t mention this needed systemic reform. He probably didn’t want to steal the thunder of the progress in reducing health care costs by Oregon’s CCO system.

Then a series of speakers outlined how they have organized their CCO’s in communities throughout Oregon. Much emphasis was on building the Community Advisory Councils that guide CCO’s. A number of moving personal stories illustrated the partnering of behavioral, physical and dental health specialties throughout the state. Also, stories emphasized partnership with early childhood education.

Kevin Campbell, a former business man and now CEO of Greater Oregon Behavioral Health, Inc. noted that, in Eastern Oregon, it was less about talking health care transformation and more emphasizing community strengths and local control. A big piece was doing Community Health Improvement Plans. In their vast region, 12 counties developed 12 independent plans and then found a unifying consensus. Not only did they serve Medicaid/OHP users, but philanthropic support was forthcoming which meant many of the facilities and services are available for all in the communities. One grant was given for each county, and the OHSU Center for Evidence Based Policy helped assess the grant projects.

CCO 101

Judy Mohr Peterson, Director of Division of Medical Assistance Programs (Medicaid) at OHA, spoke in a break out group providing an overview of the Coordinated Care Organization system. She started by outlining the reasons for the need for transformation:

  • Health care costs are unsustainable

  • Health outcomes are not what they should be

  • Lack of coordination between physical, behavior and dental health

Previously, during a budget crisis, there were three ways to deal with a shortfall of Medicaid dollars. One was to cut people, and thus began the lottery for OHP participation. Another was to cut benefits- this often meant cutting mental health, dental health or prescription drugs, all of which are optional under Medicaid. Finally, they could cut provider rates.

Under Kitzhaber’s vision of the triple aim, the goal was better health, better care and lower costs. Not just one or two, but all three. So Oregon set out to reduce waste, improve health and take steps to build a more sustainable model.

There are now 16 CCO’s, and 95% of 1,000,000 folks on Medicaid are enrolled. Mental, physical and dental health are all in one budget. Incentives are in place for quality and achieving growth limited to 3.4% (a cut of 2%).

Mimi Haley (Columbia Pacific CCO) and Coco Yackley, Operations Manager, Columbia Gorge Health Council, outlined more of the nuts and bolts of putting CCO’s together. In the Gorge the CCO was embedded in an existing organization (Pacific Source). The Community Advisory Council was formed, giving Pacific Source one vote, with 50% consumers and 50% “at risk” (financially) organizations. The Clinical Advisory Panel (optional) was also formed.

The Columbia Pacific CCO was formed in the coastal counties of Clatsop, Columbia, Tillamook and Douglas. It operates under a global budget as a wholly owned LLC of Care Oregon in partnership with Greater Oregon Behavioral Health. There are 15-20 directors. One seat each is held by Care Oregon and GOBH. There are 4 Community Advisory Councils, one for each county. They have grown from 7,000 to 25,000 members. Some of the health strategies include Health Home Assessments (discovered a woman who used oxygen has carbon monoxide leaking from her furnace—after repairing, she no longer required oxygen) and Health Resiliency (trauma informed support to “high utilization” patients).

Among challenges cited by the CCO’s include billing issues, different payment models and provider shortages. They couldn’t give metrics on provider shortages, but noted that most dentists in the area do not take Medicaid. Coco Yackley quipped that she could “see why single payer would help” due to the complexity of the various payment systems. Well child visits paid for by Medicaid, may, in a private insurance plan, be on a different annual calculation, so those patients may have to pay out of pocket.

Appreciating the opportunity to learn about the cost savings and system improvements being pioneered in Oregon’s Community CCO transformation, a nagging question remains. If this system is indeed more patient centered, why are all the metrics cited for its success, cost saving outcomes, not health outcomes?

In the Executive Summary of the 2013 Performance Report large improvements cited are:

Decreased emergency department visits. Emergency department visits by people served by CCOs have decreased 17% since 2011 baseline data. The corresponding cost of providing services in emergency departments decreased by 19% over the same time period.

Decreased hospitalization for chronic conditions. Hospital admissions for congestive heart failure have been reduced by 27%, chronic pulmonary disease by 32% and adult asthma by 18%.

Developmental screening during the first 36 months of life. The percentage of children who were screened for the risk of developmental, behavioral and social delays increased from a 2011 baseline of 21% to 33% in 2013, an increase of 58%.

Increased primary are. Outpatient primary care visits for CCO members increased by 11% and spending for primary care and preventive services are up over 20%. Enrollment in patient centered primary care homes has also increased by 52% since 2012, the baseline year for that program.

So cost savings are great and more screenings and primary and preventative services are wonderful.

But where are the patient health outcomes? How is the health of the folks not doing emergency room visits? Are they managing their congestive heart failure, chronic pulmonary disease and adult asthma? And how is the health of the kids being screened and patients getting primary care services?

At some point beyond cost savings and increased services, health outcomes need to be the final measure of a sustainable health system. When we have metrics which say that, in Oregon, we have achieved the lower infant mortality and higher life expectancy rates, the lowered rate of disease and the other health outcomes achieved by all industrialized countries which have in common universal, publicly funded health systems, we can say we are fully succeeding in transforming our health system.

Sign up for our monthly electronic  newsletter, see our calendar and upcoming events to get informed and involved. Thanks!

Report on Cover Oregon Consumer Advisory Committee

by Roberta Hall,  Oct. 17, 2014

Despite all the bad news about Cover Oregon, its CAC met Oct. 17, with new Executive Director Aaron Patnode in attendance throughout. As a final comment, he reported that there is NO option for any state NOT to have an exchange, though Cover Oregon likely will be housed under another agency. A brief update concerning 2015 and for details contact member Bobbi Hall at rlhall@peak.org:

Budget will be 12 to 15 million dollars, down from 90 million this year; expanded Medicaid enrollees who entered via Fast-Track (Food-Stamp recipients) will need to apply, but other current enrollees will be sent a form to certify that their financial situation has not changed (or has); most people will apply via Healthcare.gov; new OHP clients can enroll anytime as can tribal members and certain others, but for most, enrollment begins Nov. 15; Navigators as well as Agents are receiving training on the use of Healthcare.gov. This past year approximately 100 small businesses (with 2 to 50 employees) were enrolled; they did not use the website and again will enroll directly but the federal government has told Cover Oregon that internet access must be ready for these businesses before the end of 2015.

Main news is the numbers: Medicaid increased 58% this year, from 614,000 to 976,000; about 77,000 Oregonians enrolled in a Qualified Health Plan. Currently  about 1,694,657 people are in either OHP or Medicare, out of 3,961,514 people so that makes ~43% covered by what is primarily federally-paid health insurance. About 5.1% of the population now lack health insurance (down from 14%) while about 5.5% have private insurance and ~46.5% have group insurance (mostly through employers). Much insurance covers an average of 70% of health care costs, however. 

A Successful Celebration of CCO Success!

A large and diverse group of people attended the August 12 CCO Celebration sponsored by MVHCA, League of Women Voters of Corvallis, Health Care for ALL Oregon-Abany, Interfaith Health Care Network, and Corvallis Physicians for a National Health Program. At MVHCA we are taking a keen interest in the Coordinated Care model because we realize that Oregon doesn't just need to change the financing of health care to a publicly funded (or single payer) system, but also needs to transform how care is delivered to give everyone the care they need when they need it in an equitable and affordable way.

Assisters from the Benton County Health Department were on hand to provide information about signing up for health care coverage.

Assisting.jpg

There was an amusing and educational skit about the difference between the old way of providing care and the coordinated way making use of Patient Centered Primary Care Homes (PCPCH). In this photo MVHCA Chair Ron Green holds the title card while Ann Brodie introduces the skit.

The skit illustrated how the focus of the PCPCH is centered on the patient, and services like physical, mental, and dental health are coordinated to give the patient better health, better care, for a lower cost -- known as the Triple Aim.  Here, the "Old Way" Dr. Sorry Imlate, played by Mike Huntington, takes a phone call from his wife while patient Shelley Ries waits and wonders why he has no time for her list of questions.

Following Dr. Sorry Imlate,  "CCO Way" Dr Still Imalate, played by Tessa Green,  took the time to examine the patient and introduce her to a councilor who will help her with her depression.

 

After the skit, Dr. Kristen Bradford, MD, Medical Director , Community Health Centers of Benton and Linn Counties, shared stories from Oregon Health Plan members about how having affordable coverage has changed their lives.

Judy Sundquist, MPH, RD, discussed the metrics that are used to measure the performance of Oregon's Coordinated Care Organizations and commended InterCommunity Health Network Coordinated Care Organization (IHN-CCO) for it's improvements in access to care, immunizations for adolescents, patient satisfaction, medical assistance with smoking/tobacco cessation, and developmental screening of children - first 36 months.

Judy.jpg

Judy introduced the panelists who spoke about how much the change to coordinated care has helped them in serving the Oregon Health Plan (OHP/Medicaid) members who are in their charge.  The panelists consisted of Kelley Kaiser, CEO of IHN-CCO; Sherlyn Dahl, BSN, MPH, Director of the Federally Qualified Health Centers of Benton and Linn Counties; Kevin Ewanchyna,  MD, Chief Medical Officer; and Larry Eby, MD, Chair, IHN-CCO Community Advisory Council. The panelists made the point that the transformation to coordinated care will not only help OHP members, but the improvements will be implemented for everyone needing care. They emphasized that they do not envision a 2-tiered system of health care.

Governor Kitzhaber recorded a video message of congratulations on the 2 year anniversary of IHN-CCO and it's many accomplishments.

There was time for questions from the audience, and then everyone enjoyed the refreshments.

Thank you to all who organized, presented, attended, and asked insightful questions. A special thanks to Mina Carson for taking the photographs used here.

 

MVHCA's Bobbi Hall reporting on the Cover Oregon Consumers Advisory Committee meeting in Portland

June 6 --I attended the statewide Cover Oregon Consumers  Advisory Committee meetings in Portland. I'm a member, and about 12 or  so of us show up once a month and hear from administrators about changes that are going on, and get updates;  we also ask a lot of  questions and give advice to the Cover Oregon administrators based on  what people in our home areas tell us.Yesterday was special because Clyde Hamstreet (the interim CEO) and  Tina Edlund  (the transitions director) spent an hour and a half with  us. They gave us the report they had given to the Oregon Legislative committee on May 28, and we had lots of questions for them. They have  made many structural changes. Re-structuring means that Oregon will complete the year on a secure  financial base. Many of the working parts of the Cover Oregon website  will be kept. In the future, OHA will be responsible for OHP enrollment, rather than Cover Oregon. Though the Federal website will  be used in November for commercial insurance plans, Oregon will retain  control of how they both are managed, and Oregon's insurance rates  will remain lower than those of most other states. Also, commercial rates in November will NOT be the same as they are now so people interested in changing their commercial plans need to check the Cover Oregon site in the fall.


The Cover Oregon board will meet  Thursday and possibly make some more decisions. Everyone at the meeting spoke very highly about the Community Partners and Navigators,  and the agents, who have helped people to enroll successfully. We also observed that many new enrollees need help in understanding how to use the system. Overall, we on the committee felt good about the meeting and the attitudes of the new managers, who very much want the programs to succeed. My own feeling is that the public attitude toward Cover Oregon is improving and will continue to, once the public learns how many people have been enrolled (more than 400,000 now). 

Report by Bobbi Hall

InterCommunity Health Network Coordinated Care Organization Delivers Medicaid Care In Linn, Benton, and Lincoln Counties

Meet the chair and coordinator

The Community Advisory Council elected Larry Eby, MD, Albany, as its chair in April, 2013. In a separate action, Rebekah Fowler, PhD, Corvallis, was hired as the coordinator for the volunteer body.

Eby is a graduate of the University of Michigan Medical School and practiced medicine mainly as a general surgeon in Ohio, Puerto Rico, and Nigeria and briefly as an emergency room physician in Newport. He has been active in health care access and improvement issues in the Albany and Corvallis areas for several years. Rebekah Fowler, PhD, and Larry Eby, MD

“I am a strong advocate for health delivery reform as a means for improved health outcomes and satisfaction leading to lower cost,” said Eby. “My son, Dr. Douglas Eby, is vice-president for medical services for the South Central Foundation, which is the agency for medical care for much of the Alaska Native population. There he has been one of the architects of a delivery system that is being copied in many other parts of the U.S. and Canada, especially their Patient-Centered Medical Home system. He was in this area about two years ago and spoke to several groups in Corvallis and Albany. I have visited Medical Homes in Alaska on several occasions and have seen how their system works. This is my strongest asset to bring to any role within the coordinated care system.”

As the Council’s chair, Eby also serves as a voting member of InterCommunity Health Network Coordinated Care Organization's (IHN-CCO) Governing Board.

View live video of Eby's address during a recent public meeting hosted by IHN-CCO.

Fowler, the Council’s coordinator, works council representatives to ensure that they have the support they need to meet the requirements spelled out by the Oregon Health Authority in its contract with IHN-CCO.

Previous to her work on the Council, Fowler, a native Oregonian, coordinated Oregon Health Plan member advisory councils for the Accountable Behavioral Health Alliance. She also worked to develop non-traditional health worker programs within that agency’s five-county region. She holds a doctorate in social psychology and a master’s of science in experimental psychology.

“I look forward to working with the Council and applying my strong commitment to transforming health care through effective collaboration and communication,” said Fowler.

“With the selection of Dr. Eby as chair, and Dr. Fowler as coordinator, our Advisory Council now has all the elements in place to begin their work to oversee a regional health improvement plan that supports Oregon’s triple aim of better health, better care and lower cost of care,” said Kelley Kaiser, chief executive officer of IHN-CCO.

The Advisory Council also works with IHN-CCO to identify and advocate for preventive care practices, oversees a community health assessment, and annually publishes a report on the progress of the improvement plan.

The public is welcome to attend any meeting of the Advisory Council and participate during the public comment period allowed. Meeting dates, agendas, and minutes of the Advisory Council are published on this website. Anyone wishing to receive an email notice of events can sign up for this service.

Oregonians! Don't Be Afraid of the Oregon Health Plan (Medicaid)

Many Oregonians who qualify for free health coverage through Medicaid via the Oregon Health Plan (OHP) are refusiing to sign up because they fear that the State will come after their assets when they die.  There was a good deal of confusion early on because the rules had not been updated to reflect the expansion of Medicaid to a larger number of people based on income alone, not assets.  

Here is what the Oregon Health Authority published in November, 2013 when they updated their forms to correct the Medicaid Recovery issue:

Estate Recovery and the Oregon Health Plan

The Oregon Health Authority will no longer implement estate recovery for OHP clients

What is happening?
The Oregon Health Authority is changing the policy on estate recovery for the Oregon Health Plan benefit. The Oregon Health Plan (OHP) is Oregon’s public medical, dental and menta health care benefit.

For any coverage that starts October 1, 2013 or later, members of OHP who are not receiving long-term care services will not be subject to estate recovery. This policy change affects all current and future enrollees on OHP.

Why this is happening?
OHA is making this change because the estate recovery program was not designed for health benefit programs such as OHP Plus. It was designed for long -term care services for people who need them due to age or disability. It allows for reimbursement of public dollars for long-term care services. These are services that go beyond medical care or hospitalization. Long-term care services can include care in a nursing home care, community-based care, such as a Foster Home or Assisted Living Facility, or full-time assistance with daily living in an individual’s own home. Long-term care is not a covered service under OHP Plus.

 

Here is what FactCheck.Org has to say:

Q: Does the Affordable Care Act allow states to confiscate the estates of seniors on Medicaid when they die?

A: No, but a 1993 federal law requires states to recover Medicaid costs for long-term care from the estates of deceased Medicaid beneficiaries over the age of 55.

The interaction of the federal Affordable Care Act and existing state Medicaid estate recovery laws is a legitimate issue and something that Medicaid recipients need to understand before they sign up. They should know that the rules vary from state to state, with some states dunning the estates of deceased Medicaid beneficiaries for all Medicaid costs and others just for long-term care. And the rules keep changing. AARP’s Moorhead says so far two states (Washington and Oregon) have changed their rules to limit estate recovery to Medicaid costs related to long-term care, as required by the 1993 federal law.

So please do not hesitate to sign up for OHP because of the Estate Recovery Program. If you are worried about the fact that your income fluctuates and you may go in and out of OHP eligibility, you may want to attend an information session about Oregon's Basic Health program on May 8th in either Corvallis or Monroe.

 

Oregon health care reform succeeds despite problems at Cover Oregon (guest opinion)

By Gil Muñoz

There’s no doubt that the Cover Oregon website has been dogged with problems since it launched last October, but the exchange’s IT problems are overshadowing a major policy success. To date, thousands of Oregonians who were previously uninsured have gained access to health care, benefiting all of us.

At the same time that Oregonians are signing up for health insurance through Cover Oregon, Community Health Centers like Virginia Garcia are working with Coordinated Care Organizations (CCOs) to update the way we provide care and implement cost-effective measures that improve patient outcomes. We’re establishing patients with a primary care home and providing them with a team of providers and staff who share knowledge and give patients personal attention. This team-based model of care is working for the benefit of our patients and it’s something we continue to expand and improve.

Virginia Garcia currently serves over 36,000 patients, but there are thousands of people in Washington and Yamhill counties who still don’t have access to care. To meet this growing demand, Virginia Garcia is increasing our capacity to provide services for patients where they live and work.

Full article here.

Cover Oregon and Other Healthcare Expansions---Update, March, 2014

The March meeting of the Cover Oregon Consumer Advisory Committee (CAC) provided little new information except that enrollments by hand and, to some extent, using agents operating directly through the internet, are continuing, but still are behind schedule. Agents help clients with commercial products and community partners help clients who qualify for the Oregon Health Plan (OHP/Medicaid), and at least as I understand it, no agents have yet been compensated for the time taken out of their business to do this. The hope is there, but in this health care episode, there are many uncompensated players. Beneficiaries are those who have succeeded in getting signed up for Oregon Health Plan  or gotten lower cost and improved insurance coverage, many (about 79%) with federal tax credits covering part of their premium. Some who qualify, however, still lack coverage.

The relationship between Cover Oregon and Oracle continues to be difficult. The Oregonian reported on Mar. 13 that a federal report on Oracle and Cover Oregon is scathing. However, it did corroborate the statements of some Cover Oregon employees that Oracle had repeatedly denied requests for information--that is, Cover Oregon had attempted to manage the contract, but been rebuffed. Clearly, the contract itself had been deficient, based on non-existent trust.

At the April CAC, members will discuss what other things Cover Oregon can do to accomplish its mission of improving the health of the population.

One optional ACA expansion, Basic Health, is being studied. It is a program to extend health services to more low-income people (those under 200% of the poverty line), including legal immigrants with less than 5 years residence who heretofore have been excluded from Medicaid (OHP). A bill to establish this study, HB 4109, passed in March. A discussion I had with the Chair and Vice-chair of the House healthcare committee about what Basic Health is aired Mar. 10 on KBOO and can be heard here.

---Roberta Hall