Monday, November 4, 2013

OPRA Confirms UHA's CAC violates State Law!

Oregon Patients Rights Association has confirmed that the composition of Umpqua Health Alliance's legally mandated Community Advisory Council (CAC) violates Oregon State law.

This fact was recently revealed to the public by the release of the legally required CAC Community Health Assessment and confirmed this evening at a community meeting in Roseburg by UHA representative Mike Shirtcliff.  

In answer to questions challenging the make-up of the CAC by an OPRA member,  Shirtcliff attempted to justify the composition of UHA's CAC by claiming that different CCOs in our state interpret the law differently.  That may be the case but that is the type of thing lawsuits are made of.

Oregon Revised Statute 414.625(1)(i) states:

(1) The Oregon Health Authority shall adopt by rule the criteria for a coordinated care organization and shall integrate the criteria into each contract with a coordinated care organization. Coordinated care organizations may be local, community-based organizations or statewide organizations with community-based participation in governance or any combination of the two. Coordinated care organizations may contract with counties or with other public or private entities to provide services to members. The authority may not contract with only one statewide organization. A coordinated care organization may be a single corporate structure or a network of providers organized through contractual relationships. The criteria adopted by the authority under this section must be designed so that:....

(i) Each coordinated care organization convenes a community advisory council that includes representatives of the community and of county government, but with consumers making up a majority of the membership, and that meets regularly to ensure that the health care needs of the consumers and the community are being addressed."

Now keep in mind, the term consumer in this legislation refers to Medicaid consumer because this law is only about Medicaid.  There would be no other "consumer" for the purpose of determining the health care needs and services for anyone but them given the intent and purpose of the law that created the CCO system.  

It seems that the only CCO that we can identify that tries to claim the language in the law allows them to pick anyone they want and are not mandated by law to pick Medicaid consumers is our very own Umpqua Health Alliance.  There may be some others out there but we have not found them. Not surprisingly they are also the one of the few CCO that operates in secrecy not even providing information about the CAC to the public.   

Fortunately the one thing the Community Health Assessment has accomplished is providing information to the taxpayer that confirms that the Community Advisory Council does not have a majority of Medicaid members.  See the letter below attached letter submitted to member of the UHA Board (Shirtcliff and Commissioner Susan Morgan) by an OPRA member that explains why.

What do you think?

November 4, 2013

Umpqua Health Alliance (UHA)
Community Advisory Council

To Whom It May Concern:

After reviewing the Community Health Assessment and the Oregon Revised Statute regarding the role of the Community Advisory Council (CAC) in overseeing it, I am very concerned about the fact that the makeup of our local CAC violates the law that was enacted to implement Oregon’s Medicaid reform efforts.  The failure of the CAC to comply with the requirements of the Oregon Revised Statute puts the validity of the Community Health Assessment, and any other work being done by the CAC, into question.   

Two statutory requirements of the CAC are to oversee the process of the Community Health Assessment and adopting a community health improvement plan based upon that assessment that will guide the provisions of services in our community.   If the configuration of the CAC does not comply with the legal requirement that 51% of its members be Medicaid consumers, then anything they come up in this process, starting with this Community Health Assessment, lacks credibility.     

Although this is not the fault of individual CAC members, it is the fault of those on the Umpqua Health Alliance (UHA) Board of Directors, DCIPA LLC and its parent company Architrave.  As Medicaid contractors, they should be well aware of the law regarding this.  So we can only assume that they are blatantly ignoring it and have failed to make sure that the current members of the CAC know the requirements of the law including the Medicaid majority.
One only need review the report itself to verify that the CAC does not have the majority of Medicaid consumers on it that is required by state law.   This same paragraph demonstrates the problem that failing to comply with the law creates.  The following appears on page 45 of the report:
“Variance between groups is notable. Higher socioeconomic groups (such as the CAC) rate lifestyle and the jobs as the biggest factors relating to health whereas those groups representing individuals living in poverty or those with health disparities listed access to health care, domestic violence, and housing as major concerns.”

As you will note, the report identifies the Community Advisory Council as being “higher socioeconomic” level.   It is clear from this that UHA acknowledges that the CAC is not 51% Medicaid consumers.  One has to be low-income to benefit from Medicaid, so by the very definition of eligibility, one could not be from a “higher socioeconomic” group.  The same sentence also makes it clear that there are differences in views among this group and those identified as “individuals living in poverty”.   This type of difference could have a dramatic impact about the very construction of the survey process, including what questions to ask and of whom.  

It seems a glaring omission to me that there is not more input from Medicaid recipients in the CHA.  One cannot identify from the focus group categories whether those responding represented Medicaid recipients either.  Although one might conclude that certain focus groups would have a at least some Medicaid consumers represented in them based on other information in the report, there is nothing that enumerates the number of Medicaid consumers participating in any part of the process.   One might also conclude that if the CAC had the required majority, there would be more engagement from Medicaid beneficiaries. 
The entire reason that the law requires a majority of those on the CAC to be consumers of Medicaid services is to ensure that those who benefit from the services are an integral part of the process.  It is no mistake that this requirement was put into the law governing CCOs and this requirement cannot be ignored.
There is really only one way to resolve this issue:
1.    The Community Advisory Council (CAC) must immediately be reconstructed to comply with Oregon Revised Statute (ORS) 414.625:
“414.625 Coordinated care organizations; rules. (1) (i) Each coordinated care organization convenes a community advisory council that includes representatives of the community and of county government, but with consumers making up a majority of the membership, and that meets regularly to ensure that the health care needs of the consumers and the community are being addressed.”
2.    The Community Health Assessment (CHA) should then be redone by the CAC with a majority of Medicaid consumers on it making the decisions about how the CHA will be conducted.  
It should go without saying that the selection of the CAC members should be done in a fair manner that does not discriminate against Medicaid beneficiaries and others who have exercised their rights, including any of those who may be here tonight to object to this process.  
Although the entire process is in question, it is hard to argue with some of the information set out in the report.  For a while, we have been aware of our low rankings in the state regarding overall health markers of our community.   The News Review has consistently reported that Douglas County has too many people who smoke, are overweight or obese, and suffer from more health problems that most of the other counties in Oregon.   Further, access to quality health care has been a problem in this community for some time, for a variety of reasons.
If we assume that these things are true, then there is nothing that stops our local CCO, Umpqua Health Alliance (UHA) from implement changes in the provision of services that includes promoting better health and health care.  These things include:
1.    Focusing on increasing access to primary care providers throughout the community.  This would include reopening clinics in Glide and Drain. 
2.    Making sure that patients receive health care services based upon individual patient need and choice. 
3.    Ensure all patients are provided with “informed choice” regarding all that is available to them, whether or not paid for by the CCO.
4.    Ensure that all providers know and honor patients’ right.  
5.    Ensure that providers are allowed to freely make medical decisions with their patients and are not forced to comply with unnecessary rules and restrictions created by the CCO.  
6.    Ensure that services are provided in a timely manner, such as dental health services.
7.    Create a global budget that adequately compensates providers for the services each patient needs, particularly in cases of chronic multiple health conditions or mental health services that may take more time and intervention than others.
8.    Include in the global budget money for health improvement such as:  YMCA and other health club memberships and exercise classes, as well funding hands-on healthy cooking classes that are free to participants.
These are just a few things that can be done to improve the health care and health in our community right now, while we are waiting for Umpqua Health Alliance to make sure their CAC complies with the law. 
Thank you for your time and consideration.

Betsy Cunningham
1026 SE Stephens
Roseburg, OR 97470
Telephone: 541-580-2746

Thursday, October 31, 2013

LUND Report Confirms: Freeman Gets Corporate Medicine Money

Today's article in the Lund Report confirms, Oregon Patient Rights Association claims that our local State Representative, Tim Freeman is in the pocket of our local health care monopoly.   Topping the list of donations to all Representatives in the State, Tim Freeman received a total of $33,500 just from the interests involved in formation of Coordinated Care Organizations (CCO), like our local Umpqua Health Alliance (UHA) during the last election cycle. 

This supports research done by OPRA that shows in the past two election cycles, Freeman received over $50,000 from DCIPA and Advantage Dental alone, both of whom are part of the local Coordinated Care Organization (CCO), Umpqua Health Alliance and whose leaders (Dr Bob Dannenhoffer-DCIPA, Mike Shirtcliff (Advantage Dental) claim to be part of the process of establishing CCO as the Medicaid transformation in Oregon.    

You can read the Lund Report article below or click the link to their website:

OPRA recommends the Lund Report for reliable information about health care related issues around the state.

Post date: Oct 31, 2013

Coalition of CCOs and Doctors' Groups Pour $1.4 Million into Elections

The Coalition for a Healthy Oregon proved an effective political counterweight to insurance, pharmaceuticals and hospital interests, backing legislation to create and strengthen CCOs.
Christopher David Gray
The combined efforts of a coalition of CCOs and doctor’s groups shelled out nearly $1.4 million in the last election cycle, roughly the same money spent by the Oregon hospital association, health insurance companies and drug companies combined.
The Coalition for a Healthy Oregon, a political action committee that represents seven coordinated care organizations, spent $478,000 since 2011 on political campaigns.
Rep. Tim Freeman, R-Roseburg, topped their list at $33,500, followed by his fellow Roseburg Republican, Rep. Bruce Hanna, who got $32,000. Sen. Arnie Roblan, a Coos Bay Democrat and former co-speaker in the House with Hanna, raked in $27,000.
All three represent parts of Douglas County, where coalition member Umpqua Health Alliance manages care for Oregon Health Plan members and the Douglas County Individual Practice Association is a prominent healthcare player. Western Oregon Health participates in the coalition and provides care in Coos and Curry counties.
Each CCO in the state has been allowed to form organically, creating different makeups at each one, but the CCOs in the Coalition for a Healthy Oregon are heavy with physician groups, while others give a more prominent role to hospital systems or insurance companies.
The other CCOs in the Coalition for a Healthy Oregon are Trillium in Lane County; Willamette Valley Community Health in the Salem area; FamilyCare in Portland; Cascade Health Alliance in Klamath Falls and AllCare in the Medford area.
Jeff Heatherington, the CEO of FamilyCare, said the organization formed a political action committee 10 years ago to comply with campaign finance law and influence health policy after the state Medicaid plan was hit with big cuts and faced an uncertain future.
“We were concerned about adequate funding for the Oregon Health Plan,” Heatherington said candidly. “Now it’s a matter of survival. We need to be at the table.”
Heatherington said bigger moneyed interests like drug companies, insurance companies and hospital systems have an outsized presence in healthcare, and the coalition allows the physician groups to even the playing field.
As a comparison, the Oregon Association of Hospitals and Health Systems spent $246,000 and 19 drug companies handed out $491,000. Leading insurer Regence BlueCross Blue Shield spent $236,000, almost entirely on Republicans, many of whom lost their elections.
The dollar amount is still lower than the combined total of four major unions — AFSCME, SEIU, the Oregon Nurses Association and the Oregon Education Association. The labor groups spent just under $2 million in the past election cycle.
SEIU spent $700,000 through two funds close to evenly split — one borne out of union dues and the other from a political action committee, Citizen Action for Political Education, in which thousands of SEIU members gave directly for political causes.
"The members are concerned about the affordability of healthcare. We're concerned about long-term care. We're concerned about worker's rights issues," said Arthur Towers, political director of SEIU. "We need to be involved in that process."
Heatherington said the coalition was effective in pushing legislation like Senate Bill 725 that gave more certainty to CCO contracts as well as keeping pressure on Salem Health to drop a lawsuit against the Willamette Valley CCO through the bad actor bill, House Bill 3309.
“It was used very prominently to get Salem Hospital to the table,” he said. “We hope that it calmed down everything.”
The bill died in the House Rules Committee, but the two parties agreed to a settlement just before the end of the session.
The coalition’s money was bolstered by doctor’s groups in several counties, including Douglas, Marion, Polk, Jackson and Josephine.
The Douglas Physicians spent $413,000, most heavily on Roblan, giving him $37,500. They also gave $28,500 to Sen. Laurie Monnes Anderson, despite her seat being across the state in Gresham. Monnes Anderson chairs the Senate Health Committee and wields hefty over healthcare bills.
These physicians also gave $28,500 to hometown son Hanna and $22,500 to House Speaker Tina Kotek, D-Portland.
The doctors in Marion and Polk counties, who worked to form the Willamette Valley Community Health CCO, paid out $441,000 under their political action committee, Doctors for Healthy Communities.
The Salem area physicians favored the same cast of characters — $31,000 to Monnes Anderson; $27,500 to Roblan; $20,500 to Kotek; and $19,000 to Hanna. Their committee also disbursed $17,500 to the campaign of Sen. Alan Bates, a Medford Democrat and osteopathic physician.
Bates was not up for re-election in 2012 but he faces a tough rematch in 2014 with his 2010 nemesis, retired Marine Col. Dave Dotterrer, whom he bested by just 275 votes last time, nearly sweeping Bates out of office in the Republican Tea Party wave.
The political action committee of the Mid Rogue Independent Physician Association chipped in another $50,000, about half of which went to Bates, who practices medicine in that region. Rep. Wally Hicks, R-Grants Pass, received $9,000, followed by Kotek with $5,000.
To review previous articles on campaign finance in Oregon click here and here.
Chris can be reached at

Monday, October 21, 2013

UHA, CAC to Hold 3 Public Meetings to Discuss Community Health Assessment

Here is an opportunity to find out more about our local Coordinated Care Organization (CCO), Umpqua Health Alliance (UHA).  This coming Wednesday evening (10/23/2013), at the Sutherlin Community Center, from 5:30 to 6:30 pm, UHA’s  Community Advisory Council (CAC)   will reveal the results from a community health assessment and let communities know what the local Coordinated Care Organization is doing.   

Below is a link to the Health Assessment, so you can read what a group of folks who met in secret decided were the health problems in our community.  

This may be a good time for folks to ask questions of this group of people who is supposed to be representing the community’s interest in the CCO. This Community Advisory Committee is required by law and is supposed to be set up in a particular way and be the public’s vehicle to be part of the CCO process, yet UHA will not even tell us who is on it or when or where they meet.   These meetings should at least reveal who they are, or who at least some of them are.  Set out below is the Oregon law section that deals with the requirements of Community Advisory Councils (CAC).  Based on information provided to us, UHA may be violating the law regarding the make-up of the CAC.  

These meetings may be a good time to hold UHA representatives, including the CAC members there, accountable for failing to reveal the members of the CAC to the public, failing to hold all CAC meetings in public, allow public comment at meetings, and provide minutes of the meetings and related documents to the public.    

The meetings will also provide a forum for input about what you want UHA to spend our tax dollars on locally to promote healthy lifestyles, better health care services and improved medical outcomes.   

UHA’s Community Advisory Council (CAC) will also be holding meetings in Riddle, October 29th from 1:00 to 2:00 pm at Riddle Community Center, and in Roseburg from 5:30 to 6:30 pm, Ford Rm, DC Library on on the 4th of November.  

Tuesday, September 24, 2013

Sorry, the DOCTOR is no longer taking new patients!

Even though this article was posted on the web in May, 2013, I think it is useful now -- long after the 76th Oregon Legislative Assembly has closed up shop and the reps gone home.

Meet Maggie: Walking Medical Time Bomb

And if you haven't seen the documentary called "The Healthcare Movie" I urge you to see it as soon as possible.

Produced by Canadian/American couple Laurie Simons and Terry Sterrenberg, this documentary reveals the public relations campaigns that have been prevalent in the United States since the early 1900's to dissuade the American public from supporting national health care.  It also shows the personal and emotional impact on Canadians who now have access to health care because of the heroism of people who took a stand to bring universal health care to Canada over 50 years ago.
The film reveals the real story of how the health care systems in Canada and the United States evolved to be so completely different, when at one point they were essentially the same. Most people under the age of 50, in both countries, are not aware of the intensity of the political struggle that led to the universal medical care system in Canada. Nor are they aware of the public relations campaigns, still active today, that have been prevalent in the United States since the early 1900’s to dissuade the public from supporting national health care.  Every day people are dying or going bankrupt due to the ills of the United States system. Who are we in the face of this human tragedy? If you agree that people are more important than profits, then you must watch this film.

Best 90-second Speech of the 76th Oregon Legislative Assembly

Saturday, August 17, 2013

If cannabis contributes to (this) mood elevation, should patients be deprived of it?

Dr Lester Grinspoon is Associate Professor Emeritus of Psychiatry at Harvard Medical School. For 40 years, he acted as Senior Psychiatrist at the Massachusetts Mental Health Center, and supports the use of marijuana for a variety of ailments.

If you want to learn more about treating chronic pain with cannabis, visit this website:

If you want to learn more about the medical uses of marijuana, here are some sources:

Abrams, D. I., Jay, C. A., Shade, S. B., Vizoso, H., Reda, H., Press, S., et al. (2007). Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology, 68(7), 515-521.
Ellis, R. J., Toperoff, W., Vaida, F., van den Brande, G., Gonzales, J., Gouaux, B., et al. (2008). Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology, 34(3), 672-680.
Russo, E. B. (2008). Cannabinoids in the management of difficult to treat pain. Therapeutics and Clinical Risk Management, 4(1), 245-259.
Russo, E. B., Guy, G. W., & Robson, P. J. (2007). Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex((R)), a Cannabis-Based Medicine. Chem Biodivers, 4(8), 1729-1743.
Wallace, M., Schulteis, G., Atkinson, J. H., Wolfson, T., Lazzaretto, D., Bentley, H., et al. (2007). Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology, 107(5), 785-796.
Additional Research
Karsak, M., Gaffal, E., Date, R., Wang-Eckhardt, L., Rehnelt, J., Petrosino, S., et al. (2007). Attenuation of allergic contact dermatitis through the endocannabinoid system. Science, 316(5830), 1494-1497.
Lynch, M. E., & Clark, A. J. (2003). Cannabis reduces opioid dose in the treatment of chronic non-cancer pain. J Pain Symptom Manage, 25(6), 496-498.
Lynch, M. E., Young, J., & Clark, A. J. (2006). A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations. J Pain Symptom Manage, 32(5), 497-501.
Neff, G. W., O’Brien, C. B., Reddy, K. R., Bergasa, N. V., Regev, A., Molina, E., et al. (2002). Preliminary observation with dronabinol in patients with intractable pruritus secondary to cholestatic liver disease. Am J Gastroenterol, 97(8), 2117-2119.
Notcutt, W., Price, M., Miller, R., Newport, S., Phillips, C., Simmonds, S., et al. (2004). Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 “N of 1″ studies. Anaesthesia, 59, 440-452.
Notcutt, W. G., Sharief, M., Mutiboko, I., Hawkes, C., Bolt, J., & Sarantis, N. (2006). Cannabis based medicine (Sativex) for chronic pain due to multiple sclerosis or other neurological dysfunction: a randomised controlled trial. European Journal of Pain, (in press).
Nurmikko, T. J., Serpell, M. G., Hoggart, B., Toomey, P. J., & Morlion, B. J. (2005). A multi-center, double-blind, randomized, placebo-controlled trial of oro-mucosal cannabis-based medicine in the treatment of neuropathic pain characterized by allodynia. Neurology, 64(6, Suppl. 1), A374.
Pertwee, R. G. (2001a). Cannabinoid receptors and pain. Prog Neurobiol, 63(5), 569-611.
Rog, D. J., Nurmiko, T., Friede, T., & Young, C. (2005). Randomized controlled trial of cannabis based medicine in central neuropathic pain due to multiple sclerosis. Neurology, 65(6), 812-819.
Russo, E. B. (2004). Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocrinol Lett, 25(1-2), 31-39.
Russo, E. B. (2006). The role of cannabis and cannabinoids in pain management. In B. E. Cole & M. Boswell (Eds.), Weiner’s Pain Management: A Practical Guide for Clinicians.(7th ed., pp. 823-844). Boca Raton, FL: CRC Press.
Wilsey, B., Marcotte, T., Tsodikov, A., Millman, J., Bentley, H., Gouaux, B., et al. (2008). A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain. J Pain, 9(6):506-21.