Oregon Patients Rights Association was formed late last year in response to concerns about policies being implemented by our new local Coordinated Care Organizations (CCO), Umpqua Health Alliance (UHA). We quickly learned that although there seems to be a means to ensure local accountability, in practice there really is not.
Umpqua Health Alliance is solely owned by Douglas County Independent Practice Association (DCIPA). Although there is a “board of directors” made up of people representing various providers under the Oregon Health Plan, as well as a county commissioner and at least one “community member”, according to the Secretary of State (as of today), UHA is owned by DCIPA. This means that the “board of directors” is really only advisory in nature and does not have the legal authority or right to set policy for the CCO.
In a rush to get a handle on escalating cost for the state’s Medicaid program, the state jumped on the CCO bandwagon. Unfortunately they failed to ensure CCO operate in the open or with sufficient safeguards for local accountability were in place. The structure of our local CCO is just one example.
There are two experiments going on today in Oregon regarding access and delivery to medical services. One revolves around implementation of health insurance exchanges provided for under the Patients’ Rights and Affordable Care Act (ACA). The other revolves around the ACA provision to expand Medicaid coverage to those whose household income is 133% or below of the federal poverty line.
Oregon already has expanded Medicaid coverage, to those not otherwise eligible under federal Medicaid rules, via the experiment known as the Oregon Health Plan. However those more will be added in 2014 when the ACA expands eligibility to those not currently covered under OHP.
Although a May 2, 2013 New England Journal of Medicine Special Article, The Oregon Experiment-The Effects of Medicaid on Clinical Outcomes, reveals that the benefits of having Medicaid verses being uninsured in Oregon shows little in the way of overall health care improvements, the state hopes to change this with implementation of the Coordinated Care Organization model. The state has high hopes for this new delivery system: they believe they will provide better care, with better health care outcomes, and save money too.
The CCO is based upon provisions in the ACA for Accountable Care Organizations (ACO) to serve Medicare fee-for-service beneficiaries, particularly those with chronic health conditions. Although the CCO is now just a Medicaid program, its set up is such that they can easily become recognized for Medicare as an ACO. The concept is a good one.
Coordinated care is important for people with chronic health conditions and may be critical for people with multiple chronic conditions. Coordinating care, making appropriate referrals, and doing follow-up has always been the model for good quality medical care, mental health services, and social services. Having a way to make sure that happens is welcome.
What is not welcome is the fact that how this will all happen is being done without the public’s knowledge or input. Currently there is no means for us to know what policies, procedures, or plans are being made by our local Coordinated Care Organization: Umpqua Health Alliance (UHA).
Our group, OPRA came together because of some policies being enacted by several UHA members and although there are ways we are addressing some of our concerns through program appeals etc, we believe that the best way to address the basis of our concerns is through an open and public process for the development of plans, policies, and procedures regarding how coordinate care will take place in our community. This will not only serve our interest, it will serve everyone’s interest.
This is not just the demand of a few disgruntled, OHP clients, but is based upon proven social psychology models that recognize the rights of the population being served, as well as their ability to help design programs that work to accomplish long term goals. It is also based upon sound principles of good governance.
So we have been working to get CCOs, particularly our local CCO, Umpqua Health Alliance (UHA), to operate in the open and be accountable to the public by promoting state legislative efforts that would accomplish this. Now that the legislative session is almost over and there is little hopes in getting anything passed that will protect our right to know, OPRA will be asking our local CCO to voluntarily comply with Oregon Public Records & Meeting law.
If UHA needs examples to follow, they can look to other CCO in Oregon who are open and transparent without being told to be. These include Trillium and CareOregon, both are similar to UHA, where private doctors group owns the CCO, and they are able to operate in the open. We should demand no less of our local CCO, Umpqua Health Alliance (UHA).
CITED: (n engl j med 368;18 nejm.org may 2, 2013)