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

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