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)
