Douglas County Providers Form the State’s First Coordinated Care Organization

A non-profit organization, the Community Health Alliance, has brought together physical, dental, mental health and addiction services

January 30, 2012—A group of nine healthcare providers in Douglas County are forming the state’s first coordinated care organization (CCO), calling it “the Community Health Alliance.”

The provider groups include Douglas County Independent Physician’s Association (DCIPA), Douglas County’s Health and Human Services Department, Greater Oregon Behavioral Health, Inc. (GOBHI), Mercy Medical Center, Umpqua Community Health Center, Advantage Dental, and ADAPT, which provides substance abuse and addictions treatment and recovery services.

DCIPA, GOBHI and Advantage Dental already provide care to nearly 16,000 Oregon Health Plan members in Douglas County.

The Community Health Alliance’s announcement is well ahead of the curve in the state: many organizations are just beginning to meet to talk about forming a CCO. The Legislature, which begins meeting on Wednesday, will begin considering a business plan outlining how CCOs will be implemented. If the Legislature approves that plan and Oregon receives the necessary federal waivers, the Oregon Health Authority would begin soliciting proposals in April for CCOs to get under way.

These CCOs will coordinate the physical, mental and dental healthcare for more than 600,000 people on the Oregon Health Plan starting in July. The organizations, which are expected to provide more efficient, effective and therefore less expensive healthcare, are the backbone of the reforms to the Oregon Health Plan as a result of the passage of House Bill 3650 during the 20111 Legislature.

Dr. Bob Dannenhoffer, the CEO of DCIPA, said discussions about forming the Community Health Alliance began as House Bill 3650 worked its way through the Legislature. DCIPA, representatives of Douglas County, and other healthcare providers had begun meeting to discuss how to better provide healthcare in Douglas County. Honing that conversation to be about CCOs was not difficult. “We’ve been working together for a long time,” he said.

“It was natural for us to just expand that group to a few more people and just continue our discussions,” said Peggy Madison, director of Douglas County’s Health and Human Services Department.

Bruce Piper, ADAPT’s executive director, said “it’s very early to know” exactly how the Community Health Alliance will work and how the various organizations will work together to coordinate care. “It’s not like all of our previous roles will vanish,” Piper said, adding that ADAPT will continue tor provide primary care, substance abuse and behavioral health treatment.

Dannenhoffer doesn’t think the care provided by each organization will change, but anticipates better coordination, communication, and more sharing of information among the various providers.

He envisions the alliance having a two-stage process: first, learning how to coordinate and share information, and once those kinks are ironed out, begin focusing on “the patient and the patient’s needs” versus a fee-for-service model that pays providers per visit, not by how effectively they treat someone.

“We have a lot of redundancies and a lot of gaps,” said Kevin Campbell, GOBHI’s CEO. “How do we reduce the redundancies and eliminate those gaps? How do we allow people to more easily access the care they need?”

Dannenhoffer said the providers comprising the alliance deliberately chose to only serve Douglas County, which is approximately 5,000 square miles large, and has about 16,000 Oregon Health Plan members. Providing care over such a large distance will be challenging, and it would become more so had the alliance chosen to expand into other parts of southern Oregon.

“Delivery of healthcare is, really, a local event,” Dannenhoffer said. “I don’t see a great advantage in being much bigger. The decision making would get hard, and we’ve got everyone we would like to have.”

The alliance intends to hold its first formal meeting in mid-February to adopt bylaws, and begin forming a community advisory committee, but will have to wait for legislative action before moving forward. There also remain several unanswered questions.

“We still don’t know if we’re going to get the [Centers for Medicaid and Medicare] waivers,” Dannenhoffer said.

And there are questions about the global budget that will impact how much money will be available to the alliance. “Clearly, if we’re asked to do new and great things with the same or less money is a great challenge,” Piper said.

“We have lots of…business-like questions,” Madison said. “We’re not trying to get too far ahead of the [business] plan.”

If, for some reason, the Legislature does not approve the business plan and allow the Oregon Health Authority to move forward with creating CCOs, the Community Health Alliance will proceed, regardless.

“Coordinated care is a worthwhile thing to do,” Dannenhoffer said.

Cutting reimbursement or people from the Oregon Health Plan just doesn’t work, said Piper, “The alternatives are not really palatable.”

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Interesting article especially since CCO legislative approval and application process have not yet been completed.