Fast Track Legislation Scrapped, Lacking Political Support

It’s rumored that CMS would not have given Oregon additional money to fund coordinated care organizations had the fast track option succeeded

February 9, 2012— The managed care plans that are currently providing services to Oregon Health Plan members appear to have lost their bid to create what’s known as “fast track,” legislation, giving them the ability to turn into coordinated care organizations (CCOs) by July, without having to meet all the criteria, guidelines and the certification process developed by the Oregon Health Policy Board.

These CCOs are the backbone of the transformation reform under way and are expected to begin integrating the physical, mental and dental healthcare of 600,000 people on the Oregon Health Plan and help stabilize healthcare costs by relying on primary medical homes and community health workers and also avoiding hospital emergency room visits.

Rep. Tim Freeman (R-Roseburg) and Sen. Alan Bates (D-Medford) championed the fast track concept, and co-sponsored House Bill 4153, which would enabled the current managed care organizations to become CCOs as long as they had at least five years experience providing services to Oregon Health Plan members.

Freeman and Bates both argued during the Oregon Health Policy Board’s December meeting that it was important to fast track these managed care organizations to ensure continuity of care throughout the state. “We have a very short timeline to form CCOs,” Bates told the board. “If we don’t have the ability to move these forward quickly, we’re going to have some real problems.”

“I think we’d be wise to let that occur,” Freeman had said.

Now legislators have scrapped the fast track idea and created one set of criteria for organizations interested in becoming CCOs.

"We've all moved past the idea of fast tracking organizations," Bates said during a Senate healthcare committee meeting last Friday.

When the House Rules Committee—co-chaired by Rep. Tina Kotek (D-Portland) – met on Monday, it completed replaced the fast track language bill, House Bill 4153, merging that legislation into the implementation proposal leading to the creation of CCOs known as Senate Bill 1580. The two bills are now identical.

All along, advocates were concerned that by granting fast track status, managed care organizations might not have provided more efficient and coordinated care – and it would simply have been business as usual.

“It would be a shame for [CCOs] to turn into something like we already have,” said one lobbyist who preferred not to be named.

Meanwhile, on the other side, the managed care organizations have been pushing for the fast track out of concern that they’d be left out of the new transformation model and be taken over by larger health plans and hospital systems.

“It didn’t seem to make any sense to discriminate against communities where it might take a little more time,” said Doug Riggs, who lobbies on behalf of the Oregon Primary Care Association. “The goal is to get it right; not do it fast.”

But Freeman said any likelihood of “MCOs just morphing into CCOs” has evaporated. “We’re going to set one level of criteria and encourage people to set up [a CCO] as early as possible.”

“Early on, there was some concern,” he said, that some areas of the state would not have had a CCO. But with the announcement that Douglas County providers have formed the Community Health Alliance, which intends to become a CCO, and with the discussions under way in Portland focused on creating a single CCO for the tri-county areas (known as the Tri-County Medicaid Collaborative) those worries have been somewhat erased.

“Common sense prevailed,” Riggs said.

Did CMS step in?

Numerous sources, including lobbyists and legislators, have told The Lund Report that the biggest nail in the fast track’s coffin was the lack of support from the Centers for Medicare & Medicaid Services (CMS), which is carefully watching Oregon’s efforts to transform the Oregon Health Plan delivery system and are promising millions of dollars to help CCOs get off the ground.

Those sources, who would only speak anonymously, also said that CMS would not be willing to give Oregon additional federal dollars if the fast track legislation had succeeded.

“There was concern that there was different criteria,” Freeman said, but added he “had not heard the concern” that federal dollars hang in the balance.

“Having one bar [of criteria] is very important to CMS,” Governor John Kitzhaber told The Lund Report.

But when asked if CMS would have limited financial assistance, Kitzhaber said, “I don’t know if that’s a concern. [But] we need to cover all our bases.”

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This is great news! We can now all hope for a valid and sustainable transformation. The fast track process would have rewarded the people and politics behind current ills in the system. Patients, providers and communities deserve better for our money. PR

Rewarding based on simple longevity those health plans who have been poorly accountable to their members and the state was always a bad idea. It would be nice to see Senator Bates begin devoting to health plan members more of the energy he perennially commits to protecting the plans. It is past time to recognize that what is good for plans-turned-CCOs is not always good for members and the public which funds the plans. Increasing public membership in CCO governing bodies from one to three is a good first step.