Access to Care and Defining Preventative Care Concern Health Share

The wait times for routine mental health care at times took six to seven weeks.

Health Share ‘s Community Advisory Council heard CEO Janet Meyer’s report on the coordinated care organization’s first two year’s work, remaining work for the next 12 months, and beginnings of the CCO’s next two- to three-year plan at the council’s monthly meeting.

Meyer said Health Share’s board gave strong support to focusing on two issues going forward -- capacity and access to care along with how to define preventive care.  “We can’t end hunger or solve the housing crisis,” Meyer said, “So where do we work?  We’re developing strategies around those two.”

Council member Gary Cobb, who works as a health resilience specialist at Central City Concern, said high users of medical care, including the homeless and addicted, are the ones most in need of coordinated care but said some have “burned their bridges” in the healthcare system.  “We need to create a system where bridges don‘t get burned,” he said.

That issue connects to access and capacity.  “We need a different kind of access-- peer support and community health workers,” Meyer said.

Amy Anderson, advisory council member and chair of Multnomah County’s Community Health Council, suggested adding community health workers to reporting structures.  “How do we know we’re succeeding with community health workers?”

Meyer agreed:  “It’s something we have to learn,” Meyer said.  “The system is extremely siloed.”

Meyer also presented Oregon’s Health System Transformation 2013 Performance Report, which uses the carrot-stick approach by first funding CCOs that reach certain benchmarks before invoking punishments for failure to meet those goals. 

This year, Health Share received $13.7 million, which was distributed to its partners to invest in delivery and infrastructure. 

Discussion at the advisory council focused on areas where Health Share did not earn funding including access to care and patient satisfaction. One was the percentage of patients who thought they received appointments and care when needed; the other category was the percentage of patients who received needed information and thought they were treated with courtesy and respect by customer service staff.  

“Where does the capacity issue stand?” Council chair Stephen Weiss asked.

“I don’t know about other CCOs but we’re all very full, near capacity.  It’s not surprising.  But we’ve been able to assign.  Our partners are working with us. Enrollment is leveling off,” Meyer said.

As of June 15, total enrollment in the Oregon Health Plan stood at 1.28 million, she said, reflecting an additional 400,000 enrollees in Oregon from the expansion of Medicaid.

Anderson said she was told that people enrolled in the biggest mental health agency had to wait six to seven weeks for an appointment. “So others (smaller agencies) probably are worse,” Anderson said. “These are people with complex health conditions.”

Susan Kirkchoff, chief operating officer at Health Share, said it’s a workforce problem. Only so many mental health professionals are fully trained and available with demand for their skills rising.  “People who need routine care may wait longer so that (agencies) can get urgent cases handled.” 

Beth Epps, chief clinical officer at Cascadia Behavioral Health, said at one point when staffing issues coupled with intakes that were “through the roof” waits could be six to seven weeks.  Current wait times for routine appointments at Cascadia are now between nine and 21 days, Epps said.

Sandra Clark, Health Share’s project director for community health strategies, reported on efforts to improve cultural competence and health equity, telling the council that next month they’ll see a final plan for 2014-2015.

“Cultural competency is a foundational bedrock, not a project,” Clark said, with some 100,000 people of color making up Health Share’s membership.  “It’s front and center when one out of four people in our plan need their care in a different language.” 

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