Advocates Insist Psychological and Social Factors Integral to Coordinated Care Organizations’ Goals

However, Senate Bill 1522, heard yesterday, received a lukewarm reception in the Senate Healthcare Committee
The Lund Report

February 7, 2012—Legislation that would require coordinated care organizations (CCOs) to take into consideration psychological and social factors impacting a patient’s health received a lukewarm reception in the Senate’s Healthcare Committee yesterday afternoon.

Under Senate Bill 1522, these CCOs would have to incorporate goals related to the sociological and psychological challenges of their patients.

About 600,000 people on the Oregon Health Plan are expected to receive healthcare services under CCOs if legislators pass Senate Bill 1580 and state officials receive the necessary federal waivers.

The CCOs, which would start providing care by July at the very earliest, would integrate physical, mental and dental healthcare in an attempt to reduce overall costs and improve quality by focusing more attention on preventive services and keeping people out of hospital emergency rooms.

Craig Hostetler, the executive director of the Oregon Primary Care Association, argued that homelessness, substance abuse, being low-income and other sociological factors impact a person’s ability to not only seek healthcare, but actually become healthier as a result of accessing services.  

“It does take time and resources [to provide care] to patients who have severe barriers,” to healthcare, Hostetler told legislators.   

The current healthcare system is not good at providing services to “diabetics who are homeless and have substance abuse issues,” for example, he added, saying, unless legislators pass Senate Bill 1522, “there will be health disparities.”

This legislation is also extremely necessary because the current implementation proposal that will lead to the creation of CCOs does not detail how they’ll care for people who have non-medical challenges, said Kevin McChesney, the lobbyist for the Oregon Residential Providers Association.

“We feel that it’s important that the CCO’s outcomes reflect the special needs of these particular populations,” he said. “It’s crucial to controlling healthcare costs.”

The legislation appeared to have the support of the Senate Healthcare committee, with the exception of Sen. Alan Bates (D-Medford), who worried that, “While I agree with all that you’re saying here, I’m not sure I see the necessity of this.”  

A similar argument, Bates said, could be made for other people on the Oregon Health Plan with special needs, such as diabetics and asthmatics. “The goal of the CCOs is to take care of these people. If the CCOs do what we expect them to do, I don’t think we need to call it out any more than we are.”

He also appeared hesitant to place too many requirements on CCOs as they begin providing services. “This just throws one more thing in the fire,” he said. “It’s not time to do that right now.”

Bates’ comments were odd given that Rep. Tim Freeman (R-Roseburg) and he spoke out last week, urging the Senate Healthcare Committee to adopt amendments to the implementation bill (Senate Bill 1509) and include specific criteria about the governing board of a CCO and ways to deal with dispute resolution. That bill, however, passed out of committee without those amendments.  

Legislators will consider moving the bill out of committee and to a Senate floor vote on Monday.

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Comments

The overall success of caring for people requires multiple approaches and services, particularly those on Medicaid and Medicare. Unfortunately the State's resources do not allow for addressing all of those needs. The Legislature is strugglling with the definition of services that they will mandate and pay for under the CCO model in these tight times. The legislators are wise not to mandate more services than they can pay for. It is unfortunate, but until the economy improves or the voters allow more taxes, we will be short handed when it comes to taking proper care of the poor and disadvantaged.

Whether they are included in legislation or not, CCO's will be dealing with these issues--in expensive hospital emergency rooms!

It makes little sense to use terms like "integrated" and "holistic" and "person-centered" while putting on blinders that restrict care considerations to medical factors. Senator Bates, health plan-protective as usual, says that "it's not time" now to integrate health care into the whole fabric of the person's life. But do we really have a vision of true reform that will pay off ten state budgets down the road, or are we just clapping new labels on old intractibilities? If Oregon does not account for the social and mental health factors that drive people into sickness, this effort will fail.

I've seen how providing housing to homeless can reduce E.R. visits and is way cheaper. We are going to have to address people's social needs if we want them to get healthy and keep the system costs lower.