Cascade Comprehensive Care and Klamath County Commissioner Engage in Public Dispute

Cascade Comprehensive Care insists it receive a letter of support from the board of commissioners supporting their application to be a coordinated care organization

May 9, 2012--What started as a steady stream of emails between Cascade Comprehensive Care and Klamath County Commissioner Cheryl Hukill relating to the managed care organization’s interest in becoming a coordinated care organization turned into a testy public spat in the pages of the Klamath Herald and News.

Cascade Comprehensive Care recently submitted an application to become the coordinated care organization serving all but four zip codes of Klamath County. Coordinated care organizations — also known as CCOs — are the backbone of the reforms the Legislature put in place with the passage of House Bill 3650 and Senate Bill 1580 in the last two sessions.

CCOs are expected to integrate the physical, mental and dental care of Oregon Health Plan patients by creating patient teams. The hope for CCOs is that they will provide more efficient care, and keep patients out of the emergency room and prevent costly specialty care.

As soon as Senate Bill 1580 passed the Legislature and was signed by Governor Kitzhaber in February, Bill Guest, the CEO of Cascade Comprehensive began emailing Hukill, who is the board of commissioner’s liaison to the county’s health department.

A February 23 email, forwarded to The Lund Report by Hukill, concerned the formation of the community advisory committee, given that the county is responsible for creating a selection committee to choose the members of that advisory committee.

“[Cascade Comprehensive Care] would be interested knowing the number of individuals that the Klamath County recommends should be appointed to the selection committee,” Guest wrote. “We can convene shortly after we know who your designees for this task will be in order to begin forming the statutorily required advisory council.”

In subsequent emails, Guest asked if Jefferson Behavioral Health, which provides mental healthcare in Klamath County, and Klamath County Mental Health could provide a list of anticipated costs for providing mental health services, which Cascade Comprehensive Care used as part of its application to the Oregon Health Authority in mid-April.

But what set off the public back-in-forth between Cascade Comprehensive Care and Hukill was Cascade Comprehensive Care’s multiple requests that the county’s board of commissioners write a letter of support supporting the organization’s application to become a CCO.

Two other organizations—Pacific Source and Greater Oregon Behavioral Health, Inc. have submitted applications for a coordinated care organization to cover all, or parts, of Klamath County. United Healthcare, a national organization, is expected to turn in an application later this summer to provide care to the county as well.

Guest asked that the county write a letter of support in an April 4 email to Hukill, as well as an email to Amanda Bunger, director of the county’s mental health department, who replied to Guest that it was the board of county commissioners that needed to  end the letter, not her.

Hukill says Guest first asked for the letter during a March 13 meeting with Hukill and two other representatives of Cascade Comprehensive Care. It was during that meeting, Hukill told The Lund Report, that things started to get “testy.”

Guest and two other Cascade Comprehensive Care representatives told her that if the county did not give a letter of support, that she would not like the headlines she would see in the Klamath Herald and News.

“They’re considered a big machine in this community,” Hukill said, who is currently running for re-election.

Hukill refused to give Cascade Comprehensive Care the letter of support. What the Klamath County board of commissioners did instead during a late April board meeting was to write letters of support for all the applications applying to be a coordinated care organization.

“The Oregon Health Authority is going to make the decisions. The state will pick what’s best for Klamath County,” Hukill said.

On Monday, April 16, Hukill wrote a statement published in the Klamath Herald and News, mentioning as one of the reasons why she would not give Cascade Comprehensive Care a letter of support is that their original letter of intent showed that they would not cover all of Klamath
County.

There are 13,000 Oregon Health Plan patients in Klamath County.

“Cascade Comprehensive Care was the only [applicant] that actually limited the amount of patients they would see,” Hukill said, to 10,600, leaving out 2,400 patients that live in north Klamath County and have traditionally been served by Pacific Source and medical providers in
the Bend area.

She also said that no other organization wishing to become a coordinated care organization in Klamath County had made the “demand” of getting a letter of support from the county.

An April 17 press release from Cascade Comprehensive Care said that Hukill “grossly misrepresented” the communications between her and Cascade Comprehensive Care.

“No letter of support was “demanded”. No threats were made to smear Commissioner Hukill or any of the Commissioners if they did not support [Cascade Comprehensive Care],” the press release read. “Commissioner Hukill’s comments do not place us on a constructive path, and do not help achieve a community-based solution.”

Back and forth letters to the editor in the Herald and News between Hukill and Guest continue, and it may be as much as they will communicate to each other from now on.

Dave Groff, Klamath County’s legal counsel, recommended to the board of commissioners and the directors of the mental health and public health departments on April 27 that further communication with Cascade Comprehensive Care “be done through the respective attorneys,” that electronic or written communication between copied to all other CCO applicants and involved parties, through conference calls, and public work sessions.

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