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CCO Meetings Now Open, Somewhat; Critics Voice Complaints

January 31, 2019

Springfield family nurse practitioner Carol Crocker was irate enough with Lane County’s coordinated care organization, Trillium Community Health Plan, that earlier this month she showed up at 7 a.m. in bitter and foggy 30-degree weather to witness Trillium’s first state-mandated open board meeting in Eugene.

Crocker, a certified provider of buprenorphine, a drug used to treat opioid addiction, opened an opiate-abuse treatment practice in Eugene in January 2018. At the Trillium meeting, she sat through 1¾ hours of board discussions, until the public comment period at 8:45 a.m.

Then, stepping to the microphone, she quickly unleashed two biting complaints: Trillium had taken more than six months to “credential” her -- that is, approve her for Oregon Health Plan reimbursement, despite opioid addiction being a public health crisis; and Trillium routinely takes a week or more to authorize buprenorphine prescriptions, despite the importance of getting heroin and other opioid users much more quickly than that onto the substitute medication.

The delays, she told the for-profit’s board, were a “ridiculous barrier” to treatment.

Her designated two minutes up, she returned to her seat in the sparse audience at the firm’s Eugene headquarters.

In a small way, Crocker made history: She was the first member of the public in Lane County to use a new opportunity created by Oregon lawmakers last year. HB 4018, which took effect on Jan. 1, , requires that portions of meetings of the boards of the state’s 15 coordinated care organizations be open to the public.

The aim is to boost public understanding of the Medicaid insurers, which spend roughly $6 billion a year in federal and state money for health care for roughly 1 million Oregonians covered by the Oregon Health Plan.

Critical Time For Medicaid Insurers

The new transparency requirement comes at a critical time for coordinated care organizations. By Feb. 1, they must tell the state whether they want to renew their Oregon Health Plan contracts for five years or bid for contracts in other geographic areas of the state. Trillium says it will apply for the Lane County contract. The state will award contracts by late summer.

Crocker said it was “fantastic” the Trillium meeting was open to the public. “I came in with complaints, but as I sat through the meeting I came to the belief they are trying to address the opioid epidemic but could use some ‘boots on the ground’ real life stories,” she said after the meeting.

Crocker said other insurers, aware of the opioid crisis, have been quick to credential her. Springfield-based PacificSource did it in a week, she said. Getting buprenorphine to heroin users is vital, she added.

“The critical problem with this group of patients is getting them going on this medication when they come in. If we don't do that, we know they are going to go out and use again. They cannot tolerate delays,” she said.

Trillium declined to comment on specific complaints or requests that Crocker and other members of the public made at the meeting. In response to questions from The Lund Report,  the company said it is “committed to delivering the best quality care to our members and continually invests in programs that deliver on our mission to listen to, respect and empower our members.” The  statement said it reviews all prescription preauthorization requests within 24 hours. Trillium is owned by Centene Corp., a publicly traded company that specializes in managing Medicaid and other insurance programs nationwide.

Law Gives Organizations Wide Latitude

The open-meetings law gives coordinated care organizations wide latitude in how much they let the public see. The law is a watered-down version of an original proposal, by state Rep. Mitch Greenlick, D-Portland, that would have required the insurers’ boards to obey Oregon public meetings law and have all their meetings open to the public, except in narrow circumstances. Greenlick had also proposed that all of Oregon’s for-profit CCOs eventually switch to nonprofit status, an idea that was scrubbed.

The law that was eventually passed says board meetings must be open only when “substantive decisions are made final.” So a board could have extensive discussions behind closed doors and open the meeting to the public only when it makes a final decision. Whether the boards will follow that route remains to be seen.

Greenlick declined to be interviewed by The Lund Report about the implementation of the new law.

In Portland, Health Share, a nonprofit that serves 315,000 Oregon Health Plan patients, excluded the public from the first part of its monthly board meeting, at which it conducted discussions. Then it opened the meeting to the public for only 10 minutes to take two votes. -

Health Share spokeswoman Stephanie Vandehey said the agency is still evaluating how to function under the new law. It learned from that meeting that when it opens up the meeting to public view, it needs to provide the public with more information about the discussion that has taken place in closed session, she said.

“This way the public can get a better idea of our process,” she said.

Trillium, on the other hand, opened its entire two-hour meeting to the public and had copies of the agenda and relevant reports on hand for everyone to see.  The board touched on a smorgasbord of topics: annual reports of various committees; Trillium’s planned application for a new five-year Oregon Health Plan contract with the Oregon Health Authority later; whether other insurers might apply for the Lane County Medicaid contract; and the thorny problem of many Oregon Health Plan patients failing to show up for medical appointments. They also heard one board member caution that under a new five-year state contract, Trillium would receive less money than before with which to pay Lane County health providers, and that providers need to be warned about that.

Aside from most of the 18-member board, attendees included about a dozen Trillium employees and five members of public, three of whom spoke.

In addition to Crocker, two employees of a Eugene health services agency addressed the meeting. One highlighted the problem of clients being violent or threatening toward employees; the other asked Trillium to help fund Eugene’s sole alcohol detox center, arguing that the center reduces the number of injured or otherwise impaired people who otherwise would need costly ambulance trips and hospital emergency room care.

At Health Share’s first open-to-the-public meeting, more than a dozen health care professionals and members of the public gathered to watch the 19-member board unanimously approve spending the remaining $800,000 from its 2016 quality pool funds on diabetes projects.

Vandehey said that Health Share has tried various ways to reach out to the public, including quarterly public meetings of its community advisory council, semi-annual joint meetings of the board and advisory council and public engagement meetings. Health Share supported HB 4018 and also supported an earlier version of the bill that did not pass, Vandehey said.

Push For Transparency

The bill is part of a legislative push for improved transparency among Medicaid insurers and to set limits on reserves following  Centene’s purchase of Trillium in late 2015 for an estimated $109 million. For years, for-profit Trillium had been locally owned by a large group of Lane County doctors and business people. By the time of the sale, Trillium had channeled into its reserves more than $41 million it had received under the Oregon Health Plan. With the sale, Centene took ownership of the reserves. Trillium’s group of 217 shareholders divided the $109 million in sale proceeds among themselves, with some shareholders receiving multi-million-dollar payouts. Critics decried the process, saying Oregon Health Plan money should be used to benefit low-income patients, not provide profits to owners of the for-profit insurer.

In addition to mandating open meetings, HB 4018 also includes steps that could potentially limit the amount of money coordinated care organizations can take as profits or hold in reserves. Trillium, which is wholly owned by publicly traded Centene Corp., has accumulated about $66 million in reserves, some of it from annual profits since Centene bought Trillium, its filings with the state show.

The Oregon Health Authority said it has not yet begun to write rules for this part of HB 4018. It’s unclear how or whether the profits/reserves law will affect Trillium.

The company receives about $480 million a year in federal and state money to serve about 90,000 Oregon Health Plan members in Lane County. For the first half of 2018, Trillium posted a $2 million loss on its Oregon Health Plan work, following profits of $6.5 million in 2017 and $4.2 million in 2016. Trillium declined to answer questions for The Lund Report about its profits and reserves.

You can reach Christian Wihtol at [email protected].