Health Share reported to its community advisory council in October about member complaints but with no comparable state or national data yet to benchmark against and little beyond the numbers, it’s hard to know where Oregon’s largest coordinated care organization stands.
In the second quarter of 2014, 792 complaints were filed in categories including interaction with providers, office wait times and billing. “Lots of [billing complaints] happen when members are traveling out of state and end up in an emergency room,” said Barbara Carey, compliance and quality improvement manager. Those healthcare providers without contracts with the state send bills directly to Health Share members who then have to turn them over for processing.
The council had more questions than the report could answer.
“Do we know who’s complaining?” asked council vice chair Dalila Sarabia, wondering if cultural competence might be to blame?
“Is there any way to tease out which clinics are not meeting performance to members?” asked council member Gary Cobb.
“I wanted the health transformation to make OHP work better,” said advisory council chair Stephen Weiss. “We haven’t had sufficient member stories to meet our oversight function.”
Carey promised to return with more qualitative data in addition to the numbers.
In other discussions, Matt McCormick, vice president of Access2Care, shared his company’s plans to provide non-emergency transportation to both CCOs in the tri-county area.
Access 2Care is an affiliated company of American Medical Response, which now provides emergency medical transportation in Clackamas and Multnomah Counties and offers non-emergency ambulance transportation in Washington County.
Heath Share and FamilyCare, Inc. have issued a letter of intent to engage with Access2Care to broker Non-Emergency Medical Transportation services for their 340,000 Oregon Health Plan members. The contract, which is still being negotiated, is estimated to be worth $30 million per year and will start next January.
NEMT assists clients going to and from routine or scheduled medical services. Because of the diversity and the vulnerability of their populations, the brokerage must also maintain a culturally aware and sensitive working environment. McCormick said he’d be hiring a full-time, Oregon-based community liaison manager to “facilitate our continued outreach, self-education and program improvement efforts.”
McCormick also made a commitment to create a Transportation Advisory committee comprised of drivers and representatives from both CCOs to be “very transparent about complaints and open about our experiences” as well as provide a “two-way dialog.”
Some 800,000 rides a year typically are requested by members in the tri-county area. Such services must be available to a medically and culturally diverse community in a geographical region covering more than 3,000 square miles.
“Our operating philosophy is ‘no errors, no complaints’,” McCormick said. “If you’re defensive, you don’t see the problem. We try to be objective about how we’re operating.“
Jan can be reached at [email protected].
