Politicians, policy makers, and those interested in healthcare reform are keeping a close eye on the performance of the state’s 16 coordinated care organizations that cover almost 90 percent (942,811) of Oregonians eligible for the Oregon Health Plan. But what about the people these CCOs serve? Is anyone asking about their experience?
The Oregon Health Authority evaluates the performance of the state’s 16 CCOs on 17 incentive metrics and 16 additional state performance metrics. However, none of these metrics relate to the consumer’s experience much less their satisfaction. In response to this shortcoming, a group of healthcare reform advocates formed the Consumer Confidence Project to design a consumer-focused evaluation of the CCO model.
“The Consumer Confidence Project provides a unique view inside CCOs. Performance metrics defined by OHA are important, but understanding the consumers’ experience is also valuable and is missing from the discussion,” said Bob Brown, a Consumer Confidence Project steering committee member.
Housed at the Oregon Public Health Institute, the project recently released a report of its pilot evaluation of Oregon’s CCOs. Based on data collected by volunteers in September 2014, the report includes aggregate data on 81 consumer-focused indicators that relate to four key areas: Person-Centered Services, Responsiveness to Members and Community, Transparency of Governance, and Accessibility of Information.
“All these indicators evaluate areas that all CCOs should be able to do. This was one of our indicator selection criteria. There are no inherent barriers to providing this information to consumers,” Brown noted.
“The report provides information about how members of CCOs are able to effectively use these organizations to participate in their own healthcare decisions,” Brown said. “As an Oregonian, I’m proud that we are challenging the status quo about healthcare delivery. We have to reinforce what is working and improve what isn’t. This report provides a first step in such an evaluation.”
None of the results indicate which specific CCOs are doing a better job in any of the four key areas, but they do highlight how many CCOs are performing among the various indicators such as the availability of nontraditional healthcare services or whether member handbooks are comprehensive.
Only two CCOs show upcoming health events for members, while only one offered an
explanation about whether members can remain on Oregon Health Plan if they leave their CCO. And, only two CCOs shared information on how to arrange for interpreter services.
The evaluation also indicated that CCOs provide little information to consumers about their governance structure, and very few let members know they can attend community advisory council meetings, which are open to the public.
Originally, Brown said, the steering committed intended to compare CCOs side-by-side, but that proved difficult for the pilot evaluation, partly due to lack of engagement from the CCOs.
“Because this was our first evaluation, it took us a long time to get information verified from the CCOs," Brown explained. "We didn't have great responses from the CCOs, and we kept giving them more time. During that time, there were changes that the CCOs made to their information. This was a good thing, but it made it difficult for us to be able to compare CCOs side-by-side. It is our expectation that the next report will do just that.”
Based on its findings, the project recommended that CCOs:
* Ensure that websites and handbooks are comprehensive, stand-alone information sources.
* Provide more information about governance structures and process, including opportunities for consumer and community involvement and governance.
* Use the indicators included in the report when creating consumer-oriented materials.
* Engage with the Consumer Confidence Project
Alissa Robbins, spokesperson for OHA, called the project’s report a welcome addition to evaluating CCOs.
“We appreciate the work the Consumer Confidence Project put into this report,” Robbins said. “It's one of many tools that can be of use as we continually strive for excellent service to our members. It's a great affirmation of the positive work CCOs have already done and a resource to show where continued progress can be made.”
The committee expects another round of data collection later this year and welcomes all CCOs to participate.
“We hope they will all engage,” Brown said. “We believe that people will see the benefit of the project and it will be inappropriate for them not to.”
FOR MORE INFORMATION:
http://www.oregon.gov/oha/Metrics/Pages/HST-Reports.aspx http://www.oregon.gov/oha/analytics/CCOData/2015%20Measures.pdf http://www.oregon.gov/oha/healthplan/DataReportsDocs/August%202015%20Coordinated%20Care%20Service%20Delivery%20by%20County.pdf http://www.oregon.gov/oha/Metrics/Pages/ccos.aspx http://ophi.org/download/PDF/CCP%20Report_FINAL.pdf
Joanne can be reached at [email protected]
Can anyone miss the irony of the Oregon Health Authority standing on the sideline while a private not-for-profit performs the job OHA should be undertaking in regard to consumer satisfaction?
No one familiar with the OHA-CCO scheme can honestly deny that CCOs occupy the top tier of OHA's clientele. Consumers are ancillary. A very senior OHA official recently told me that OHA is "much more about results" than about controlling how CCOs get them. If OHA can churn out the necssary statistics -- mainly the ones with dollar signs in front of them -- .to proclaim "Health System Transformation" a success, then to hell with the actual consumer experience.
Tim Baxter Attorney at Law
Lane County Legal Aid and Advocacy Center