Department of Corrections’ TPA May Create CCO for Prisoners and Parolees
April 25, 2012— Eyebrows almost instantaneously raised during the Oregon Health Policy Board’s meeting earlier this month when board members realized that an organization serving the Department of Corrections’ inmates had submitted a letter of intent to become a coordinated care organization (CCO).
That’s because CCOs are intended to serve Oregon Health Plan patients, who are on Medicaid. Oregon’s 14,000 prisoners are not covered by Medicaid, and don’t receive their healthcare through the Oregon Health Plan. The Department of Corrections, instead, provides primary and mental healthcare within prison facilities.
The Department of Corrections’ inmates therefore do not need to be covered by a CCO. However, money could be saved and administrative complexities lessened by using the Medicaid rate by becoming a CCO, said Jeff Archambeau, president and CEO of Correctional Health Partners, the third-party administrator for the Oregon Department of Corrections.
The Denver-based company has been the Department of Corrections’ third-party administrator for three years, and only manages care when prisoners require hospitalization or need specialty care. That’s because when prisoners stay in a hospital for more than a day, the federal government allows the organization managing that prisoner’s hospital care to bill Medicaid.
“It is the only exception,” he explained, when prisoners are covered by Medicaid.
Currently, Archambeau said, Correctional Health Partners pays hospitals that provide care to inmates “promptly and smoothly,” and at a rate “based more on market rates” and not on Medicaid rates.
Correctional Health Partners is not the only out-of-state organization interested in becoming a coordinated care organization. Missouri-based Centene Corporation and Minnesota-based United Healthcare have also submitted letters of intent to the Oregon Health Authority. But unlike those two organizations, Correctional Health Partners already has been working with a network of hospitals and specialty care providers in Oregon.
In the long term, Archambeau is interested in working with the Oregon Health Authority and the Department of Corrections to provide all the healthcare services to inmates under the Oregon Health Plan.
Making certain that a parolee’s healthcare needs are met is one way to help them successfully transition back into the community and not reoffend, he said. To make that happen, Archambeau said his company would develop a primary and mental healthcare network in Oregon, and might contract with federally qualified health centers and community health centers.
Its parent company, Physician Health Partners, has experience coordinating healthcare in Colorado and recently created a Regional Coordinated Care Organization that provides integrated care to 15,000 Medicaid members west of Denver.
“The structure we’re talking about is something we’ve talked about in Colorado, and they find it intriguing,” he said. “I’m hopefully that Oregon would see it that way as well.”
On April 30, organizations that filed letters of intent must submit their formal applications to the Oregon Health Authority. On August 1, these coordinated care organizations are expected to begin integrating physical and mental healthcare for the 650,000 members on the Oregon Health Plan. Coordinated patient teams are expected to deliver more efficient care and reduce costs by keeping patients out of hospital emergency rooms and reducing the need for specialty care
Image for this story appears courtesy of The Oregonian.