Geographic Factors Seem Tied to CCO Members’ Access, Experiences With Health System

Umpqua Health Alliance and PacificSource-Central Oregon members report more frustrations with healthcare in CCO surveys than Trillium Community Health Plan or PacificSource-Gorge

Geography matters. Two of the four coordinated care organizations featured in this story are run by the same parent company – but at one, members report frustrations with getting appointments or accessing specialized care, and at the other members are among the happiest CCO clients in the state.

What sets them apart? PacificSource-Central Oregon, where members are less satisfied with their care, serves a region with lower incomes and fewer doctors. PacificSource-Gorge, where members are happier, serves a region with higher incomes and more available providers. Patients at both CCOs have low or no income and quality for Medicaid. But living in an area with more people, wealthier neighbors and more doctors seems to correlate to better experiences.

Likewise, of the other two CCOs featured in this story, the Umpqua Health Alliance, which also serves Central Oregon, reported less satisfied members than Trillium Community Health Plan in Lane County.

Those are among the details revealed by the CCOs’ “Banner Books,” the label given to a series of 340-page documents that assesses the state of Oregon’s Medicaid-funded health plans. Commissioned by the Oregon Health Authority, these documents take an in-depth look at how members feel about the care they’ve received. It’s a different evaluation tool than the profit and revenue reports The Lund Report has reported on the past, focusing on how well each health plan works for patients seeking care.

In this fourth story in The Lund Report examination of the survey results, we’re looking at how adult members of these four CCOs say their health insurance measures up. We started the series with a look at AllCare Health, continued with three CareOregon affiliated-CCOs, and in part three examined the two CCOs operating in the Portland area.

In the coming weeks, we’ll look at the same surveys at the state’s remaining CCOs, and we’ll conclude this series by comparing their performance to see if some CCOs rate considerably better or worse than others.

Trillium Community Health Plan

Trillium Community Health Plan is rare among Oregon CCOs, in that it is owned by a corporate parent from outside the Pacific Northwest – St. Louis-based Centene Corp., which also owns Health Net Health Plan of Oregon, and Medicare and marketplace insurance names that operated under the Trillium brand.

Trillium’s CCO serves Lane County residents.

On most metrics, Trillium’s members reported experiences similar to patients at other CCOs across the state:

  • On a scale of zero to 10, 68 percent gave Trillium a top score of 8, 9 or 10, when asked to rank their experience against the best and worst care possible.
  • 84 percent said it was usually or always easy to get the care, tests or treatment they needed.
  • 87 percent said their doctor usually or always explained things in a way that was easy to understand.
  • 91 percent said the health plan’s customer service treated them with courtesy and respect.

When it came to coordinating care within the system, Trillium outperformed most other CCOs in the state:

  • 86 percent of its members said their personal doctor usually or always seemed informed about care received by specialists and other medical providers within the CCO, compared to a statewide average of 79 percent.
  • 72 percent said it was usually or always easy to the medical equipment they needed, compared to a statewide average of 63 percent.
  • 68 percent said it was usually or always easy to get special therapy, such as physical or occupational therapy, when needed, compared to a statewide average of 60 percent.

However, Trillium members reported that they were given fewer options when faced with medical issues:

  • 80 percent said their doctor talked to them about the pros and cons of healthcare choices they had to make, compared to a statewide average of 89 percent.
  • 23 percent said their doctor did not ask them which of several choices they preferred, when they faced more than one treatment choice, compared with 16 percent of members of all Oregon CCOs statewide.

As with other CCOs, Trillium’s members reported discrepancy in how they were treated depending on how healthy they were when they sought care.

Of Trillium members in excellent, very good or good health: 75 percent said they would give a top score for the quality of care they’ve received; 58 percent said it was always easy to get the care, tests or treatment they needed; 93 percent said their personal doctor always or usually explained things in a way that was easy to understand; 77 percent said they would rate their doctor with a top score.

Of Trillium members in fair or poor health: 56 percent said they would give a top score for the quality of care they’ve received; 38 percent said it was always easy to get the care, tests or treatment they needed; 77 percent said their personal doctor always or usually explained things in a way that was easy to understand; 56 percent said they would rate their doctor with a top score.

Umpqua Health Alliance

The Umpqua Health Alliance serves Douglas County, and was created as a collaboration between a number of separate health-focused organizations within the community.

On some metrics, Umpqua’s members reported experiences similar to patients at other CCOs across the state:

  • 88 percent said their doctor usually or always explained things in a way that was easy to understand.
  • 73 percent said the health plan’s customer service treated them with courtesy and respect.

But Umpqua Health’s ratings fell below average in many categories, and its patients were slightly less healthy than the statewide average, as well. Although only 29 percent of CCO members statewide said they consumed tobacco every day or some days, a full 39 percent of Umpqua Health Alliance members gave the same answer. And 72 percent of Umpqua members said they were in excellent, very good or good health – slightly below the statewide average of 75 percent.

Umpqua Health Alliance members reported experiences that did not measure up to other CCOs in the state on a number of metrics:

  • On a scale of zero to 10, 58 percent gave Umpqua a top score of 8, 9 or 10, when asked to rank their experience against the best and worst care possible. Statewide, 67 percent of CCO members gave their plans a top score.
  • 71 percent of Umpqua members said it was usually or always easy to get the care, tests or treatment they needed, compared to 80 percent of CCO members statewide.
  • 67 percent said they would rank their doctor near the top of all possible doctors, compared to 76 percent statewide.
  • Only 37 percent of Umpqua members said they were able to track down information about their health plan online, compared to 52 percent of CCO members statewide.
  • 49 percent said it was usually or always easy to get the medical equipment they needed, compared to 63 percent statewide; 40 percent of Umpqua members said they were never able to access this equipment, compared to 21 percent of CCO members across all of Oregon.

Umpqua members were also less likely to be guided to quit using tobacco than members of other CCOs, even though they were more likely to use tobacco. Of Umpqua members who used tobacco, 45 percent were advised to quit, 18 percent were sometimes or always offered medication to help with quitting, and 17 percent sometimes or always discussed methods other than medication to help quit. Of all CCO members across Oregon who consumed tobacco, by contrast, 50 percent were advised to quit, 29 percent were sometimes or always offered medication to help with quitting, and 24 percent usually or always discussed methods other than medication.

As with most CCOs, Umpqua’s healthiest members were more upbeat about the plan than its sickest members.

Of those in extremely good, very good or good health: 63 percent would give a top score for the quality of care they’ve received; 76 percent said it was always or usually easy to get the care or treatment they needed; 75 percent said their doctor always explained things in a way that was easy to understand.

Of those in fair or poor health: 51 percent gave a top score for the quality of care they received; 62 percent said it was always or usually easy to get the care or treatment they needed; 51 percent said their doctor always explained things in a way that was easy to understand.

Men and women also reported different experiences at Umpqua on several metrics:

  • 95 percent of men said their personal doctor always or usually listened carefully to them, while 80 percent of women gave the same answer.
  • 64 percent of men said a lot of effort was made to help them understand their healthcare problem, compared with 49 percent of women.

PacificSource-Central Oregon

Insurance company PacificSource runs two CCOs in Oregon, one serving the Columbia River Gorge and the other serving Crook, Deschutes, Jefferson and northern Klamath counties.

On most metrics, Pacific Source-Central Oregon members reported experiences similar to patients at other CCOs across the state:

  • On a scale of zero to 10, 69 percent gave the Central Oregon CCO a top score of 8, 9 or 10, when asked to rank their experience against the best and worst care possible.
  • 89 percent said their doctor usually or always explained things in a way that was easy to understand.
  • 92 percent said the health plan’s customer service treated them with courtesy and respect.

On one metric, PacificSource-Central Oregon members reported better experiences than most CCO members across the state:

  • 83 percent said their health plan’s customer service always or usually gave them the information they needed, compared to 76 percent of all CCO members across Oregon.

The CCO also performed worse than other plans across the state on several measures:

  • 73 percent of PacificSource-Central Oregon said it was usually or always easy to get the care, tests or treatment they needed, compared to 80 percent of all members of CCOs.
  • 66 percent said they could usually or always get an appointment with a specialist as soon as needed, compared to 75 percent statewide.
  • 41 percent said it was usually or always easy to get special therapy, such as physical or occupational therapy, compared to 60 percent statewide
  • 57 percent rated Pacific Source-Central Oregon as a top health plan, compared to 64 percent of all CCO members saying they had a top-ranked plan.

As with most CCOs, PacificSource-Central Oregon’s healthiest members reported different experiences from its sickest members.

Of those in extremely good, very good or good health: 80 percent said it was always or usually easy to get the care, tests or treatment they needed; 94 percent said their doctor always or usually explained things in a way that was easy to understand; 94 percent said their doctor always or usually spent enough time with them; 62 percent said they would give their health plan a top score

Of those in fair or poor health: 58 percent said it was always or usually easy to get the care, tests or treatment they needed; 81 percent said their doctor always or usually explained things in a way that was easy to understand; 80 percent said their doctor always or usually spent enough time with them; 45 percent said they would give their health plan a top score.

PacificSource Gorge

PacificSource’s Gorge CCO serves members within the Columbia River Gorge – and unlike the company’s Central Oregon CCO, these members are generally happier with their plan than most CCO members statewide:

  • 96 percent of PacificSource-Gorge members said their personal doctor usually or always explained things in a way that was easy to understand, compared to 90 percent of all members of CCOs in Oregon.
  • 86 percent of its members said their personal doctor usually or always seemed informed about care received by specialists and other medical providers within the CCO, compared to a statewide average of 79 percent.
  • 82 percent said they had one of the best doctors possible, compared to 76 percent statewide.
  • 83 percent said the health plan’s customer service usually or always gave the help they needed, compared to 76 percent statewide.
  • 92 percent said a lot of effort was made to listen to the things that matter to members most, compared to 63 percent statewide.

PacificSource-Gorge membersreported that they were less likely to consume tobacco than members of most CCOs – 22 percent said they use tobacco every day or some days, compared to 29 percent of all members of CCOs.

As with most CCOs, PacificSource-Gorge’s healthiest members reported different experiences from its sickest members.

Of those in extremely good, very good or good health: 76 percent gave a top score when asked to rank the quality of the care they received; 84 percent said their doctor always explained things in a way that was easy to understand; 74 percent said they could definitely trust their doctor or other provider with their medical care.

Of those in fair or poor health: 61 percent gave a top score when asked to rank the quality of the care they received; 69 percent said their doctor always explained things in a way that was easy to understand; 58 percent said they could definitely trust their doctor or other provider with their medical care.

On several questions, PacificSource-Gorge saw Hispanics answering differently than non-Hispanics:

  • Of Hispanics: 53 percent said their personal doctor always spent enough time with them; 28 percent said their health provider told them when they had more than one choice for their treatment or health care; 40 percent said their provider always made it easy to ask questions or raise concerns.
  • Of non-Hispanics: to 74 percent said their personal doctor always spent enough time with them; 39 percent said their health provider told them when they had more than one choice for treatment or health care; 55 percent said their provider always made it easy to ask questions or raise concerns.

It’s worth noting that with most other CCOs reviewed so far for this Lund Report series, not enough Hispanic members responded to identify statistically significant differences in care.

Courtney Sherwood investigates public records and digs into data for The Lund Report. Reach her at [email protected], or follow her on Twitter at @csherwood.

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