Greenlick Renews Call for Transparency and Accountability for State CCOs

House Speaker Tina Kotek is confident that some of the key changes that she and Rep. Mitch Greenlick want for the state Medicaid system will pass in February, despite their defeat in 2017.

Representative Mitch Greenlick, D-Portland, and House Speaker Tina Kotek, D-Portland, are reintroducing legislation that will provide greater daylight and accountability in the state’s Medicaid system, opening up their board meetings to the public and spending any surplus funds on upstream health costs.

Greenlick and Kotek intend to protect the reserves of the coordinated care organizations that insure Medicaid members by requiring any excess funding to be spent on improving the social determinants of health.

They believe this will not only reduce health costs and better people’s lives in the long-term, but it will make the taxpayer investment less likely to be poached by investors and sent out-of-state, a top worry after the Eugene CCO, Trillium Community Health Plan, was purchased by St. Louis-based Centene Corp.

“We want the reserve piece and the public meeting requirement in place to go in the next five-year contract,” Kotek told The Lund Report earlier this month.

Bowing to opposition, Greenlick and Kotek have abandoned plans to require the CCOs to be nonprofit or else convert to a benefit corporation to maintain a for-profit status.

With Greenlick’s encouragement, the Oregon Health Authority extended the old contract to the end of 2019, making the new contract, as well as the legislative proposals, effective in January 2020.

The legislative concept also changes the makeup of the CCO boards so that only one member would need to be from a risk-bearing entity delivering care instead of a majority of its members.

Greenlick tried mightily to pass his CCO reforms in the 2017 session but ran into a buzzsaw of opposition from for-profit Medicaid providers, including Centene Corp, AllCare Health and the Coalition for a Healthy Oregon.

The House Health chairman admitted he hadn’t negotiated his legislation with these adversaries since the 2017 bill failed, and these groups continue to spend freely on political campaigns to maintain their influence among legislators. “I have not met with them,” he said. “I suspect they will not like it.”

The new rules for spending excess capital are modeled on a proposal last year from CareOregon and a handful of CCOs, including FamilyCare and Health Share, which supported later versions of Greenlick’s 2017 bill. FamilyCare, however, will cease operations at the end of the month, leaving just Health Share to do Medicaid business in Portland.

Dedicating more money to upstream investments in the social determinants of health is a widely popular idea and unlikely to run into opposition. That would also mitigate concerns about profiteering from out-of-state corporations running off with the Medicaid investments that taxpayers have made.

Increasing transparency and requiring CCO boards to follow the open meetings law is likely to have more opposition, but Kotek said that Moda Health and PacificSource already hold open meetings for their CCOs in central and eastern Oregon.

“People come from miles away to come to their meetings,” Kotek said. “They’re all public. They’re very partner-driver. They’re like, ‘We don’t think that’s a problem.’”

Despite the House leaders’ confidence, support for their reforms may be more tepid in the Senate. Sen. Laurie Monnes Anderson, D-Gresham, the Senate Health chairwoman, told The Lund Report she would take her cues from the Oregon Health Policy Board, which has mulled changes to the CCO framework for the past two years.

“The ideas are worth discussing but I don’t know where the Health Policy Board stands,” said Monnes Anderson. “We set up a system to deal with this. It could be that every part that Mitch has is good but I want to hear from them.”

The Oregon Health Policy Board, whose members are appointed by the governor to advise on healthcare, meets monthly in Portland and has also conducted workshops across the state with providers and Medicaid recipients.

Reach Chris Gray at [email protected].

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 Greenlick and Kotek talk about transparency, but it’s only for other people. What is left out of green like proposal is any transparency on the operation of the Oregon Health Authority. Until the authority to quit hiding behind or trade secrets and unreported profits Oregon taxpayers will never know what’s going on with their money and Medicaid.