The 2015 Legislature could see a bill codifying an agreement made last year between health insurance companies and the state that created uniform rules for patient-centered, primary care homes, the state’s much-touted vehicle for enhancing basic healthcare services.
The recommendation is very preliminary and would take the blessing of the Oregon Health Policy Board, but the idea could become a key legislative result of the board’ s work to improve quality while keeping a lid on healthcare costs, a direction fostered by Gov. John Kitzhaber.
“That [would] give it legitimacy that it’s in for the long-term,” Lisa Angus of the Oregon Health Authority, told the Lund Report on Tuesday.
The primary care home was a key plank of the 2012 bill creating the coordinated care organizations, and has been used as a metric to pay CCOs based on quality rather than based on the number of services they provide to Oregon Health Plan members. Everyone on Medicaid is expected to have a primary care home, while the state has set a goal of offering the same standard of care to 70 percent of the private commercial market.
Under a primary care home, a team of care providers is wholly accountable for a patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care.
The agreement reached last fall sets up the same rules for primary care providers when contracting with all health insurers, a key move to cut down on the extra paperwork that comes with adopting this model. The primary care model mirrors attempts by other governmental sectors, particularly education, to use better data in attempts to guide improvements.
Recently, the CCOs were evaluated based on how many people had enrolled in primary care homes, and their bonus grants were partially determined based on that figure.
In some cases, such as at the family practice clinic of state Sen. Alan Bates, an osteopathic physician in Medford, the primary care home model has meant improving service for patients with evening hours and weekend appointments. The same is true at the West Salem Clinic.
But Jeff Heatherington, president of FamilyCare, a Portland-based CCO, said although many private physician offices had been following the basic tenets of a primary care home, some have chosen not become certified because of the extra layer of bureaucracy, which requires more paperwork without any extra compensation.
“It’s an academically developed model that doesn’t work in the real world,” Heatherington told The Lund Report, following the meeting of the Oregon Health Policy Board.
Heatherington said all of the providers in the Portland-area FamilyCare network had conformed to the state’s standards, but about half his practitioners had resisted in Eastern Oregon’s Umatilla County, where FamilyCare offers Medicare Part C private plans.
“Part of the problem is that it’s a primary care shortage area,” he said, adding that many of the doctors are now in their 60s. The few that remain in communities such as Pendleton have less incentive than providers in more competitive environments.
The Eastern Oregon CCO just met the 60 percent hurdle set by the state for its primary care home enrollment during the metric scoring process, but according to Heatherington, rural Oregon may face special challenges in transforming how healthcare is delivered.
Kerry Gonzales, executive director of the Oregon Academy of Family Physicians, echoed some of Heatherington’s concerns, noting that while two-thirds of her members now practiced in a primary care home, there was an additional administrative burden, with payments not keeping up with the extra work.
Nicole Merrithew of the Oregon Health Authority acknowledged the same concerns, but also noted that primary care doctors and nurse practitioners have benefited from an increase in payments thanks to the Affordable Care Act, which placed their Medicaid payments on par with Medicare. Presumably, these dollars, channeled through CCOs, would result in greater global payments to providers. Heatherington said his CCO had additionally made a greater investment in reimbursement for primary care practitioners in 2012.
The Quality Corporation published a report last year that showed certified clinics had higher mean scores for diabetes monitoring and child well visits for preschoolers than clinics that don’t complied with the primary home program. Primary care homes also showed significantly lower rates of emergency department usage.
Chris can be reached at [email protected].
