December 15, 2011— As the Oregon Health Policy Board develops the requirements that coordinated care organizations (CCOs) must meet to deliver care to more than 600,000 Oregonians, they’re faced with finding the right balance between prescriptiveness and flexibility.
Those requirements will become part of the business plan legislators will consider when they meet in February.When the board met on Tuesday, their opinions varied as to whether those requirements should be rigid – which could deter some organizations from participating – or too lax – which could result in inefficient healthcare, stifling transformation.
“I think we are getting a little too wishy washy on things,” said Nina Werner, president and CFO of Ornelas Enterprises Inc. “We recommend and encourage throughout this entire document. We need to require some things. Encouraging and recommending through an entire document doesn’t lay a good foundation. We have to require something.”
Dr. Joe Robertson, president of Oregon Health & Sciences University, said he is “beginning to fear the barriers we are putting up for the organizations that serve the most needy among us.”
Felisa Hagins, the political director of the Service Employees International Union Local 49, objected to language that simply recommended that CCOs work with local hospitals and public health departments to reduce health disparities and health inequities.
“It doesn’t say in here that there are consequences, [and] that part of the goal of the CCO should be eliminating health disparities,” she said. “I feel like we’ve had that discussion. We’re not encouraging people to be a little less racist. We’re telling people—‘don’t be.’”
After some discussion, the wording was changed to say that CCOs will be “required to demonstrate elimination of health disparities.”
Similar heated and intense dialog about specific wording also characterized the discussions about whether CCOs should have clinical and community advisory councils, as well as the incentives to entice healthcare providers to join CCOs.
“Why we would encourage but not require a [clinical advisory council] is beyond me,” said Dr. Chuck Hofmann, a Baker City physician. “You’ve gotta have one. There must be a community advisory committee.”
Board members agreed that such a council was needed to assure that consumer interests were represented.
Meanwhile, Eileen Brady, co-founder of New Seasons and a candidate for mayor of Portland, said the business plan was missing some bigger idea policy statements that define the board’s intent.
“What may be missing, in general, are some value statements, or why we are doing some of these things,” she said. “I wouldn’t mind having [some] more purpose statements so we get at the transformational impacts that we’re looking for.”
“We’re going to be asking providers to perform in a way that they haven’t before,” agreed Lillian Shirley, the board’s vice-chair and director of Multnomah County’s Health Department.
If provider organizations decide not to become part of a CCO, they’ll face negative consequences -- reduced reimbursements.
Meanwhile, those who participate will gain technical assistance, said Mike Bonetto, Governor John Kitzhaber’s health policy advisor, which should be especially appealing to rural counties, and organizations experiencing workforce issues.
“To bring people in as quickly and as effectively as possible, we need some options,” said Eric Parsons, who chairs the board.
The coordinated care organizations should also be required to file financial reports with the Department of Consumer and Business Services. Currently, the managed care organizations that provide healthcare to people on the Oregon Health Plan send those reports to the Oregon Health Authority.
Next Tuesday, this draft business plan will undergo a scrutiny test when the Legislature’s House and Senate healthcare committees discuss that document with policy board members.
Following that meeting, the board will have one more opportunity to finalize the plan, on January 10. “On the tenth, we’re going to be marching through this proposal, section by section,” said Diane Bianco, principal at Artemis Consulting.
Felisa Hagins and Dr. Hofmann are right on target. If health care delivery is to fulfill the goals of the "triple-aim" --- Better Health Outcomes, Improved Patient Experience, and Reduced Costs --- there must be some firm and binding expectations, not soft nudges.