Health Share Mulls Over Enrollment Problems

The coordinated care organization is gearing up for a process it anticipates will be complex – assigning new members to their preferred providers and plans


October 8, 2013 – Days before the end of September, the Oregon Health Authority began notifying low-income people around the state by mail – 260,000 letters went out – that they were eligible for fast-track enrollment on the Oregon Health Plan and that Medicaid coverage would begin Jan. 1. The notification letter included a simple application asking applicants to designate which coordinated care organization they wanted and whether they had a primary care provider they'd like to keep.

Now coordinated care organizations are waiting to get application data from the state, and preparing for what they anticipate will be a lot of administrative work making sure member assignments go smoothly – a matter that took up the bulk of the discussion at Health Share of Oregon's community advisory council meeting last week.

During a presentation on member assignments, chief operating officer Susan Kirchoff said the first few days of open enrollment had already seen a major response, with the Health Authority having received thousands of calls from prospective Medicaid patients last week alone.

Kirchoff said the organization is concerned about making sure patients get referred to the provider and the plan they want the first time, and recognizes that work is going to be complicated.

“There are problems up and down the system starting with the fact that Health Share and healthcare organizations in general are very confusing and large organizations,” Kirchoff said. Some of the potential placement mentioned by Kirchoff include: new enrollees designating a provider who is no longer in practice or not accepting new Medicaid patients, enrollees getting assigned to a health plan that doesn't cover visits to their preferred provider, and a possible glut of appointments made within the first few weeks after coverage kicks in.

Sonja Ervin, council member and director of cultural development and specialty services, mentioned that Kaiser Permanente does a particularly good job of reaching out to new members, having member navigators call them and ask about their needs and preferences when it comes to finding a provider. When she participated in a workgroup with Kirchoff that identified many barriers to member assignments, they left optimistic that reaching out to new members – which the health authority is doing – will help guide new enrollees to the correct coordinated care organization, plan and provider team.

“While we understand that may be difficult in terms of being able to get somebody to connect with everybody, I think there was really a belief in the room that if you do that, you will make assignments correct the first time,” Ervin said.

“I think it's about just about asking the question in a way that we draw the story from them without asking a lot of questions or making it real hard,” said Amy Anderson, who recently worked with Providence Health Plans to help them develop their consumer engagement survey. “If their underlying issue is trauma, they may not tell you that out of the gate because some of those topics are too traumatizing to talk about with strangers.” She suggested that a call center – possibly staffed by mental health peer workers – dedicated to engaging and placing members could help make certain people got the right providers.

However, none of the CCOs even know who a member’s preferred provider is, said CEO Janet Meyer, and won’t start getting that data from the state until later this year.
“This is not a Health Share problem, this is an Oregon Health Plan problem,” Meyer said.

The council also heard a presentation by Barbara Carey, compliance and quality improvement manager for Health Share, on customer service. Carey’s office has received some of the first results of customer satisfaction surveys – from the first quarter of 2012 – but the form wasn't standard, so her department hasn't really been able to aggregate data or identify trends. The office is working to create a survey that will be easier to compile and sort.

Near the close of the meeting, council member Lyla Swafford made a motion to make the meeting's site – the Edwards Center in Aloha, a nonprofit organization that serves people with developmental disabilities – its Washington County home. Meeting sites for the CCO rotate between its three counties – Clackamas, Multnomah and Washington. The motion initially passed without discussion, but several members expressed concern that the Aloha location may not attract diverse members, and that parking could become more difficult as the center expands its capacity. Chair Steve Weiss said the motion could not be overturned in the same meeting it would passed, but the matter would be revisited later.  

Christen McCurdy can be reached at [email protected].

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Sounds Like HSO is engaging in the Blame Gain Early on. Maybe Janet Meyer should focus on activities that positively affect her members rather than a constant stream of spin, exaggeration, and blame. Once again personal agendas and bloated egos dominating the local medicaid landscape- it is the poor who suffer. I imagine her sitting on a throne while making her proclamation that the state is at fault once again. The choice between HSO and Familycare is "Dumber and Dumber" Redux!