It’s been nearly 18 months since the first Coordinated Care Organizations got under way in Oregon. And like the rest of the healthcare industry, it’s been a time of transition, transformation and challenges.
The Eastern Oregon CCO in northeastern Oregon has had particular success reaching providers, helping them become recognized as Patient-Centered Primary Care Homes.
It began as a partnership between ODS Community Health (now known as Moda Health) and Greater Oregon Behavioral Health, but eventually several providers became owners of the CCO.
“We knew we needed to have provider input (for the success of the CCO),” said Sean Jessup, Moda Health Medicare and Medicaid programs manager.
Now 42 percent of the CCO is owned by Good Shepherd Health Care System, Grand Ronde Hospital, Saint Alphonsus Health System, St. Anthony Hospital, Pendleton IPA, Inc. and Yakima Valley Farm Workers Clinic.
“We have had genuine collaboration especially considering that it’s a remote and difficult landscape to work in,” Jessup said.
The 12-county area, home to Eastern Oregon CCO, spans more than 50,000 square miles and has approximately 36,000 Oregon Health Plan members.
Given the size of the area, the rural nature of the region, and the complexities of administering a new organization, the Eastern Oregon CCO has navigated the challenges of implementing transformation in a region that’s already healthcare challenged. Notably, when it started, there was only one Patient-Centered Primary Care Home in its 12-county area. Now, in just a little over a year, there are 34.
Now, Jessup said, the CCO’s goal is to have 100 percent of its members enrolled in a primary care home.
How did they achieve this growth so quickly? Not only did they host two provider summits to train clinics, but staff from the Oregon Health Authority provided assistance.
“It has been a daunting task, and I’ve seen a real commitment to make it work,” said Rod Harwood, who chairs the Umatilla County Community Advisory Council. “They have had staff crisscrossing the area providing support. They send resources and guidance every step of the way and are committed to seeing Patient-Centered Primary Care Homes established in all 12 counties. If a local clinic had to figure it out all by themselves, it would take a lot longer.”
Clinics must meet certain quality standards to be recognized as primary care homes. The Eastern Oregon CCO has offered hands-on guidance and support, and even found a way to provide enhanced payments to assist clinics with the financial burden.
“Most of the providers in our service area are rural health clinics or federally qualified health centers so they already receive extra funds,” Jessup added. “We had to be strategic about how we could go above the additional funding they are already receiving.”
As transformation unfolds across the state, the unique landscape of rural healthcare can be overwhelming.
“One of the big questions is how is it going to work in rural America,” noted Jonathan Nicholas, vice president of marketing at Moda Health.
To meet that challenge, the Eastern Oregon CCO has created 12 local community advisory councils for each of its counties.
“I feel supported and I know I can always call on them (EOCCO staff) for advice or guidance,” said Harwood. “I think that’s a huge thing, particularly in a rural setting. Each of the counties has common healthcare issues and unique issues but the focus has been on working together.”
The financial impact of healthcare transformation on its hospitals – all 10 hospitals within their 12-county region are classified as either Type A, Type B or critical access, and, as such, currently receive cost-based reimbursement – also concerns the CCO.
“We genuinely care about the community and as much as we embrace the healthcare transformation and the economic realities driving that, we are acutely aware that the local hospitals are major employers,” Nicholas said. “We want to make sure that hospitals are somehow sharing in the benefits of the cost savings (from healthcare transformation).”
FOR MORE INFORMATION:
http://www.eocco.com/about.shtml
http://www.oregon.gov/oha/OHPR/HEALTHREFORM/PCPCH/docs/pcpch-self-assessment-form-2011-1017.pdf
http://eocco.com/pdfs/20131009_PCPCH_letter.pdf
http://www.oregon.gov/oha/ohpr/Pages/healthreform/pcpch/index.as
Joanne can be reached at [email protected].
