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Policy Board Wrestles with Future of CCOs

The Legislature is expected to delve into how CCOs are being run when they gather in Salem next February and consider recommendations from the Policy Board.
December 8, 2016

Rep. Mitch Greenlick (D-Portland) is quite adamant that the state’s coordinated care organizations need to revamp their governance structure by holding their board meetings in public so everyone can see how their money is being spent, with community members representing a majority of the board. He also wants reserves held in a Treasury account, and require all CCOs to be non-profit organizations within five years.

Greenlick’s particularly troubled by the substantial wealth accumulated by the 16 CCOs which reached $923 million when the first quarter ended on March 31. It’s unknown whether those reserves have grown because the Oregon Health Authority hasn’t made public subsequent quarterly reports, and doesn’t intend to release those reports until sometime in January, according to Courtney Warner Crowell, Communications Officer.

When the Oregon Health Policy Board met earlier this week to discuss the future of the CCOs, they offered few specifics about changing their financial structure, but indicated they wanted a consistent policy on reserves with revenues not spent on medical care re-invested in local communities.

They also suggested the CCO boards only hold one public meeting a year with their community advisory councils, unlike Greenlick’s proposal to open the entire process. Currently, CCOs do not have to reveal the names of their board or community advisory members.

The policy board intends to firm up its recommendations in January, prior to the start of the next legislative session.

CCOs need to be explicit about the money they’re investing in local communities with reserve levels consistent across the board, reiterated Chairman Zeke Smith, chief impact officer at United Way who also wants full disclosure when CCOs have contracts with private entities and called the Triple Aim the linchpin. “These are Oregon Health Authority resources and we need to be clear about how they’re being dispensed in the immediate and the long term.”

From the perspective of Dr. Joe Robertson, president of Oregon Health & Science University, there’ll be pushback to share those details because such information is not typically disclosed to competitors. OHSU is a partner in HealthShare, whose members include Legacy Health and Providence Health Services.

“We should know where the money is going, to the degree it’s invested in the public’s interest,” said Carlos Crespo, director of the School of Community Health at Portland State University.

And, when there’s a change in ownership, similar to the sale of Trillium Health to Cenene Corp., standards should be in place, said Dr. Carla McKelvey. “It bothers me that CCOs can sell themselves without any oversight.”

The board also tangled with the lack of progress on whether everyone is receiving appropriate dental care under the coordinated system. Children aren’t coming to school because of pain in their

mouths, yet 98 percent of children are covered under the Oregon Health Plan, said Health Authority Director Lynne Saxton, who’d recently spoken with a school-based health clinic.

“We’re not seeing as many people access the system, and there may or may not be barriers in place that require legislation,” she said.

Other board members echoed her sentiments, “We’re not seeing the same progress in oral health as behavioral health,” said Robertson. ”Dental care lags considerably, and there should be expectations set.”

The rising costs of pharmaceutical drugs also came before the board, which hesitated to recommend a comprehensive study that could look at the feasibility of creating a single preferred drug list for CCOs and enable the state to operate as a pharmacy benefit manager, among other recommendations. It could cost $500,000 for such a study.

Given the state’s precarious fiscal crisis, no one seemed in favor of going down that route, least of all Robertson.

“I don’t want to spend a half million dollars to determine what we already know,” said Robertson who’s been adamant about corralling drug costs at previous meetings.

“Our role is to set high-level guidance,” said Smith, who urged the Health Authority to adopt a monitoring system to make sure all CCOs are meeting the performance targets.

“We need to strengthen the voice of the consumer and be very clear about what criteria need to be in place for all CCOs to exist; it’s clear that’s not in place everywhere.” Said Smith who did call out any CCOs.

Integrating long-term care into the CCO structure isn’t on the horizon, given the strong lobbying power of that industry. The Health Authority is also hesitant because such a move would require another federal waiver which could prove difficult given the political climate in Washington DC.

“There are so many other compelling areas,” Robertson said. “And, I’m not sure it’s a compelling need, but it obviously would be in an ideal world.”

Saxton also reiterated the turbulence at the federal level and the financial pressure facing the Legislature with the looming $1.7 billion deficit next biennium.

“It requires us to look at all the structure efficiencies we can create,” she told the board. “We have a very real obligation using taxpayer dollars to ensure the health and well-being of 25 percent of the most vulnerable Oregonians. That’s our social contract.”

Diane can be reached at [email protected].