TLR: What are your thoughts about the future of Oregon’s healthcare system?
LM: I’m pretty optimistic right now. We’ve had a rough couple years as an industry and a system, and we’re pretty well positioned organizationally. The model of population health is the right direction to go with the cost of healthcare escalating too fast, and we’ve had to fundamentally reset how we deliver and fund healthcare. I’m not sure ACOs and the CCOs are the exact answer, but they’re a step in the right direction and need some fine tuning.
TLR: I understand you’re about to enter the commercial market after your experience as a CCO?
LR: Yes, we’ll be competing with all the commercial plans – the usual cast of characters– Regence, Providence, PacificSource, and we’ll offer a unique combination of a health plan and delivery network. Over the years we’ve learned a lot from our CCO development, and want to share the lessons with the commercial side of the house. We’re positioning ourselves right now, and will have a much more robust approach to the health plan market with the use of brokers.
TLR: Does that mean you’ll be going outside your market reach?
LM: It’s a little too early to talk about but we are gearing up with our infrastructure and identifying partnerships. We’ll have more physicians and hospitals outside our area as we go forward and expand into other markets.
TLR: How about the statewide pools, the Public Employer Benefit Board and the Oregon Educators Benefit Board, with the latter accepting new bid proposals in 2015
LM: I see us creating that opportunity with OEBB. We didn’t make the PEBB application this year but see our new plan model going into 2015 and 2016 to serve our communities here. With PEBB we’re one of the partners of the statewide Moda Plan, and we’re going to continue partnering with other health plans and not do things much different in that respect.
TLR: How has the Medicaid expansion treated your CCO?
LM: We were expecting 8,000 additional patients during enrollment for 2014 and ended up closer to 19,000 in the first three months. We didn’t have to close enrollment but challenged ourselves and our partners to make sure we could take care of our patients, and everyone sacrificed a little more on the hours they worked and the patients they saw. We now have 59,000 members, Medicaid and dual eligibles.
TLR: There’s lots of speculation about Samaritan merging or forming a strategic partnership with Legacy Health. Is there any truth to that?
LM: It’s certainly fair to say that Legacy is one of the parties that we’re having conversations with. I like Legacy, and I like George Brown, It’s a great organization, but it’s premature to say we’re merging. There’s always a possibility but we’re also working with other organizations on other projects, and arehaving a robust conversation with PeaceHealth on bio-preparedness and Ebola. We talk to a lot of great people all the time on how we can work better to improve healthcare services in our community, and Legacy is a party I could certainly work with. We are constantly evaluating our positon and capability to serve this community. Several years back there was a hot rumor we were selling to Dignity Health but that didn’t happen.
TLR: Any imminent announcements about other partnerships or mergers?
LM: There’s a likelihood of several announcements coming out on multiple fronts in 2015 – maybe even some by year end but again it’s premature right now. Certainly on the operational side of the house Legacy is a friend of ours, and George is a friend of mine-- so stay tuned.
TLR: Could such an announcement be tied to your retirement?
LM: I’m not planning to retire in the immediate future. As long as the board feels I’m serving the organization well and I’m up to it, I could certainly be here for several more years. I have a real passion for what I do.
TLR: Competition seems to have intensified in Lincoln City where Portland Adventist and Oregon Health & Science University have a definite presence.
LM: It’s a very interesting phenomena. Lincoln City and the north Lincoln area is one of our smallest population bases – 10-15,000 people. Doctors in that community still need a place to admit patients, and we provide that service. I welcome competition in the context that it makes all of us do a better job.
TLR: Are you in talks with the Adventist system and OHSU similar to Legacy Health?
LM: As I said before, we’re in talks with a lot of different people. We might work with some on the VA relationship and others on bio-preparedness and a third on the health plan. I don’t have anything else to say about whether I’m in talks with either Adventist or OHSU.
TLR: In a report issued earlier this year by the Oregon Health Authority that dealt with the financial and utilization trends of Oregon’s acute care hospitals, the hospitals in your network ended up in the negative column on total margin during the first quarter, including Good Samaritan Regional Medical Center (-2.1%), Samaritan Lebanon (-3.2%), Samaritan Pacific Communities Hospital (-0.2%), Samaritan Albany Hospital (-0.6%) and Samaritan Lebanon Hospital (-3.2).
LM: Those quarterly earnings don’t tell the whole story. There’s a bias in the state numbers that show the operating sites with everything loaded in whereas the system doesn’t survive that way.
As of September 30, our unaudited results show that our system had $12 million in excess reserves. We thought that we’d come in at $3.7 million. In the third quarter of 2013 we were at a negative $9.4 million.
So let’s be transparent. As a system, we’re in a much more positive position than this time last year because of our innovative approaches, and the majority of our hospital sites have turned into a positive position. Part of what pulls down our hospital operation earning numbers is that our physician practices are built in. If we separate out the physician side, we get a much different picture because physician practices are not as high revenue producers in hospitals. When we blend everything together -- physician practices and hospitals – it has a negative effect that’s tougher on the hospital side.
What made our system so much healthier was all our other activity including our health plan, property investments, non- operating related income like SamFit and our other fitness and wellness ventures.
We generate about as much in non-operating income as we do in operating income. That’s the model we need to have as we shift toward more capitated care and population health models.
TLR: Do you foresee closing any of your five hospitals?
LM: I’m envisioning all hospitals redefining their mission. We may do different things at different sites, and need to create more capacity for mental health and look at post-acute rehabilitation, and offer more robust outpatient and urgent care type services. Things not necessarily done inside the hospital.
We also need more education and training preparedness. Every time we have an event – Ebola—H1N1 --- we go through this mad scramble about what we’re going to do, and how we’re going to do it. We’re better than that.
TLR: What are your thoughts about mental, physical and dental integration under the CCOs? Can they fit within the same facility?
LM: Yes, dental and mental health objectives are very achievable with that model. I don’t see handicaps but as opportunities, and I’m particularly optimistic about the future of mental health. I don’t see quite as much activity with dental. Folks are focused in large part on mental health because of its critical nature. That’s not to say we don’t have equally critical issues with dental care and hygiene, but we’re making some real headway with mental health
TLR: What’s the future look like for specialists in your community?
LM: We’re seeing a lot of movement toward specialists becoming employed and have hired 400 physicians, and 100-150 are specialists, primarily hospitalists. Specialists are looking for opportunities to practice medicine in the way they’d like to practice and not necessarily be burdened with economic considerations
TLR: Any thoughts about what’s likely to come before the next legislative session
LM: Honestly I’m not in that realm but I do see a lot of issues related to healthcare reform, and a lot of work on CCOs -- the enrollment process. There’s still a lot of work to do, and I’m sure the state is focused on making sure things go forward. The work is just beginning.
Diane can be reached at [email protected].
