February 25, 2013 — Oregon’s healthcare delivery transformation has been rolled out so quickly that Oregon Health Authority Director Dr. Bruce Goldberg still talks about the age of coordinated care organizations not in years or even months but in days.
Legislation was passed just a year ago directing the Oregon Health Authority to set up the CCOs. A $1.9 billion boost in federal Medicaid funding came just months later. By August, the first CCO, designed to integrate all aspects of a client’s healthcare needs from a primary care home, was up and running.
But now amendments are coming forward that would modify the state’s arrangement with CCOs, including one heard last Thursday before the Senate Health Committee, Senate Bill 436, which would require CCOs to maximize use of school-based health centers in their geographic area, starting in 2017.
“We were all excited about CCOs but people were excited about the Titanic,” said Paula Hester, executive director of the Oregon School-Based Health Care Network in Portland. “We have to make sure that the rowboats are in place.”
Hester said that several of the centers serve not just students but adults in communities that are starved for primary care access, such as Wheeler, a coastal village of 400 people north of Tillamook.
Sen. Elizabeth Steiner Hayward, D-Portland, said school health centers could provide a good complementary role for CCOs, although they would need to be partnered with primary care providers as well as make their records electronic.
“There is an ability to augment the CCO with school-based health centers,” said Steiner Hayward, who sponsored the bill along with the rest of the Senate Health Committee members with the exception of Sen. Tim Knopp, R-Bend.
“We think that they would play an important part in healthcare reform and education reform,” said Bill Thomas of the Washington County Commission on Children and Families. “They provide integrated physical health, mental health and dental healthcare services. Now what does that sound like?”
After the hearing, Thomas said that all school-based clinics have at least three employees — a nurse practitioner, a receptionist (who can also act as a medical aide), and a mental health therapist. And, they often provide a dentist or dental hygienist.
Coordinated care organizations are already using school-based health services along with other resources in a community. SB 436 would just clarify their role in the delivery system.
Hester added that school clinics are often set up in Title I schools and schools with a high number of reduced-priced lunches — exactly the kind of students who would be covered by the Oregon Health Plan.
The governor’s proposed budget maintains funding for school-based health centers at $7 million next biennium. Since many of the state’s 63 health centers are affiliated with community health clinics, they can also receive federal funding.
“The only concern I have is that there are no CCOs here and this would be a mandate on them,” said Sen. Laurie Monnes Anderson, D-Gresham at the hearing, where only school clinic advocates testified. “We’re on a train that is going very fast.”
Dr. Bob Dannenhoffer, who chairs the Umpqua Health Alliance, a CCO in Douglas County, told The Lund Report that Umpqua uses school-based clinics a fair amount, but he hoped legislators would not tamper so soon with the laws guiding CCOs.
“We’re getting conflicting advice,” said Dannenhoffer, a Roseburg pediatrician. As he understands it, one of the chief goals of the CCO model is to direct patients toward primary care homes, which school clinics typically are not. “We’re seeing a lot of bills designed to tweak us. Stay off, back away, let us do this without passing anymore bills.”
But Doug Riggs, a lobbyist for CareOregon, said if CCOs or the Oregon Health Authority were truly worried about the ramifications of SB 436, they would have raised those concerns at the public hearing. “It’s not an attempt to add a binder to the CCOs,” he said.
Riggs said the process to launch CCOs had moved so quickly that stipulations such as integrating early learning councils and youth development councils had been left out.
A special tax on insurance premiums has helped fund the Healthy Kids program, including school-based community health centers. That tax is expiring and is unlikely to be renewed since children in the program will be covered with federal funding once the Affordable Care Act kicks in next year.
But with that tax going away and general fund levels so volatile, Hester worries about the long-term viability of the student health centers. Presumably, if CCOs maximized their use, they’d provide greater reimbursement for their services.
A separate measure, House Bill 2326, would create a dedicated fund for school-based health centers. Rep. Peter Buckley, D-Ashland, sponsored that bill, whichFebruary 25, 2013 — Oregon’s healthcare delivery transformation has been rolled out so quickly that Oregon Health Authority Director Dr. Bruce Goldberg still talks about the age of coordinated care organizations not in years or even months but in days.
Legislation was passed just a year ago directing the Oregon Health Authority to set up the CCOs. A $1.9 billion boost in federal Medicaid funding came just months later. By August, the first CCO, designed to integrate all aspects of a client’s healthcare needs from a primary care home, was up and running.
But now amendments are coming forward that would modify the state’s arrangement with CCOs, including one heard last Thursday before the Senate Health Committee, Senate Bill 436, which would require CCOs to maximize use of school-based health centers in their geographic area, starting in 2017.
“We were all excited about CCOs but people were excited about the Titanic,” said Paula Hester, executive director of the Oregon School-Based Health Care Network in Portland. “We have to make sure that the rowboats are in place.”
Hester said that several of the centers serve not just students but adults in communities that are starved for primary care access, such as Wheeler, a coastal village of 400 people north of Tillamook.
Sen. Elizabeth Steiner Hayward, D-Portland, said school health centers could provide a good complementary role for CCOs, although they would need to be partnered with primary care providers as well as make their records electronic.
“There is an ability to augment the CCO with school-based health centers,” said Steiner Hayward, who sponsored the bill along with the rest of the Senate Health Committee members with the exception of Sen. Ben Knopp, R-Bend.
“We think that they would play an important part in healthcare reform and education reform,” said Bill Thomas of the Washington County Commission on Children and Families. “They provide integrated physical health, mental health and dental healthcare services. Now what does that sound like?”
After the hearing, Thomas said that all school-based clinics have at least three employees — a nurse practitioner, a receptionist (who can also act as a medical aide), and a mental health therapist. And, they often provide a dentist or dental hygienist.
Coordinated care organizations are already using school-based health services along with other resources in a community. SB 436 would just clarify their role in the delivery system.
Hester added that school clinics are often set up in Title I schools and schools with a high number of reduced-priced lunches — exactly the kind of students who would be covered by the Oregon Health Plan.
The governor’s proposed budget maintains funding for school-based health centers at $7 million next biennium. Since many of the state’s 63 health centers are affiliated with community health clinics, they can also receive federal funding.
“The only concern I have is that there are no CCOs here and this would be a mandate on them,” said Sen. Laurie Monnes Anderson, D-Gresham at the hearing, where only school clinic advocates testified. “We’re on a train that is going very fast.”
Dr. Bob Dannenhoffer, who chairs the Umpqua Health Alliance, a CCO in Douglas County, told The Lund Report that Umpqua uses school-based clinics a fair amount, but he hoped legislators would not tamper so soon with the laws guiding CCOs.
“We’re getting conflicting advice,” said Dannenhoffer, a Roseburg pediatrician. As he understands it, one of the chief goals of the CCO model is to direct patients toward primary care homes, which school clinics typically are not. “We’re seeing a lot of bills designed to tweak us. Stay off, back away, let us do this without passing anymore bills.”
But Doug Riggs, a lobbyist for CareOregon, said if CCOs or the Oregon Health Authority were truly worried about the ramifications of SB 436, they would have raised those concerns at the public hearing. “It’s not an attempt to add a binder to the CCOs,” he said.
Riggs said the process to launch CCOs had moved so quickly that stipulations such as integrating early learning councils and youth development councils had been left out.
A special tax on insurance premiums has helped fund the Healthy Kids program, including school-based community health centers. That tax is expiring and is unlikely to be renewed since children in the program will be covered with federal funding once the Affordable Care Act kicks in next year.
But with that tax going away and general fund levels so volatile, Hester worries about the long-term viability of the student health centers. Presumably, if CCOs maximized their use, they’d provide greater reimbursement for their services.
A separate measure, House Bill 2326, would create a dedicated fund for school-based health centers. Rep. Peter Buckley, D-Ashland, sponsored that bill, which was referred to the House Health Committee, but a hearing has not yet been scheduled. HB 2326 does not specify where the special funding will come from or the amount of funding required. was referred to the House Health Committee, but a hearing has not yet been scheduled. HB 2326 does not specify where the special funding will come from or the amount of funding required.
Image for this story by Samuel Sharpe (CC BY 2.0) via Flickr.
