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State Employees, School Districts Expected to Follow Coordinated Care Plan Model

December 14, 2011—The 600,000 people on the Oregon Health Plan aren’t the only ones who will see their healthcare delivered by the newly-formed coordinated care organizations (CCOs).
December 14, 2011

December 14, 2011—The 600,000 people on the Oregon Health Plan aren’t the only ones who will see their healthcare delivered by the newly-formed coordinated care organizations (CCOs). 

The state’s public employees, school district and community college employees will also benefit from this healthcare delivery model, starting in August 2014, which will coordinate physical, mental and dental care. In preparation, the Public Employees’ Benefit Board (PEBB) and the Oregon Educators Benefit Board (OEBB) have started considering how to incorporate the delivery model into their existing health plans.

At OEBB’s December 8 meeting, the board considered the draft criteria being developed for those CCOs. Some of that draft criteria includes an expectation for CCOs to incorporate programs and practices to reduce health disparities, ensure that people have a team-based primary care home and are provided with community health workers, if necessary, according to Joan Kapowich, OEBB’s administrator.

“They are also expectations of good, quality care,” she told the board, adding that the criteria are a work in progress. “But I wanted to give you a picture of what may be coming.”

Currently the health plans offered by OEBB – Providence Health Plans and ODS Health Plans  – already incorporate some of the criteria and standards being developed by these CCOs. “In many of these, we may not have to change them,” she said.

For instance, some plans offer a medical home model of care, and OEBB tracks outcome measures related to tobacco use, along with the number of people with high blood pressure or diabetes.

However, the draft criteria under consideration also include tracking the rates of mental illness and chemical dependency, which are either not measured or done in a way that doesn’t line up with those criteria.  

The Oregon Health Policy Board is expected to draft a business plan for the development of CCOs that will incorporate those criteria. That plan must be approved by the legislature next February to enable the Oregon Health Authority to request the necessary federal waivers to begin implementation in July for people on the Oregon Health Plan.

That change was set in motion by the passage of House Bill 3650 earlier this year.

There was little discussion about the criteria. But one board member noted that some definitions are lacking in the draft criteria related to how outcomes. Kapowich’s response might be an indication of what’s to come as far as the detail to be found in the CCOs’ business plan.

“This was all I was able to get. I was told that there might not be a lot of specifics in the business plan,” Kapowich said. “These are good bets on what might go into it.”

Concern about the lack of concrete detail was echoed at the PEBB’s December 13 meeting when the board, which administers the health plans for 127,000 state employees, also discussed the draft criteria.

“It’s been very conceptual,” said Rich Peppers, the board chair and the SEIU Local 503’s assistant executive director.

Not knowing exactly what a CCO is, or how care will be provided or integrated, makes it difficult, Peppers and other board members said, to begin developing such a care model for its members. “The PEBB board has a daunting task to operationalize this CCO process into our [request for proposal] process,” Peppers said.

By “request for proposals,” Peppers was referring to a process PEBB undertakes each year to solicit health plans from insurance carriers. The timeline for PEBB to issue such a request for a CCO model, like the timeline to have CCOs on the ground and ready to serve Oregon Health Plan patients by July, is tight: PEBB must finalize the plan design for its medical plans by March 2012, finalize how CCOs will be a part of those plan designs by September 2012, and release the request by October.

Diane Lovell, who represents the Association of Federal, State, County and Municipal Employees (AFSCME) on the board, also served on one of four workgroups appointed by Governor John Kitzhaber to hash out the criteria, budget, metrics and structure of CCOs. She said much of that work has been focused on the state’s Medicaid and Medicare programs, with little focus on how CCOs will be integrated into PEBB and OEBB’s health plans.

Sean Kolmer, Governor Kitzhaber’s assistant health policy adviser and a new PEBB board member, also agreed that “They are different questions from the Medicaid program.”

“Our RFPs are extremely rigorous, to the point of tears,” Lovell said. “What will happen if the Oregon Health Authority certifies a CCO, we run it through our RFP, and they don’t meet the mark? Will we be pressured to be not as rigorous as we’ve been in the past? That is something for us to worry about.”

Lovell expressed numerous other concerns, including whether PEBB will need to audit a CCO’s finances and budget and if services for PEBB’s members will be reduced because a CCO will have to stay within its budget.

Sen. Betsy Johnson (D-Scappoose), a non-voting member of PEBB, also voiced numerous concerns about how CCOs will work. Among the many questions she asked Kolmer where whether a single community could have more than one CCO, what would happen if a CCO goes out of business, and what will happen to healths that do not contract with CCOs.

“The questions you’re asking are critical,” Peppers said. “I wouldn’t have known the answers to all those questions myself.”

“I’m asking them rhetorically, because I don’t know if anybody knows the answers,” Johnson replied.