Surveys Show Men, Women Report Differences in Satisfaction with CCO Care

On the surface, most members of Oregon’s coordinated care organizations are generally satisfied with their health coverage. But dig deeper, and differences emerge across the plans.

At Cascade Health Alliance and Primary Health of Josephine County, women gave higher scores to their CCO than men, but at Eastern Oregon CCO men seemed to like their doctors better than women. At most CCOs across Oregon, people who reported health problems said they had a harder time accessing care or communicating with their doctor than healthier members – but at InterCommunity Health Network and at Primary Health of Josephine County, survey results didn’t follow that trend.

These are among the details that have emerged in this fifth story in a seven-part Lund Report series, in which we are digging deep into how CCO patients feel about the care they are receiving.

Drawing on in-depth surveys that were commissioned by the Oregon Health Authority and published in 340-page analyses dubbed “Banner Books,” the series aims to look beyond the profit and revenue reports typically used to assess the state of Oregon’s Medicaid-funded health plans, instead focusing on how well each health plan works for patients seeking care.

We started the series with a look at AllCare Health, continued with three CareOregon affiliated-CCOs, then examined the two CCOs operating in the Portland area, and in part four we looked into Trillium, Umpqua Health Alliance and PacificSource’s two CCO plans.

Our next story will look at the two remaining Oregon CCOs: Western Oregon Advanced Health and Willamette Valley Community Health. We will conclude the series with a step back to look at the big picture, comparing performance to see if some CCOs rate considerably better or worse than others.

Cascade Health Alliance

Based in Klamath Falls, Cascade Health Alliance serves Klamath County with a network of hospitals, doctors and clinics.

On most metrics, Cascade Health Alliance members reported experiences similar to patients at other CCOs across the state:

• On a scale of zero to 10, 64 percent gave Cascade a top score of 8, 9 or 10, when asked to rank their experience against the best and worst care possible.
• 78 percent said it was usually or always easy to get the care, tests or treatment they needed.
• 92 percent said their doctor usually or always explained things in a way that was easy to understand.
• 92 percent said the health plan’s customer service treated them with courtesy and respect.

On several metrics, especially related to their service experience, Cascade Health Alliance members reported a better experience than members of other CCOs in Oregon:

• 65 percent of members said Cascade’s online written materials usually or always provided the information they needed about how the health plan worked, compared to a statewide average of 52 percent.
• 87 percent of members said the CCO’s customer service usually or always offered the answers or help they needed, compared to a statewide average of 76 percent.
• 72 percent said it was usually or always easy to get the medical equipment they needed, compared to a statewide average of 63 percent.

Still, members did not have a fully favorable view of Cascade Health Alliance, which on several points ranked worse than the average Oregon CCO:

• 58 percent of Cascade members said they had one of the best health plans possible, compared to 64 percent of all members of CCOs.
• When there was more than one choice for treatment or healthcare, 77 percent of Cascade members said their provider asked which choice was best for them, compared to 84 percent statewide.
• And Cascade doctors appeared less likely to push tobacco users to quit: 20 percent usually or always discussed medication use to quit tobacco, compared to 29 percent of doctors statewide; 18 percent usually or always discussed non-medication methods for quitting, compared to 24 percent of doctors statewide.

Some Cascade Health Alliance members reported a discrepancy in how they were treated depending on how healthy they were when they sought care – although the gap was smaller than at many other CCOs.

Of Cascade members in excellent, very good or good health: 60 percent ranked their CCO as one of the best possible health plans; 69 percent said a lot of effort was made to help understand their health issues

Of Cascade members in fair or poor health: 51 percent ranked their CCO as one of the best possible health plans; 53 percent said a lot of effort was made to help understand their health issues.

Men and women also reported different experiences at the CCO, with men less happy, overall, with the quality of care they received:

• Asked if they would consider Cascade Health Alliance one of the best possible health plans, 61 percent of women gave it a top score, compared to 54 percent of men.
• Asked how often their doctors made it easy to ask questions or raise concerns, 43 percent of men said always, compared to 57 percent of women.
• 69 percent of women said “yes, definitely,” when asked if they could trust their doctor or other provider with their medical care, compared to 57 percent of men. Only 5 percent of women answered “no” to the same question, compared to 14 percent of men.

Eastern Oregon CCO

Eastern Oregon CCO serves members in 12 rural counties across Eastern Oregon, and is administered by Greater Oregon Behavioral Health and MODA Health.

On most metrics, Eastern Oregon CCO members reported experiences similar those of members at other CCOs across the state:

• 81 percent said it was usually or always easy to get the care, tests or treatment they needed.
• 92 percent said their doctor usually or always explained things in a way that was easy to understand.
• 89 percent said their personal doctor usually or always showed respect for what they had to say.

On several metrics, Eastern Oregon members reported a significantly better experience than members of other CCOs in Oregon:

• 97 percent said the health plan’s customer service treated them with courtesy and respect. Only 91 percent of CCO members across all Oregon plans said the same.
• 63 percent said Eastern Oregon CCO’s website usually or always provided information they needed about how their health plan works. Statewide, 52 percent of CCO members said the same about their plans.

But on other metrics, Eastern Oregon members said their plan was behind most other CCOs:

• On a scale of zero to 10, 60 percent of Eastern Oregon members gave their plan a top score of 8, 9 or 10, when asked to rank their experience against the best and worst care possible. Across all CCOs, 67 percent of members gave their health plan a top score.
• Only 47 percent of Eastern Oregon members said it was usually or always easy to get the medical equipment they needed, compared with 63 percent statewide.
• 42 percent of Eastern Oregon tobacco users were advised to quit using by their doctor or another health provider, compared to 50 percent statewide.

As with other CCOs, Eastern Oregon CCO members reported MISSSING WORD discrepancy in how they were treated depending on how healthy they were when they sought care.

Of Eastern Oregon members in excellent, very good or good health: 66 percent gave their health plan a top score; 87 percent said it was always or usually easy to get the care, tests or treatment they needed; 98 percent said their doctor listened carefully, and 78 percent said their doctor always showed respect for what they had to say.

Of Eastern Oregon members in fair or poor health: 50 percent gave their health plan a top score; 73 percent said it was always or usually easy to get the care, tests or treatment they needed; 81 percent said their doctor listened carefully and 59 percent said their doctor always showed respect for what they had to say.

On several questions, Hispanic and non-Hispanic members described different experiences with Eastern Oregon CCO: 91 percent of Hispanic members said their doctor never interrupted them, although only 35 percent of these members said the provider always made it easy to ask questions or raise concerns; whereas 78 percent of non-Hispanic members said their doctor never interrupted, while 55 percent said the provider always made it easy to ask questions or raise concerns.

Men and women also reported slightly different views, with 83 percent of men saying they had one of the best doctors possible, compared to 72 percent of women.

InterCommunity Health Network CCO

InterCommunity Health Network CCO serves people in Benton, Lincoln and Linn counties through a partnership of a number of health organizations based largely in the Willamette Valley.

On most metrics, InterCommunity Health Network members reported experiences similar to patients at other CCOs across the state:

• On a scale of zero to 10, 67 percent gave IHN a top score of 8, 9 or 10, when asked to rank their experience against the best and worst care possible.
• 85 percent said it was usually or always easy to get the care, tests or treatment they needed.
• 90 percent said their doctor usually or always explained things in a way that was easy to understand.
• 95 percent said the health plan’s customer service treated them with courtesy and respect.

On several metrics, IHN members reported a better experience than members of other CCOs in Oregon:

• 68 percent said it was usually or always easy to get the special therapy, such as physical, occupational or speech therapy, that they needed. Statewide, only 60 percent of all CCO members said this was usually or always easy.
• Of IHN members who use tobacco, 59 percent said they were advised to quit – compared to 50 percent of CCO members statewide.

IHN members did not report a drastically worse-than-average experience than people enrolled at other CCOs on any survey question – though when it came to accessing medical equipment, 58 percent of IHN members said it was usually or always easy to get the medical equipment they needed, compared to 63 percent of CCO members statewide.

Only 292 IHN members agreed to participate in the survey, and on many questions only a few dozen – or even fewer -- were qualified to talk about specific types of care. Quite often, the number of people answering was too small to draw conclusions about a gap in the experiences of sicker and healthier patients, but there were exceptions:

• Asked if their provider made at least some effort to help them understand their health issues, 95 percent of members in excellent, very good or good health said yes, compared to 82 percent of members in fair or poor health.
• Also, 88 percent of members in excellent, very good or good healthy said their doctor or provider was never condescending, compared to 75 percent of those in fair or poor health.

Primary Health of Josephine County

On most metrics, Primary Health of Josephine County members reported experiences similar to patients at other CCOs across the state:

• On a scale of zero to 10, 69 percent gave Primary Health a top score of 8, 9 or 10, when asked to rank their experience against the best and worst care possible.
• 93 percent said their personal doctor usually or always listened carefully to them.
• 93 percent said the health plan’s customer service treated them with courtesy and respect.

On several metrics, Primary Health members reported a better experience than members of other CCOs in Oregon:

• 87 percent said it was usually or always easy to get the care, tests or treatment they needed, while only 80 percent of members of all CCOs across Oregon said this was usually or always the case.
• 96 percent said their doctor usually or always explained things in a way that was easy to understand, compared to 91 percent statewide.
• 65 percent said they could usually or always find information online about how their health plan worked, compared to 52 percent of CCO members across the state

On other metrics, Primary Health members said their experience was worse than average:

• 65 percent said they could always or usually get an appointment with a specialist as soon as needed, compared to 75 percent of CCO members across Oregon.
• 71 percent of Primary Health members said they would give the specialist they saw a top score of 8, 9 or 10, on a scale of zero to 10, compared to 78 percent of CCO members statewide.

Unlike most CCO members across Oregon, Primary Health’s sickest members did not report a significantly different experience than its healthiest members. Also, Primary Health members were less likely to identify themselves as being in fair or poor health: 76 percent rated themselves as being in excellent, very good or good health. Only 70 percent of all CCO members said the same about themselves.

Men and women at Primary Health did report some differences, however: asked how often their personal doctor showed respect for what they said, 97 percent of men said always or usually, compared to 80 percent of women; 69 percent of men said it was always or usually easy to ask questions or raise concerns with their provider, compared to 81 percent of women; and 60 percent of men compared to 74 percent of women said they definitely felt they could trust their doctor or other provider with their medical care.

Courtney Sherwood investigates public records and digs into data for The Lund Report. Reach her at [email protected], or follow her on Twitter at @csherwood.