Officials racing to set clear goals for program, companies serving one in four low-income Oregonians

OREGON HEALTH AUTHORITY - Pat Allen, head of Oregon Health Authority, oversees the organizations, which work like insurance companies, that serve Oregon Health Plan members.The next big step for reforms that were adopted in 2011 and 2012 to save the state money and improve care for one in four Oregonians is coming, but decision-makers have only a vague idea of the next phase — and limited time to fill in the blanks.

On Tuesday, the Oregon Health Policy Board is scheduled to frame the next round of reforms for the Oregon Health Plan, the state's version of the low-income health care program, Medicaid.

But according to some observers, the vision being handed to the citizen members of the board is vague and needs refining — and the state has only a few months to do that crucial work to guide the state program for the next five years.

"They haven't gotten very far," said Rep. Mitch Greenlick, D-Portland, the lawmaker and head of the House Health Care committee, who has been a vocal proponent of stepped-up oversight of the program. "They're afraid they are running out of time."

Savings promised

In 2011, then-Gov. John Kitzhaber spearheaded reforms to set up a system of more than dozen new, beefed-up regionally based "coordinated care organizations." They function much like health insurers, managing networks of doctors and other providers to provide care.

The groups are given a slice of funding and leeway on how to spend it, while reporting back on a series of state-approved benchmarks intended to ensure quality of care.

In return for agreeing to cap the growth of cost inflation by 3.4 percent per year over the first five years, Kitzhaber won $1.9 billion in federal funds to help plug a gaping hole in the overall state budget, averting crisis.

But while the reforms were intended to promote efficiencies and cut spending, several of the groups reported record profits in the early years of the reforms.

Earlier this year a report funded by the Oregon Health Authority, which oversees the program, found that while it appeared to have achieved some of its ends, major portions of the reforms had not yet been accomplished.

"The system is working," said Jeremey Vandehey, director of health policy and analytics for the Oregon Health Authority. He said the state has saved money and patients are reporting better care, but "We still have a lot of work to do."

The Oregon Health Plan is funded with about 60 percent federal Medicaid dollars, and the remainder in state funds.

New contracts

To advance the work on further reforms, officials plan to put new requirements and goals into the next round of contracts for the organizations delivering the care — Coordinated Care Organizations, or CCOs.

The first round of CCO contracts were awarded for five years, then extended a year to give incoming director Pat Allen and Oregon Health Authority staff time to prepare options for the appointed health policy board members overseeing the agency.

Gov. Kate Brown last September issued a letter framing her vision for further reforms, and the agency has prepared some policy options for consideration by the policy board on Tuesday to advance those goals.

Some, however, suspect the options are already being watered down in response to behind-the-scenes pushback from some of the CCOs, which contribute large sums to Oregon elected officials' campaigns.

"It's all about protecting what they have," said one CCO executive, who spoke on condition of anonymity.

If that's true, it could make for an interesting meeting on Tuesday.

Zeke Smith, chair of the health policy board, said the board wants to make sure all views are heard and that decisions are made out in the open.

Moreover, he said the board input should not only set expectations for the CCOs, but for state bureaucrats, ensuring appropriate oversight of the CCOs.

"I really want to know whether people feel that there's been transparency in this process and that their input is being incorporated," he said.

The reforms were supposed to integrate mental health treatment into physical health provision years ago. But that effort has run into major obstacles and is now a focus of the next round of contracts.

The reforms don't at all tackle what was supposed to be integration of dental and oral care with the CCOs, largely because dental companies successfully lobbied the legislature to block those reforms.

One who will be watching the board's efforts is Greenlick, who has advocated that the state take further steps to protect the public's investment in the reforms. For instance, the state should ensure that the CCOs are locally-based nonprofits, he believes, in contrast to the for-profit out of state health care giant, Centene, which purchased the CCO operating in Lane County.

Greenlick hopes the board takes up a similar effort, but he's not optimistic they will. However, he defends the progress made by the state in the last five years; he said the board members need to set a specific vision and goals to take the reforms further.

"This is going to be a real test of the health policy board," he said. "If they don't come up with some new things and some strong policy, it's going to be a waste of time and it's going to lose them the credibility to move forward on other decisions."

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