Oregon’s New Coordinated Care: City Club Meeting May 13

Coordinated care organizations are the new health care model for participants in the Oregon Health Plan, also known as Medicaid. The organizations combine physical, mental, and eventually dental care to lower costs while improving quality.

Oregon legislators passed a bill just over a year ago to transform Oregon’s health care delivery system to coordinated care. The state won a $45 million federal grant in February to support the new system and start making key coordinated care elements available to other groups, like Public Employees’ Benefit Board and Medicare.

City-ClubOn Monday, May 13, two speakers will talk to City Club about implementing and measuring the success of the new system.

The first speaker, Kelley Kaiser, is chief executive officer of Samaritan Health Plans and InterCommunity Health Network Coordinated Care Organization. InterCommunity serves Linn and Benton counties.

Kaiser said that the main goals of coordinated care are better health, better care, and better cost of care: “Giving the right care at the right time in the right place.”

“Under the Oregon Health Plan we’ve had different mechanisms for administering physical, mental, dental,” she said. In the past, these different pieces were all managed separately. The fundamental role of coordinated care is coordinating the three pieces.

The first thing participants might notice is a reduction in member handbooks, ID cards, and phone numbers to call for care. Instead of having three of each, now they’ll have one.

“Hopefully what they’re seeing is better coordination,” Kaiser said.

Better coordination will hopefully lead to better care and lower costs.

The second speaker, Jeff Luck, associate professor of Health Management and Policy at Oregon State University and a member of the Oregon Health Authority’s Metrics and Scoring Committee, said that coordination leads to lower costs by reducing duplication.

For example, a person has a test done at his doctor’s office and later ends up in the hospital. If the hospital has the test results, it can use those results instead of redoing the test.

In addition to reducing costs, coordinated care is about improving the care people receive. Luck said that in any insurance program, a small number of people account for most of the spending.

“In Medicaid, many of those people have mental illness as well as medical issues, so by coordinating their mental and physical health care you can mitigate the severity in both cases,” he said.

Improving quality and reducing waste is one goal of coordinated care. Another goal is bringing Oregon’s Medicaid budget in line with what state taxpayers can afford.

“Before the transformation the state Medicaid budget was growing at a rate that couldn’t be sustained,” said Luck. “The reform also puts strict limits on the Medicaid budget per person.”

Increasing quality while reducing costs is a tall order. That’s where the Metrics and Scoring Committee comes in.

“The Metrics and Scoring Committee was set up to measure the quality of care that beneficiaries receive so that we can have some confidence that coordinated care organizations continue to provide quality care at the same time that they’re becoming more efficient,” said Luck. “These are themes that the nation is going to have to deal with overall. Oregon is just coming to grips with the problem sooner than other states.”

Kaiser said that this transformation will set up a model that can be used elsewhere in Oregon or around the country.

“This is the way things are moving forward,” she said. “It could be much bigger than just Medicaid.”

City Club meets on Monday, May 13 at noon in the Banquet Room of the Renaissance Building on Washington and 1st. The meeting is free. A catered lunch is also available for $8 for members or $10 for non-members. Registration information is available online at http://www.cityclubofcorvallis.org/.

By Lana Jones