State Finalizes Federal Grant

Oregon announced a the finalization of a comprehensive agreement with the Centers for Medicare and Medicaid Services (CMS) that sets expectations for Oregon’s Coordinated Care Organizations. The agreement fulfills the Special Terms and Conditions of last July’s 1115 Medicaid demonstration.

Entitled “Oregon’s Accountability Plan  and Expenditure Trend Review,” the plan “lays out the methods, measurements and accountability” for Oregon’s health system transformation including:

• How Oregon will be held accountable for reducing the state’s Medicaid expenditure growth trend while improving quality and access;

• Details on the health quality improvement metrics to be used to measure progress. These metrics include a set established by a stakeholder-led Metrics and Scoring Committee that will provide financial incentives for CCOs that show performance improvement.

• How the 2 percentage point reduction in per capita medical expenditure trend will be lowered; and,

• Quality assessments - and the penalties that would occur if health quality were to diminish among the OHP population.

View the Agreement

Included in the agreement are 17 CCO Quality Pool Metrics established by the stakeholder Metrics and Scoring Committee and additional metrics that CMS will expect over the long term. All are geared towards ensuring that transformation of the health system, improved outcomes and bending of the cost curve will occur.

OHA will hold a webinar on January 4^th at 2:00 p.m. to go over the key elements of the Accountability Plan and allow stakeholders to ask questions. 

Register for the Webinar

	FOR IMMEDIATE RELEASE November 9, 2012 CONTACT: Katie Briedwell Executive Assistant Yamhill County Care Organization 503-434-7339 briedwellk@co.yamhill.or.us

Yamhill County Care Organization names Carlough new Executive Director

 Yamhill County Care Organization, one of Oregon’s newest Coordinated Care Organizations (CCOs) serving recipients of the Oregon Health Plan, has named James Carlough as its new Executive Director.

With more than 18 years experience working with managed care services and multiple health care delivery systems, Carlough combines business acumen with a broad knowledge of the community members served by the Oregon Health Plan, according to Silas Halloran-Steiner, the CCO’s board chairman.

“Jim’s experience in senior leadership positions with a diversity of health plans, will allow him to make an immediate contribution to Yamhill County Care Organization’s strategic planning and implementation efforts,” says Halloran-Steiner.

“Jim has lived with his wife and children in Newberg since 2005, so he is not only familiar with local concerns, but committed to our community’s well-being.”

Carlough, who says he feels deeply committed to vulnerable populations and delivery system enhancements, spent several years working with a Medicaid plan in Arizona. Most recently, Carlough served as senior manager, provider services, for CareOregon, the largest managed care organization serving OHP members.

Carlough’s task will be to manage both operations and coordinate with partner organizations, such as CareOregon and Mid-Valley Behavioral Care Network (MVBCN), which provide claims processing, provider contracting and other services for the CCO. He also will work with the board, member advisory council, and clinical advisory panel in developing a transformation plan demonstrating how Yamhill County Care Organization will work to improve health outcomes, increase member satisfaction and reduce costs. Each CCO is required to develop a transformation plan geared specifically to the needs of the local community it serves.

“I am excited about the opportunity to work with Yamhill County Care Organization,” says Carlough. “My goal is to increase access to services, help reduce costs, and benefit my local community.”
Yamhill County Care Organization has approximately 18,000 members.

# # #

If you have further questions please contact:

• Jim Carlough, Executive Director, Yamhill County Care Organization
  carloughj@careoregon.org  or 503-416-8038
• Silas Halloran-Steiner, Director, Yamhill County Health and Human Services
  halloras@co.yamhill.or.us or (503) 434-7523
• Gil Munoz, CEO, Virginia Garcia Memorial Health Center
  gmunoz@vgmhc.org or (503) 352-8610
• Dan Ordyna, CEO, Willamette Valley Medical Center
  daniel.ordyna@capellahealth.com or (503) 435-6320
• Alan Olive, CEO, Providence Newberg Medical Center
  Alan.Olive@providence.org or (503) 537-1701
• Jim Russell, Executive Manager, Mid-Valley Behavioral Care Network
  jimr@mvbcn.org or (503) 585-4991
• Patrick Curran, Director of Business Integration, CareOregon
  curranp@careoregon.org or (503) 416-4100

 For general questions, e-mail carloughj@careoregon.org  or visit http://yamhillcco.com/

Oregon Health Policy Board to host public forum on progress of health system transformation

From the Oregon Health Policy Board "Health News"

The December Oregon Health Policy Board meeting will focus on the progress to date of Oregon’s Medicaid health system transformation and provide a format for public input in the early stages of the new Coordinated Care Organizations.

The board meeting will be a forum for consumers, advocates, and stakeholders to offer feedback on certain questions related to health system transformation and Oregon's coordinated approach to care. More information will be provided as the meeting approaches.

The meeting will be held at its usual time Tuesday, Dec. 11, from 1 p.m. – 5 p.m. but will be conducted at the Multnomah County Commissioner's office, 501 Southeast Hawthorne Blvd., Portland, OR 97214.

If you or your organization wish to give a public comment, please email the Oregon Health Policy Board staff at ohpb.info@state.or.us with the subject line: Health System Transformation Feedback. For those around the state who cannot travel to Portland, alternative means of commenting will be provided.

DCOs and Legislators Ask for OHA Rule Change

Dentistry Would Be Mandated Through DCOs Until 2017

Mike Shirtcliff of Advantage Dental and two state legislators, Senator Alan Bates and Representative Tim Freeman have filed a petition with the Oregon Health Authority to require that CCOs must contract directly with Dental Care Organizations if they are to provide dental care to their members. The change would specifically prevent CCOs from contracting with any other dentist, dental hygienist, or dental organization.

View the Petition Here.

Update from Health Share of Oregon

See below for an update from Health Share of Oregon on their current status.

The latest activities at Health Share: 

• HSO began operating as a CCO and serving OHP enrollees on September 1.  It was a very smooth transition, with only one minor glitch in the computer system at OHA over the Labor Day weekend that was fixed almost immediately.

• HSO's first priority was to do no harm to our Members.  In order to minimize any potential disruption for OHP members, HSO allowed members to stay enrolled with their current health plans, under the HSO umbrella.  This will ensure that members may continue access all of their current providers.

• In the coming months, HSO will be working with members, the provider community, and other stakeholders to migrate and consolidate CCO services, where appropriate, to maximize efficiency and coordinate across systems.

HSO's CAC has held two monthly meetings to date.  Stephen Weiss is the Chair of the CAC; Dalila Sarabia is the Vice Chair; Ronda Harrison is the Secretary; and Amy Anderson and Faith Gilstrap are members of the Executive Committee.  The complete CAC roster can be found on the HSO Fact Sheet.

• The  CAC has begun the process of discussing and thinking through their responsibility of overseeing the Community Needs Assessment process, adopting a Community Health Improvement Plan, and producing an annual report on the progress toward achieving the Community Health Improvement Plan
  
The CAC will also participate and contribute to the development of HSO's Transformation Plan.

• Beginning at the October 5th CAC meeting, there will an opportunity for the Public to come and submit oral or written comments on the CAC's or HSO's work. Please visithttp://healthshareoregon.org/about/community-advisory-council/ closer to the meeting date for more details.

Metrics and Scoring Committee begins meeting with task of identifying outcome and quality measures for CCOs

From the OHPB E-bulletin:

The newly-formed nine-member Oregon Metrics and Scoring Committee held its first meeting in August with the task of identifying the outcome and quality measures for Coordinated Care Organizations.

“This committee's work is important to ensuring better health outcomes. These are the metrics that will tell us where we’re going and will allow us to make quick course corrections as needed along the way to improve the health of Oregonians,” Tina Edlund, Oregon Health Authority chief of policy, said after the meeting.

The committee includes three at-large members, three members with expertise in health outcomes and three representatives of Coordinated Care Organizations. The committee was established by Senate Bill 1580, and members serve for two-year terms.

Metrics and quality measures will be used by the Oregon Health Authority to determine whether CCOs are effectively and adequately improving health, making quality care accessible, eliminating health disparities, and controlling costs for the populations that they serve.

For more information on the committee, including meeting materials and schedules, please visit the Metrics and Scoring Committee webpage.

New Coordinated Care Organizations in Hood River, Wasco, Yamhill Counties

Oregon Health Authority News Release

August 29, 2012

Contact: Patty Wentz, 503-932-6243

New Coordinated Care Organizations moving forward in Hood River, Wasco and Yamhill counties

Majority of Oregon Health Plan clients will have access to more coordinated, patient-focused care 

Two new coordinated care organizations have been provisionally certified to serve Oregon Health Plan clients, officials announced today.

Pending final approval later this month, the new CCOs will begin operation on November 1, 2012. PacificSource Community Solutions Coordinated Care Organization – Columbia Gorge Region will serve OHP clients in Hood River and Wasco counties. Yamhill County Care Organization will serve local clients there.

In total, 13 CCOs have received final approval to serve OHP clients and three have been provisionally certified. The majority of OHP clients in the state will be served through a local coordinated care organization.

“Oregon has truly come together with a renewed commitment to patient-centered care and lower costs,” said Governor John Kitzhaber. “I want to commend everyone who has worked so hard this year to launch coordinated care organizations. Your efforts will benefit your patients, your community and our state.”

Under the CCO model, for the first time care for OHP clients is jointly managed for physical and mental health to be better able to coordinate care and reduce unnecessary hospitalizations. The model also emphasizes using community-based health workers to help patients with chronic illnesses stay healthier and reduce costs.

OHP clients who are going to be enrolled in a new CCO in their communitywill receive personal notification with the name of the new coordinated care organization.

As the new coordinated care organizations prepare to begin serving clients, a committee of Oregonians is working to identify objective quality measures for all CCOs on outcomes such as ambulatory care, inpatient care, chemical dependency and mental health treatment, and all other health services provided by coordinated care organizations.

“The best path to lowering health care costs is through improved health,” said Bruce Goldberg, M.D., director of the Oregon Health Authority. “With the final CCOs approved this year the pieces are in place for a system that works for all of us in bringing better health, better care and lower costs.”

More information about CCOs can be found at health.oregon.gov.

# # #

Tri-County Medicaid Collaborative Names Board of Directors

The Tri-County Medicaid Collaborative has named their board of directors.

Board members include:
Community-At-Large 
Mel Rader – Co-Executive Director, Upstream Public Health
Ramsey Weit – Executive Director, Community Housing Fund
Chair of Community Advisory Council
Stephen Weiss – Chair of the Elders in Action Commission of Multnomah County, Current Board President of Independent Living Resources, the Community Alliance of Tenants, and the Oregon State Council for Retired Citizens
Dentist 
Michael Biermann, DMD – Pediatric Dentist, Owner, Co-Chair, Oregon Head Start Dental Home Project
Mental Health Provider 
Mary Monnat – President and CEO, LifeWorks NW
Addictions Provider 
Jacqueline Mercer – CEO, Native American Rehabilitation Association of the Northwest, Inc.
RN/NP 
Jean-Claude Provost – Lead Clinician/Family Nurse Practitioner, Housecall Providers, Inc., Chair-Elect, Nurse Practitioners of Oregon
Primary Care Physician 
Jill Ginsberg, MD – Retired, Northwest Permanente, Founding Board Member, North by Northeast Community Health Center
Specialty Care Physician
Walter Hoffman – Member, Past President, Practicing OB/GYN, Women’s HealthCare Associates, LLC
In addition, the founding members include:
George J. Brown, MD, FACP, Chair, Legacy Health
Cindy Becker, Clackamas County Health , Housing & Human Services
Ed Blackburn, Central City Concern
Rod Branyan, Washington County Dept. of Health & Human Services
David E. Ford, CareOregon
Andrew R. McCulloch, Kaiser Permanente
Joseph E. Robertson, Jr., MD, OHSU
Thomas Russell, Adventist Medical Center
Lillian Shirley, Multnomah County Health Department
Dick Stenson, Tuality Healthcare
Greg Van Pelt, Providence Health & Systems


For more information on the Board of Directors, visit the Tri-County Medicaid Collaborative website.

New Coordinated Care Organizations approved for Oregon Health Plan

Contact: Patty Wentz, 503-932-6243

CORRECTED RELEASE: This release has been updated to correct the number of clients served by CCOs beginning Sept.1 and the Eastern Oregon Community Care Organization service area.

July 31, 2012

New Coordinated Care Organizations approved for Oregon Health Plan

Five new Coordinated Care Organizations will begin serving Oregon Health Plan members in September, the Oregon Health Authority announced today.

The new CCOs will provide services for OHP members in 22 counties. In total, there are 13 Coordinated Care Organizations serving 33 counties in the state. By   Sept. 1 nearly 500,000 adults and children – the majority of Oregon Health Plan members – will have access to a CCO.

“In Oregon we are showing that it is possible to build a health care system around patients and their providers for better health and reduced costs,” said Governor John Kitzhaber. “These new Coordinated Care Organizations will be leading the way for everyone in our state.”

Oregon Coordinated Care Organizations to start September 1

To see full list of Coordinated Care Organizations, go to www.health.oregon.gov.

Columbia Pacific Coordinated Care Organization, LLC – All of Clatsop, Columbia and Tillamook counties. Parts of Coos and Douglas counties.

Eastern Oregon Community Care Organization – Baker, Malheur, Sherman, Union, Wallowa starting Sept. 1. (Gilliam, Grant, Harney, Lake, Morrow, Umatilla and Wheeler counties starting at a later date.) 

Jackson County Coordinated Care Organization, LLC – Jackson County.

PrimaryHealth of Josephine County, LLC – Josephine County and parts of Douglas and Jackson counties.

Tri-County Medicaid Collaborative – Clackamas, Multnomah and Washington counties.

Under Coordinated Care Organizations, benefits for Oregon Health Plan clients will not change. The vision of CCOs is to allow providers better ways to address health care problems.

Through a waiver from the federal government, Oregon has flexibility to provide more preventive care and disease management than has been possible under traditional Medicaid guidelines. Research shows that 80 percent of health care costs are driven by 20 percent of patients, many with chronic conditions such as heart disease, diabetes and serious mental illness. CCOs will have the ability to hire community-based health workers to help people manage their conditions, ensure they are taking appropriate medications, and avoid unnecessary acute or emergency care. By focusing on improved health, Oregon has agreed to reduce Medicaid inflation by 2 percentage points within two years by focusing on improving the health of clients to reduce waste, inefficiency, and unnecessary expenditures.

OHP members will receive personal notification of their new Coordinated Care Organization, and they do not need to take any action. More information for members and providers can be found at health.oregon.gov.  

# # #

New Coordinated Care Organizations approved for Oregon Health Plan

Today's News Release from the Oregon Health Authority outline five new Coordinated Care Organizations approved to begin service on September 1st, 2012.

July 31, 2012

Contact: Patty Wentz, 503-932-6243

New Coordinated Care Organizations approved for Oregon Health Plan

Five new Coordinated Care Organizations will begin serving Oregon Health Plan members in September, the Oregon Health Authority announced today.

In total, there are 13 approved Coordinated Care Organizations serving 33 counties in the Oregon. By Sept. 1 more than 500,000 adults and children – the majority of Oregon Health Plan members – will have access to a CCO.

“In Oregon we are showing that it is possible to build a health care system around patients and their providers for better health and reduced costs,” said Governor John Kitzhaber. “These new Coordinated Care Organizations will be leading the way for everyone in our state.”

Oregon Coordinated Care Organizations to start September 1

Columbia Pacific Coordinated Care Organization, LLC – All of Clatsop, Columbia and Tillamook counties. Parts of Coos and Douglas counties.

Eastern Oregon Community Care Organization – Baker, Malheur, Sherman, Union, Wallowa Gilliam, Grant, Harney, Lake, Morrow, Umatilla and Wheeler counties.

Jackson County Coordinated Care Organization, LLC – Jackson County.

PrimaryHealth of Josephine County, LLC – Josephine County and parts of Douglas and Jackson counties.

Tri-County Medicaid Collaborative – Clackamas, Multnomah and Washington counties.

Under Coordinated Care Organizations, benefits for Oregon Health Plan clients will not change. The vision of CCOs is to allow providers better ways to address health care problems.

To see full list of Coordinated Care Organizations, go towww.health.oregon.gov.

OHP members will receive personal notification of their new Coordinated Care Organization, and they do not need to take any action. More information for members and providers can be found at health.oregon.gov.

Through a waiver from the federal government, Oregon has flexibility to provide more preventive care and disease management than has been possible under traditional Medicaid guidelines. Research shows that 80 percent of health care costs are driven by 20 percent of patients, many with chronic conditions such as heart disease, diabetes and serious mental illness. CCOs will have the ability to hire community-based health workers to help people manage their conditions, ensure they are taking appropriate medications, and avoid unnecessary acute or emergency care. By focusing on improved health, Oregon has agreed to reduce Medicaid inflation by 2 percentage points within two years by focusing on improving the health of clients to reduce waste, inefficiency, and unnecessary expenditures.

# # #

Senator Winters Sets Health Care Summit

State Senator Jackie Winters, Oregon Health Authority Director Bruce Goldberg, Oregon Health Insurance Exchange Directory Rocky King, and Health Reform Leaders in Marion and Polk Counties put together a health care Summit in August.


Read More From the Statesman Journal Here.

Eastern Oregon Coordinated Care Organization receives provisional certification to pursue formation for twelve rural counties

MEDIA RELEASE

Contact –

 Kevin Campbell, GOBHI CEO – 541-298-2101

Tammy Dennee, GOBHI Communications Director – 541-980-6887

Jonathan Nicholas, ODS Community Health, Inc. (ODS Health) Vice President – 503-219-3673

Eastern Oregon Coordinated Care Organization receives provisional certification to pursue formation for twelve rural counties

Pendleton, Oregon – The Oregon Health Authority has granted provisional certification to the Eastern Oregon Coordinated Care Organization (EOCCO) to form a Coordinated Care Organization encompassing twelve of Oregon’s rural counties including Wheeler, Gilliam, Sherman, Morrow, Umatilla, Lake, Harney, Grant, Union, Malheur, Wallowa and Baker. 

GOBHI and ODS Community Health, Inc. (ODS Health), the partners forming the EOCCO, are pleased to receive this provisional certification and now undergo preparations for the next phase of the process which involves a “Readiness Review.”  The Readiness Review will require the EOCCO demonstrate engagement with providers and hospitals in the twelve county service area’s healthcare communities and how that engagement has resulted in policies and procedures that will shape how care is provided to all Oregon Health Plan members in the service area.  The twelve county area spans more than 50,000 square miles and is home to approximately 36,000 Oregon Health Plan members. 

Upon final approval, the EOCCO will begin providing service on September 1, 2012. 

 “The EOCCO will provide a different way of providing care for members in the Oregon Health Plan,” said Sean Jessup, ODS Health Medicare and Medicaid Programs Manager. “By forming the EOCCO, both ODS Health and GOBHI will work within the service area to bring new models of care that are patient-centered and team-focused.” In addition, the EOCCO will be governed by a partnership among local healthcare providers and community members. “

Kevin Campbell, GOBHI CEO, stated the EOCCO is committed to delivering better care in Eastern Oregon. “Our commitment is providing better care, with better outcomes,” said Campbell. “When we achieve better care and outcomes, we also achieve savings for these Eastern Oregon communities.” Once savings are achieved, each Eastern Oregon community will be able to determine how to reinvest those savings back in their communities for continued enhancements.

GOBHI has a 15-year history as a mental health organization with a proven track record of serving the patient efficiently and effectively. Campbell stated, “Oregonians who choose to reside in rural communities deserve quality healthcare that addresses all needs of the patient starting with quality prenatal care.  Patients who receive regular care are ultimately in better health and require less healthcare in the emergency room setting. The bottom line is investing in the less expensive care results in savings for the long-term.”

ODS Health has been serving Oregonians for more than 55 years. ODS Health has been nationally recognized by the National Committee for Quality Assurance (NCQA) for the quality of their Oregon PPO plan, achieving an accreditation status of commendable.  ODS plans to bring that same focus on patient quality to the EOCCO partnership.

The EOCCO is in the process of securing members of the Community Advisory Committees.  If you are interested in participating in a Community Advisory Committee, please contact GOBHI at (541) 298-2101.  Additional information regarding the formation of Coordinated Care Organizations in Oregon is available on line at http://health.oregon.gov/oha. 

###

Provider Webinar: Coordinated Care Organizations

Provider Webinar: Coordinated Care Organizations Join us for a Webinar on July 17 Space is limited. Reserve your Webinar seat now at: https://www2.gotomeeting.com/register/302979666 Please join us for a presentation on the development and status of Coordinated Care Organizations (CCOs) and how Oregon's provider community can become involved. Oregon Health Authority (OHA) Director, Bruce Goldberg, M.D. will lead the discussion about CCOs and Oregon's direction to improve health care and how providers will play a key role in Oregon's health systems transformation efforts. Additionally, Cathy Kaufmann, Administrator for the Office of Client and Community Services/Healthy Kids, will be on hand to present information on the status of CCOs, OHA's plans for member transition and what resources are available. Ample time will be given for questions. Title: Provider Webinar: Coordinated Care Organizations Date: Tuesday, July 17, 2012 Time: 11:00 AM - 12:00 PM PDT After registering you will receive a confirmation email containing information about joining the Webinar. System Requirements PC-based attendees Required: Windows® 7, Vista, XP or 2003 Server Macintosh®-based attendees Required: Mac OS® X 10.5 or newer

NEWS RELEASE

JULY 9, 2012

Media Contact:
Tim Raphael, 503-689-6117
Amy Wojcicki, 503-689-5324

Oregon’s Federal Agreement on Health System Transformation Finalized   

Brings more flexibility for prevention services and investment in health care workforce

(Salem, OR) — The federal government has signed off on Oregon's health transformation initiative, approving a waiver that grants the state more flexibility to improve its Medicaid services program. Governor Kitzhaber announced the agreement with the Centers for Medicare & Medicaid Services as a key step forward in Oregon's goals to improve the quality of care for Oregon Health Plan members while reducing costs.

“I want to thank our federal partners for their responsiveness and strong partnership,” said Governor Kitzhaber. “This waiver is the final building block to creating a better model of care, and Oregon is ready to demonstrate how local communities can lead the nation in keeping people healthier over the long term in a more effective way.” 

Oregon's 1115 Medicaid demonstration affirms federal financial investments over the next five years, which will be used to increase access to better coordinated, more patient-centered care and support a more efficient delivery system. In return, Oregon has committed to reducing the state’s growth in Medicaid spending, resulting in significant savings to the federal government through improved health care, not through reductions in eligibility or benefits covered. 

Kathleen Sebelius, Secretary of the Department of Health & Human Services, said, "These efforts to coordinate care, which mirror our efforts at the national level thanks to the Affordable Care Act, will mean better care for those on Medicaid, better health outcomes, and lower costs. This is another example of how we are collaborating successfully with States in their efforts to find innovative healthcare solutions that work for their communities."

Under the agreement, Coordinated Care Organizations responsible for providing care to Oregon Health Plan members will have more flexibility to pay for services that improve health and lower costs, but that are not traditionally covered by Medicaid. Examples include preventive services to reduce unnecessary hospitalizations and acute care, more primary care, and greater emphasis on local community health workers who can help Oregon Health Plan members manage chronic illnesses. 

To support a larger workforce necessary for this model of care, the federal agreement includes funding for a loan repayment program for primary care physicians who commit to working in rural or underserved communities in Oregon and training for 300 community health workers by 2015. 

Agreement terms also call for Coordinated Care Organizations and the state to meet high standards for care and quality. Measures of success include patient experience of care, hospital readmission rates, care received after hospitalizations due to mental illness, health disparities among races and ethnicities, and rates of obesity and tobacco use. Eight Coordinated Care Organizations have been approved by the Oregon Health Authority to begin serving patients in August, with more scheduled to begin operations later this year. 

“The new model of care we are creating will bring a better quality of life to people on the Oregon Health Plan,” said Bruce Goldberg, M.D., director of the Oregon Health Authority. “With the federal support, we will be able to invest in local, patient-centered care that works to improve health and lowers costs.”

The 1115 waiver can be viewed in its entirety at health.oregon.gov. 

###

Columbia Pacific Coordinated Care Organization Approved by the State

FOR IMMEDIATE RELEASE 


Columbia Pacific Coordinated Care Organization Approved by State 

On June 28, 2012, the Oregon Health Authority has provisionally approved Columbia Pacific
Coordinated Care Organization’s application to serve as a Coordinated Care Organization
Columbia Pacific CCO will serve Medicaid/Oregon Health Plan (OHP) recipients in Clatsop,
Columbia, Tillamook counties and parts of Coos and Douglas counties.
CCOs are key to the state’s groundbreaking effort to reinvent health care in Oregon. The goal is
to bring all types of health care providers, including medical, behavioral health, addiction
treatment—and soon dental—under a single umbrella to better serve individual communities.
Then, to put patients at the center of the health team, to reinvent care in a way that meets the
individual’s needs.
CareOregon and Greater Oregon Better Health Initiative (GOBHI) are partnering with
communities, social service agencies, providers and OHP members to form the Columbia
Pacific CCO. Since 1994, CareOregon has served OHP recipients in rural as well as urban
communities, with a current membership of approximately 160,000. GOBHI has a long history of
serving behavioral health needs in rural Oregon and has approximately 70,000 members.
“You should be able to enter the health system at any point, and then receive the help you need
to navigate all your health needs,” says David E. Ford, CareOregon’s CEO.
Health navigators that help individuals with multiple health issues manage their care will be a
part of the new CCO. And patients who struggle with homelessness, hunger or behavioral
issues will have a support system that helps them overcome these barriers to health.
“Health care should be set up for the patient’s convenience, comfort and their individual needs,
not based on outdated payment methods,” says Ford.
For example, under the CCO umbrella, if it better fits the health issue, patients could request an
e-visit or phone call with their provider, rather than going into the office. In the past, statemandated payment structures required that a patient visit the clinic in order for the doctor to be
paid.
“The member, the family, the community will be central to Columbia Pacific CCO,” says GOHBI
CEO Kevin Campbell. “Our goal is to create a support system that meets the needs of the total person, rather than separating out the mind from the body, or primary health needs from
specialty care.
“The first thing we did was hold public meetings to garner ideas from the community. We’ll have
members represented on the governance board and very robust Community Advisory Councils
in each area. Together, we’ll create a member-centered plan that can improve patient
experiences, health outcomes, and use health funding wisely to ensure the right care at the right
time.”

For more information, contact Jeanie Lunsford.

CONTACT:  Jeanie Lunsford
503-416-3626
lunsfordj@careoregon.org



If you have questions, e-mail Columbia Pacific CCO at CCOinfo@careoregon.org
or read more at tinyURL.com/ColumbiaPacific.

Eight Coordinated Care Organizations are Certified

Oregon Health Authority News Release:

Eight new health care organizations are certified to begin serving local communities in Oregon on August 1, 2012, the Oregon Health Authority announced today.

The new entities, called Coordinated Care Organizations (CCOs), will provide care for Oregonians enrolled in the Oregon Health Plan/Medicaid. CCOs are the foundation of Oregon's vision to improve care, achieve better health and lower costs. Under bi-partisan state legislation passed earlier year, the new CCOs will be able to deliver care in new ways. Key to CCOs will be the ability to coordinate mental and physical health care and focus on prevention. CCOs will also provide effective support to patients with chronic conditions, ensuring that they are taking appropriate medications and managing their appointments.

"I am proud of the way the Oregon health care community has come together to create a more patient-centered and sustainable health care system," said Governor John Kitzhaber. "By eliminating the unnecessary and unhelpful elements of health care such as bureaucracy, duplicate testing, and preventable hospital visits, we can save billions of dollars and have a healthier population. We are on our way to fulfilling our vision for Oregon for a more effective, efficient health system."

Under the new model, Oregon has agreed to reduce Medicaid inflation by 2 percentage points within two years by focusing on improving the health of clients to reduce unnecessary expenditures. The agreement calls for saving $11 billion over the next decade. Coordinated Care Organizations are an Oregon-based reform and are not affected by the pending Supreme Court ruling about the federal Accountable Care Act.

The eight certified CCOs are contracted to begin enrolling people August 1. The communities they will serve are listed below. This is the first wave of certification. Additional CCOs are expected to be certified and begin providing services later in the year.

AllCare Health Plan - All of Curry, Josephine, Jackson and part of Douglas counties

FamilyCare, Inc. - Clackamas, Multnomah, Washington, and part of Marion County

Intercommunity Health Network Coordinated Care Organization - All of Benton, Lincoln and Linn counties

PacificSource Community Solutions, Inc. - All of Deschutes, Crook and Jefferson and part of Klamath counties

Trillium Community Health Plan - All of Lane County

Umpqua Health Alliance - Most of Douglas County

Western Oregon Advanced Health, LLC - All of Coos and Curry counties

Willamette Valley Community Health, LLC - All of Marion and most of Polk counties

Bruce Goldberg, M.D., director of the Oregon Health Authority, says that the creation of the new CCOs marks the beginning of historic changes to Oregon's health care system. At the same time, as the new Coordinated Care Organizations are forming, clients will not see much of a change, especially at first. Oregon Health Plan benefits are not changing and services that are covered today will continue to be covered under Coordinated Care Organizations.

"Clients do not have to take any actions," said Dr. Goldberg. "As CCOs get up and running there will be more opportunities for preventive care, education and other services that help keep people healthy."

Later this week OHP clients who are going to be enrolled in a new CCO in their community will receive personal notification with the name of the new Coordinated Care Organization. More information for clients can be found at health.oregon.gov.

Dr. Goldberg also points out that under the new state health care law, Coordinated Care Organizations will be required to implement health improvement strategies for the people they serve.

"These improvements are not only about lowering costs," said Dr. Goldberg. "We will be measuring the success of the new CCOs based on how well they do to improve the health of the people they are serving. And we will all be accountable for that."

GOBHI Plans Series of Local Meetings

COMMUNITY MEETINGS SCHEDULED FOR THE EASTERN OREGON COORDINATED CARE ORGANIZATION – Public Welcome and Encouraged to Attend

Greater Oregon Better Health Initiative (GOBHI) together with ODS Community Health Inc. have joined together to create a collaborative partnership to serve twelve of Oregon’s rural Eastern Oregon Counties (Wheeler, Gilliam, Sherman, Morrow, Umatilla, Lake, Harney, Grant, Union, Wallowa Baker, and Malheur).

Go to "Upcoming Meetings" link above to see the details.

Temporary Draft CCO Rules

The Legislature overwhelmingly approved SB1580, which implements the Oregon Health Policy Board recommendations, and finalizes action from last session's HB3650.

The full proposal and other materials from the OHPB meetings can be found at http://health.oregon.gov/OHA/OHPB/meetings/index.shtml. This includes the Medical Liability Report as well as the update on integration of Medicare and Medicaid services for individuals who are dually eligible, and Diane Lovell’s comments on PEBB/OEBB.

Initial CCOs Certified By State of Oregon

The following applicants have been provisionally certified for the service areas below
CCO Applicant Name	Proposed Service Area by County
AllCare Health Plan, Inc. – Mid Rogue Independent Physician Association, Inc.,	Curry, Josephine, Jackson, Douglas (partial)
Cascade Health Alliance, LLC	Klamath (partial)
Eastern Oregon Coordinated Care Organization	Baker, Malheur, Union, Wallowa
FamilyCare, Inc.	Clackamas, Marion (partial), Multnomah, Washington
Intercommunity Health Network Coordinated Care Organization	Benton, Lincoln, Linn
PacificSource Community Solutions, Inc.	Crook, Deschutes, Jefferson, Klamath (partial), Harney (pending), Grant (pending), Lake (pending, partial), Wheeler (pending)
Trillium Community Health Plan, Inc.	Lane
Tri-County Medicaid Collaborative	Clackamas, Multnomah, Washington
Umpqua Health Alliance – DCIPA, LLC	Douglas
Western Oregon Advanced Health, LLC	Curry, Coos, Douglas (partial)
Willamette Valley Community Health, LLC	Marion, Polk

The following applicants have been asked to resubmit their applications for a later date for the services areas below
CCO Applicant Name	Proposed Service Area by County
Columbia Pacific CCO, LLC	Clatsop, Columbia, Coos (partial), Douglas (partial), Hood River, Tillamook, Wasco
Eastern Oregon Coordinated Care Organization	Gilliam, Grant, Harney, Lake, Morrow, Sherman, Umatilla, Wheeler (partial)
Eastern Oregon Health Authority, Inc.	Umatilla, Morrow
Greater Oregon Behavioral Health, Inc., abn Greater Oregon Better Health Initiative	Klamath, Deschutes (partial)

https://cco.health.oregon.gov/Pages/CCO-Applicant-Names.aspx

CCO Timelines

https://cco.health.oregon.gov/RFA/Pages/Overview.aspx

New Coordinated Care Organizations certified (first wave) May 28, 2012
Medicaid Contract(s) signed by new CCOs by June 29, 2012
Medicaid Contract to CMS for approval by July 3, 2012
Medicaid Contract Effective for new CCOs Aug. 1, 2012

Regional CCO Lunch Forums A Success

With Special Guest: OHA Director Bruce Goldberg

Over 1,000 individuals participated in the events either live or on line.

CCOOregon will be working with the state and with emerging CCOs on a series of small video teleconferences between CCOs this summer, and will host a "CCO Overview" in early October. All certified CCOs are invited to present at this conference, which will bring state and federal officials to Oregon for a preview of plans for comprehensive health reform in our commmunities.

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EVENTS A HUGE SUCCESS

124 attended. Wednesday, April 11th / Hood River / Hood River Inn

76 attended. Friday, April 13th / La Grande / Blue Mountain Convention Center

397 attended and/or listened in via live streamingTuesday, April 17th / Portland / Doubletree Lloyd Center

131 attended. Thursday, April 19th / Eugene / Lane Community College

87 attended. Tuesday, April 24th / Medford / The Red Lion

157 attended May 15 / Bend / The Riverhouse

87 attended the "live feeds" from the events!

Oregon Governor John Kitzhaber and Obama Administration announce agreement to improve care for Oregonians on Medicaid

Care coordination will improve health, achieve $11 billion in savings.
Innovations mirror national reforms made possible by Affordable Care Act

(Washington, D.C.) — The U.S. Department of Health and Human Services (HHS) has given preliminary approval of a five-year, $1.9 billion demonstration of a Federal-State partnership to transform the way that care is delivered in Oregon's Medicaid program. The initial investment of $620 million in the second year of the State’s current biennium will allow Oregon’s new care organizations to better deliver higher-quality, coordinated care for Medicaid patients while reducing preventable errors. Oregon estimates that this will achieve $11 billion in savings over the next decade.

OHA Webinar Q&A

Our notes from the Q & A Session with the OHA:

A list of questions and Answers:
-Will there be a template posted for letters of support and are there minimum requirements for these letters:
A. There are no minimum requirements or template, OHA is asking for community support.
- There was a question regarding a specific section around anti-trust, and OHA will be writing a response and posting it.
- Can or should an applicant add details to letters?
A. Any information you can add will be welcome
- What are the minimum requirements to become a CCO?
A. Refer to the RFA itself that is posted on the website.
- Will forming a CCO take place of current IPA's in this area?
A. CCOs will not replace IPAs, the expectation is that IPAs most likely will be part of the organizations that come together to form CCOs but each region is going to be different.
- CCOs will result in fewer third party payors, how are you addressing this and have you given thought on giving organizations thoughts on how to consolidate?
A. Interesting question that will take thought and be different in each area. OHA will respond to this in writing, but recommends referring to the RFA.
- Do you consider letters of intent the same as memorandums of understanding?
A. They were unclear of the legal meaning on memorandums of understanding.
- Can you speak to requested waivers for Indian Health Organizations?
A. There are a lot of considerations for tribes in federal and state law as well as the bills that went through the legislature. Those are built into the RFA, and OHA suggests reading of the RFA for further understanding, and will address more in a written response.
- Is there a prescribed amount of process transparency required on behalf of applicants?
A. OHA is not completely clear on the question and would ask for a clarifying question. There is not currently a prescribed level of transparency. The applications will be part of the Oregon Public Records law which allows some proprietary information to be protected. OHA will make everything public that they possibly can. Where OHA leaves off and CCOs begin, there may be some differences in what they are able to make transparent.
- Where and when will letters of intent be posted?
A. Letters of Intent will be posted April 2nd or 3rd on the health.oregon.gov website.
- If administrative functions are handled outside of an organization will you accept a tmtm budget, or will you require a line by line budgetA. No one from actuarial services is in the room, so they will respond in writing.
- Will comments on the core contract be considered?
A.Comments will be considered. It is very close to the final document but can be changed, and likely will be as the rules are developed.
- Will more than one CCO be accepted per area?
A. Yes, there is not intent to limit the number of CCOs
- Does the change with respect to medicare alignment mean that a CCO does not have to file a letter of intent to participate with CMS?
A. OHA is encouraging all CCOs to submit a letter of intent as those are non-binding, but it is not required.
- Will there be any opportunity to better understand services such as non-emergent transportation?
A. That will be responded to in writing, and is part of global buget work that is on going.
- Are you seeking innovations in care and where are these considered if so?
A. Go to the website, there is an entire section that outlines innovations in care and asks applicants to put forward innovations as part of the process.
- When will written responses to questions be posted?
A. Time permitting, some will be posted Monday. As many as possible will be posted today.
- There is not a table defining all medicaid funded programs, where can this be found.
A. This will be responded to in writing as well.
- Do CCOs have to identify names of board members or just areas they represent?
A. They have to be named
- How will patients be assigned to CCOs in the event there are multiple CCOs.
A. In general, there is hope that people will choose their CCO.
- Will there need to be a minimum number of people served?
A. There needs to be a minimum number, although it won't be prescribed. It will be part of the review process to evaluate the capability of the CCO to manage the risk. There will be a number of factors.
- Any reccomendations for gaining support in connecting with local governments?
A. The Governor's office has some support systems, they will respond further in writing.
- Since many CCOs have no experience in managing mental health services, who will CCOs approach for managing and funding of these services?
A. A piece of this will come with connectivity with local county government as well as community organizations.
- Do you expect CCO applicants to have executed provider contracts by April 30th?
A. OHA expect provider contracts be executed by the start date in August, understanding that part of the application process is an adequate provider network.
- What are the expectations as part of the initial RFA submission?
A. Complete response to all of the questions within the RFA within the page limits.
- Will there be financial incentives for applicants in the first wave compared to later applicants?
A. At this time there are no plans for this.
- Many CCOs will probably contract with affiliates for other administrative services and other things, are there any services a CCO cannot contract for?
A. There are none that they can think of, they will give a more detailed written response.
- Are you expecting one letter of intent per CCO contract?
A. Yes.
- Does the letter of the intent need to be in the exact format of that in the RFA?
A. Yes, we want to get the information in that format consistently from all the CCOs.
- A. The existing MCO can continue in Business through the end of June 2014. If necessary, OHA can review and renew contracts through 2017. It would be up to the governance of an MCO to determine if they want to continue. If so they would have to meet all the requirements of being a CCO and they would be allowed to continue.
- What is the status of the state's waiver request to not have to use actuarial soundness around payments to CCOs.
A. That is not actually a waiver that was requested. The flexibility OHA asked for was for Actuarial sound rates with fixed budgets.
- We have been getting mixed messaged about MCO contracts. We have been hearing MCOs will be required to meet CCOs requirements even if not ready to become CCOs.
A. There are some requirements in HB3650 in order to advance transformation. OHA is currently working on how to implement these requirements realistically.