Legislators Ponder the Rural-Urban Divide Facing Coordinated Care Organizations

September 26, 2011--At the State Capitol in front of a packed house last Thursday, legislators got their first progress report on the formation of Coordinated Care Organizations (CCOs), which are expected to provide healthcare to more than 600,000 Oregonians starting next July.   

“We don’t know what these CCOs are going to look like,” acknowledged Dr. Chuck Hofmann, of Baker City, a member of the Health Policy Board. “They’re going to have the structure to integrate physical and mental health, but those organizations don't exist everywhere.”  

To reach consensus on the criteria for these new CCOs and iron out details about global budgets, outcome measurements and services for the dual eligibles (people who receive both Medicare and Medicaid), Governor Kitzhaber has tapped 133 people to serve on work groups which are holding monthly meetings.  

Nevertheless, Rep. Jim Thompson (R-Dallas), who co-chairs the House Healthcare Committee, relayed fears from his constituents that not all Oregonians are being adequately represented.

“I’m hearing from rural groups around the state that their community interests will be left out in favor of a state interest or a bureaucratic interest,” he said.

Hofmann, who seemed confident everyone’s voice would be heard, also said it was vitally important that local leaders keep their constituents informed, in particular the Association of Oregon Counties (AOC).

“The AOC needs to be having regular updates from people serving on those workgroups and stay actively involved in those processes,” he pointed out. “We’re supposed to make this an open, public process. We’re doing that and are continuing to do it.”

Overall, there’s a feeling of optimism about the policy recommendations being developed, said Lillian Shirley, who runs the Multnomah County Health Department and is vice-chair of the Health Policy Board.

Conversations at these work group meetings have been more dialogue-driven, she said, and aren’t just policy orientations.

“The real positive thing that's happened is that people are really talking to each other in a much more robust way than even when we were all involved in committees of the [Oregon] Health Fund Board [established in June 2007],” she told legislators.

Rep. Jim Weidner (R-Yamhill) asked which mechanisms are going to be in place to make certain people are receiving appropriate medical care. 

“How many people are being seen for influenza, diabetes, etc?” he asked.  “Would we be able to track that [information]?”

It’s too early to know those answers because the work groups are still engaged in coming up with the best mechanisms to measure patient outcomes, said Eric Parsons, who chairs the Health Policy Board. But he reassured Weidner that agreement would be reached on those measurement tools by December, when the work groups complete their recommendations.

There’s also a geographical divide exists within the medical profession about the type of care a person receives, said Hofmann, which could impact health outcomes.

 “We realize the type of care is a lot different,” he said. “In Baker, I am the diabetes specialist. In the [urban] area, I would not be. If you develop the right criteria, you could compare my results with a patient and in an [urban] area.”

“[Stakeholders] agree that the issues in the urban area are very different, and very complex,” Parson said. “There’s some progress being made, but we have yet to conclude them.”

On November 17, the Senate and House committees on healthcare will reconvene and hear an updated report on health system transformation.

For more information on work groups visit the Oregon Health Policy Board Health System Transformation page.

To read The Lund Report’s previous stories on this topic, go here and here.