Rep. Mitch Greenlick’s desire to reform the coordinated care organizations has new momentum, as the Oregon Health Policy Board plans to scrutinize the structure of the Medicaid programs, with improvements recommended for the 2017 legislative session that gets underway in February.
The Portland Democrat wants the CCOs to hew more closely to a social insurance model with greater public accountability and to that end, the chair of the Oregon House Health Committee met earlier this month with the governor’s office, Oregon Health Authority Director Lynne Saxton, policy board Chairman Zeke Smith and other top healthcare legislators to move the ball toward legislation.
The meeting comes in the wake of new public disclosures that the physician investors of Trillium Community Health Plan made off with $34 million in the sale of the CCO’s parent company to Centene Corporation, the bulk of the wealth generated from the profit potential of a government health plan designed for poor people.
Greenlick’s vision is unchanged from the failed House Bill 4100 that he introduced this winter, which calls for the removal of the CCOs’ massive reserves into a designated community trust and calls for the organizations to take steps toward a non-profit, community driven board subject to public records and meetings laws.
“I want to get the reserves out of the hands of the CCOs. I believe the reserves should be in escrow,” Greenlick told The Lund Report. “I don’t think Centene should own the reserves for the Lane County CCO. I think Lane County should own that.”
Managed care contracts could still be delegated to either non-profit or for-profit entities -- as they are now -- but the CCOs’ governing board of directors should have up to 50 percent impartial community membership and the overarching company should have a non-profit, social insurance model, according to Greenlick.
The call for Smith and the Oregon Health Policy Board to take on the challenge would be a significant investment in the lethargic board, which is generally seen as rubber-stamping what the Oregon Health Authority staff would do anyway. Greenlick saw the task as a fulfillment of the board’s promise when it was created. “They’re the ones who are appointed to set health policy,” he said. Smith could not be reached by press time.
The new CCO contracts begin in 2019, and mark a reassessment of the direction of CCOs, said Martin Taylor, the policy director for CareOregon, which manages care for a handful of CCOs, including Health Share of Oregon. “I’m very supportive of the idea of looking every five years at what CCOs should be. Five years from now, CCO 3.0 should be different than CCO 2.0.”
John Kitzhaber’s vision of the CCOs overhauling all of Oregon’s healthcare, starting with Medicaid and public employees and moving into the private sector -- probably died when he was pushed out of office. Additionally, the severe housing crisis that has moved from California up the West Coast has the CCO vision focusing more seriously on fixing the social determinants of health just to adequately serve the Medicaid population.
The Affordable Care Act has also expanded the Oregon Health Plan’s membership to more than anyone expected, to roughly 1.1 million of Oregon’s 4 million people. The program serves poor adults and people with disabilities as well as the children of many working-class and middle-class families, since it combines traditional Medicaid, the expansion Medicaid and the Children’s Health Insurance Program under one roof.
The handling of those new contracts have generally fallen in two camps -- one led by Greenlick and CareOregon, which both want some significant changes before new contracts are approved -- and a second led by Sen. Alan Bates, D-Medford, and the CCOs affiliated with the Coalition for a Healthy Oregon, which want the guarantee of a new contract as long as they are providing effective services.
Bates and COHO have argued that the CCOs need the certainty that upstream investments into improving the social determinants of health -- such as housing assistance, early learning hubs and public health initiatives -- will pay off without having their contracts cut from under them.
It’s unclear which side will win out on this delicate issue or how the two parties can reach a workable compromise. Both sides kiboshed each other’s bills in 2016, setting up the debate over the future of CCOs for the 2017 session.
Greenlick believes that as providers of Medicaid, the CCOs should and must make those improvements regardless if the CCOs investing in these projects receive a dividend. “[The for-profit perspective] is not the solution, it’s the problem,” he said. To Greenlick, the CCOs are but stewards of public money, and any upstream investments are government investments into the health of low-income and vulnerable people, not a speculative venture borne by the CCO.
“The more that Medicaid is connected to helping poor people get out of poverty, the harder it is that medical care should be a source of personal wealth,” Taylor concurred. “Most people who pay tax dollars will want low-income people to receive healthcare and get help getting out of poverty. No one out there has the hope that it will help providers get rich.”
Chris can be reached at [email protected].
