Coordinated care health program readies for summer launch

A change in health care delivery for those covered under the Oregon Health Plan (OHP), the state’s version of the Medicaid program, is moving rapidly toward implementation. Recently the Oregon Health Authority awarded provisional certification to 11 groups to operate as coordinated care organizations.

One of the 11 is Trillium Community Health Plan, which will coordinate care for Lane County residents.

“We plan to launch our plan on Aug. 1 of this year,” said Trillium CEO Terry Coplin. “Everything goes back to the ‘triple aim’ (coined by the Institute for Health Care Improvement): better health, better care and lower cost.”

CCOs are basically networks of providers that agree to work together to provide care for OHP clients. Services that are currently fragmented between different agencies will be managed under one entity.

Trillium’s network includes Lane County; Lane Care, which manages the OHP mental health benefit; Senior and Disabled Services; PacificSource; PeaceHealth; McKenzie-Willamette Medical Center; Lane County Community Behavioral Health Consortium and Lane Individual Practice Associ-ation (Lipa), a managed care organization that currently contracts with the state to provide coverage to OHP clients. Trillium is a subsidiary of Lipa, however, the CCO is a new entity.

Coplin said some patients may experience a profound change; others may not notice the switch to coordinated care.

“If a patient is young and healthy, they may not see any difference. If a patient has a chronic disease (such as diabetes) they will see a lot more hands-on management of care. I hope to see much more preventative work and more public health engagement,” he said.

There will be no co-pay or premium changes for patients. By July 2014, CCOs must also have contractual relationships with dental organizations.

In early May, Gov. John Kitzhaber announced an agreement with the Obama Administration for the state to receive an initial $620 million in federal funds in 2013 to help with the health care transition. Overall, the funds will tentatively amount to $1.9 billion over five years. In return, Oregon’s Medicaid program must show it has reduced costs by 2 percentage points in the next two years.

“That money actually saved the Medicaid plan in the state,” said Coplin. “We had received a 10 percent reduction the previous year and were anticipating another 20 percent reduction.”

Over the next decade, $11 billion is projected in state and federal savings to Medicaid by better management of chronic physical conditions and behavioral health issues. Providers across disciplines will coordinate services to improve patient health, which should result in fewer expensive emergency room visits and hospital stays.

For the complete article see the 06-13-2012 issue.

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