OMA's CCO Toolkit is Now Available - Click here!
Governor Releases Medical Liability Reform Proposal
Defensive Medicine and Patient Safety Workgroup starts work Aug. 2
During the February 2012 legislative session, the Governor committed to convening a group to work on consensus legislation to achieve meaningful medical liability reform. To that end, the Defensive Medicine and Patient Safety Workgroup will begin its work on Aug. 2. We are pleased to announce that OMA President William “Bud” Pierce, MD, was chosen to co-chair the workgroup.
The Governor has developed a proposal to be considered by the workgroup, which includes OMA input, and we will continue to monitor the process and provide further input as the workgroup evaluates the proposal going forward.
Visit http://cms.oregon.egov.com/oha/OHPR/Pages/PSDM/index.aspx for more information on the workgroup and the Governor’s proposal. If you have questions regarding the process and/or the proposal, feel free to contact Gwen Dayton, the OMA's General Counsel and Vice President of Health Policy, at gwen@theOMA.org.
First CCOs Go Live Aug. 1
Eight new state-certified Coordinated Care Organizations are contracted to start enrolling Oregon Health Plan members in communities around the state on Aug. 1. The initial eight organizations are:
- AllCare Health Plan: Curry, Josephine and Jackson Counties and part of Douglas County
- FamilyCare, Inc.: Clackamas, Multnomah and Washington Counties and part of Marion County
- Intercommunity Health Network: Benton, Lincoln and Linn Counties
- PacificSource Community Solutions, Inc.: Deschutes, Crook and Jefferson Counties and part of Klamath County
- Trillium Community Health Plan: Lane County
- Umpqua Health Alliance: Most of Douglas County
- Western Oregon Advanced Health, LLC: Coos and Curry Counties
- Willamette Valley Community Health, LLC: Marion County and most of Polk County
Five more CCOs will start serving Oregon Health Plan members in on Sept. 1:
- Columbia Pacific Coordinated Care Organization, LLC: Clatsop, Columbia and Tillamook Counties and 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
All together, the 13 CCOs going online between now and September will serve nearly 500,000 adults and children in 33 Oregon counties. The Oregon Health Authority is expected to certify additional CCOs on Oct. 1 and Nov. 1, 2012. More information from the OHA is available at www.health.oregon.gov.
Considering joining a CCO? The OMA’s CCO Toolkit can help
The OMA’s CCO Toolkit has everything you need to stay up-to-date on CCO activities and developments in your area and health system transformation throughout the state. Visit www.theOMA.org/CCOtoolkit for the latest news, resources and links and an interactive map that helps you find local sources of CCO information in your region.
Your vehicle for participation in a Coordinated Care Organization will be a contract with the CCO (or in some cases an MCO that is participating in the CCO). A recent addition to the Toolkit is a list of important issues to consider when reviewing a CCO contract. If you’re considering joining a CCO in your community, be sure to review this valuable resource.
OHA Certifies FamilyCare, Inc. as the First CCO in the Tri-County Area
The Oregon Health Authority has awarded FamilyCare, Inc. full certification to contract with the state as a Coordinated Care Organization. The certification is effective Aug. 1, 2012, making FamilyCare, Inc., the first CCO to operate in the tri-county area (Multnomah, Washington, and Clackamas). The term of the certification is for five years, through Dec. 31, 2017.
FamilyCare, Inc. was founded more than 25 years ago as a managed care organization with a comprehensive approach of integrating physical and mental health to care for underserved Oregonians on Medicaid. President Jeff Heatherington says FamilyCare is pleased to be a leader in health care transformation in the state. “I am very pleased that the state has given us the green light to move forward with our innovative approach to care,” says Heatherington. “And I want to acknowledge the Legislature, Governor Kitzhaber and his staff for their leadership.”
“We are pleased that FamilyCare has become the first CCO in Portland,” says Dr. Christina Grucella, president of the Children’s Health Alliance and pediatrician at Willamette Falls Pediatric Group. “We have been working collaboratively with them for the past two years to improve access, quality and manage health care costs for the children in our community. They have a great new team that works closely with community providers to improve care for patients in our community.”
Heatherington added, “Our responsibility in this transformation is to support our providers so that they can deliver the highest quality care for our members, with the least amount of disruption.
FamilyCare will begin receiving new members as a CCO Aug. 1, 2012. The current members will not see much of a change at this time; covered benefits and services will remain the same under the CCO. FamilyCare’s certification means the organization will be part of the State’s effort to create a more sustainable health care system.
OHA Approves Eight New Coordinated Care Organizations
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. (read more)
OHA Provisionally Certifies 11 Proposed CCOs
The Oregon Health Authority has announced that the CCO Certification Team has completed its review of Coordinated Care Organization applications. Of the 14 applications submitted in April, 11 were found to be on the path toward meeting the requirements of SB 1580 related to governance, community engagement, access and integration. A list of the provisionally certified applicants and the counties they propose to serve is available at https://cco.health.oregon.gov/Pages/CCO-Applicant-Names.aspx.
Those 11 applicants will be provisionally certified and will move forward to contract negotiations, review of additional required information and final CMS approval. It will be up to each applicant to determine its ability and timelines to meet the remaining necessary requirements and notify OHA by June 4.
By the end of June, OHA will have completed the contract negotiations and readiness review and will know the effective dates for the approved CCOs.
Governor Kitzhaber and Obama Administration Announce Agreement to Improve Care for Oregonians on Medicaid
On May 3, Governor John Kitzhaber and the Obama Administration announced an agreement in principle to coordinate care for Medicaid beneficiaries in Oregon, through a new model of care that is expected to reduce the cost trend in Oregon’s Medicaid program by at least two percentage points within two years while improving health outcomes.
The U.S. Department of Health and Human Services 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 coordinated care organizations to better deliver higher-quality care for Medicaid patients while reducing preventable errors. The state estimates that this will achieve $11 billion in savings over the next decade.
Read more in the full News Release from the Governor’s Office.
State Accepting Applications for Coordinated Care Organizations
File a non-binding Letter of Intent by April 2
The Oregon Health Authority has opened the application process for Coordinated Care Organizations for the Oregon Health Plan. These newly-created local health entities will form the basis of the health system transformation proposed by Governor Kitzhaber and passed with bi-partisan support by the Oregon Legislature. CCOs will coordinate physical, behavioral and eventually oral health care for Oregon Health Plan patients and will focus on prevention, chronic illness management and patient-centered care. A third-party analysis found that by implementing CCOs, Oregon could save more than $1 billion within three years and more than $3.1 billion over the next five years. The first Coordinated Care Organizations are expected to launch by August 2012.
Interested potential CCOs can visit https://cco.health.oregon.gov/RFA/Pages/Overview.aspx for the Request for Applications and instructions for applying for certification through the Oregon Health Authority. All applications will be accepted electronically. Technical applications are due to the OHA by April 30, and financial applications are due by May 14. This is the first of four application periods in 2012. Any entity interested in applying to become a CCO during this or subsequent periods should file a non-binding Letter of Intent by April 2, 2012.
More information is available at https://cco.health.oregon.gov/Pages/Home.aspx. If you have questions about the application process, contact the OHA Office of Contracts and Procurement at RFA.FormalQuestions@state.or.us.
Regional Forums around the State to Discuss What CCO Rules Will Mean for You - Register Today!
Coordinated Care Organization draft rules have been released, and the implementation timeline is extremely aggressive. The state is expected to certify initial CCOs by the end of June, with an expected "start date" of early August. Nearly $500 million in federal funding may be provided to help ensure that providers and populations operating within new CCO structures do not see the 25 percent or higher rate cuts that would be imposed if federal funding were not available.
CCO Oregon will host five regional forums to let you hear first-hand from Oregon Health Authority leaders, including OHA Director Bruce Goldberg, MD, what you must do to form, apply for and become a CCO, and thus become eligible for state and federal funding through this new, reorganized system that will deliver care to Oregon's Medicaid population.
These forums will outline the criteria, timelines and expectations for CCOs, providers and organizations who want to contract with a CCO, and other community members, patients and organizations interested in participating in this transformed delivery system. Register to attend a forum in the following locations:
- Hood River: April 11, 11:30 am - 2:00 pm
Hood River Inn - 1108 East Marina Way, Hood River, OR 97031
Register for Hood River
- La Grande: April 13, 11:30 am – 2:00 pm
Blue Mountain Conference Center - 404 Twelfth Street , La Grande, OR 97850
Register for La Grande
- Portland: April 17, 11:30 am - 2:00 pm
Double Tree Lloyd Center - 1000 NE Multnomah Street, Portland, OR 97232
Register for Portland
- Eugene: April 19, 11:30 am - 2:00 pm
Lane Community College - 4000 E 30th Avenue, Eugene, OR 97405
Register for Eugene
- Medford: April 24, 11:30 am - 2:00 pm
Red Lion - 200 N Riverside Avenue, Medford, OR 97501
Register for Medford
- Bend: May 15, 11:30 am - 2:00 pm
The Riverhouse - 3075 N Business 97, Suite 200, Bend, OR 97701
Register for Bend
Draft CCO Documents Now Available
On March 2, Governor Kitzhaber signed SB 1580, which will implement Coordinated Care Organizations to better serve Oregon Health Plan members. CCOs will integrate behavioral, physical and ultimately oral health care with a focus on improved wellness and prevention. The aim is to bring better health, better care and lower costs to the more than 600,000 Oregonians served by the Oregon Health Plan.
New information is now available from the OHA at www.health.oregon.gov. Interested stakeholders can review draft documents explaining each step of the CCO application and implementation process. These documents include the draft Request for Applications, a draft CCO sample contract, draft temporary administrative rules and the draft proposal for Oregon's Medicare-Medicaid Alignment Demonstration that will be submitted to CMS. The site also contains Oregon's request to the federal government for additional federal flexibilities. This Request for Amended Waiver was submitted to CMS on March 1.
The OHA accepted public comments on the RFA, draft CCO sample contract, temporary administrative rules and draft proposal for Oregon's Medicare-Medicaid Alignment Demonstration through March 13. The OMA submitted comments on these documents on behalf of physicians and stakeholders around the state, and we appreciate those OMA members who sent us their comments and concerns and who contacted the OHA directly. It is important that physicians and PAs provide their input on the documents and processes that will shape the way the new delivery model is implemented in communities around the state.
Oregon Legislature Passes Health System Transformation Bill
The Oregon House of Representatives passed SB 1580, the bill that implements Coordinated Care Organizations for the Oregon Health Plan, with a bipartisan vote of 53-7 on Feb. 23. The Senate has already approved the bill, and the Governor is expected to sign it into law soon.
Under the legislation, CCOs will be local entities that coordinate and deliver physical, mental and dental health care to OHP patients. They will be expected to meet criteria that call for a high standard of health outcomes and support prevention, early intervention, and patient-centered care.
The new coordinated delivery model is expected to improve health outcomes and reduce costs. An analysis by Health Management Associates projects that CCOs could save the state $3.2 billion over five years by reducing waste and inefficiency and improving prevention.
Passage of the bill allows the state to submit a state plan waiver to the federal government to allow greater flexibility on how Oregon Health Plan dollars are used for care in CCOs. The state will also apply for additional federal investments of up to $2.5 billion over the next five years to fund innovation in health care delivery.
In the coming months, OHA will write the administrative rules and regulations that set the criteria and expectations for CCOs, establish an arbitration process for when a dispute arises regarding participation in a CCO, and detail how the Authority and the Department of Consumer and Business Services will share financial information about CCOs.
Simultaneous to the rule writing process, the Oregon Health Authority will review and approve the first CCO applications. The OHA will begin accepting proposals from prospective CCOs in April.
While the final CCO legislation does not include medical liability reform language, it does call for the creation of a Governor-appointed Patient Safety and Defensive Medicine Work Group, which will craft and propose liability reform legislation for the 2013 Legislative Session.
More information about CCOs and the Health System Transformation from the Oregon Health Authority is available at www.health.oregon.gov.
Oregon Senate Passes CCO Bill
The Oregon Senate passed SB 1580, the state’s ‘Health System Transformation’ legislation and the implementation vehicle for Coordinated Care Organizations, in a vote of 18-12 on Feb. 14.
The bill moved quickly last week from the Policy committee to the Ways and Means Human Services Subcommittee. Legislators cited a need to pass the bill quickly in order to qualify for Federal grant dollars that will help pay for CCO implementation and to achieve savings in the delivery system that will help mitigate deeper cuts to the Oregon Health Plan. The Subcommittee held two evening public hearings and adopted a set of amendments that include the creation of a Patient Safety and Defensive Medicine Workgroup among other clarifications. The Workgroup is directed to craft and propose liability reform legislation for the 2013 Legislative Session.
On Feb. 10, the Full Ways and Means committee attempted to adopt an amendment to the bill, inserting a delayed version of the Oregon Tort Claims Act (OTCA) that would have covered CCOs. The amendment was intended to act as a “backstop” to force action from the Patient Safety and Defensive Medicine Workgroup. The amendment failed and the bill was sent to the Senate floor.
During the debate on the bill, Sen. Ted Ferrioli (R-John Day) moved to amend the bill on the floor to include the OTCA amendment that had earlier failed in Ways and Means. The amendment failed on a party line vote. Following that motion, Sen. Dave Nelson (R-Pendleton) made a motion to send the bill back to Ways and Means Committee to attempt to add liability reform language. The motion failed, again on a party line vote. After the bill passed the chamber, Sen. Jeff Kruse (R-Roseburg) made an attempt to bring another liability reform bill directly to the floor for a vote. This motion also failed on a party line vote.
During the debate, members discussed a set of memos that had been authored by the Department of Justice and OHSU citing legal concerns with the planned extension of the OTCA over CCOs.
While medical liability reform language was not in the final bill passed in the Senate, the bill does call for the creation of a Governor-appointed Patient Safety and Defensive Medicine Work Group, which would develop liability reform legislation for the 2013 session.
OMA Urges Lawmakers to Include Liability Reform in CCO Legislation
As Oregon moves toward a transformed health care system, we have a unique and urgent opportunity to improve all aspects of the system, including the medical malpractice environment. The OMA has long held that Oregon's current medical malpractice litigation system does not serve patients, physicians, or society as a whole.
During the next few weeks, some legislators intend to address liability reform in tandem with the implementation of Coordinated Care Organizations (CCOs). This is a great opportunity to fix the broken medical liability system.
At this moment, the leading liability reform proposal calls for Coordinated Care Organizations (CCOs), the central structure of the reformed delivery system, to be classified as local public bodies under the Oregon Tort Claims Act. Qualifying as a “local public body” would mean that CCOs would be subject to the cap on damages that applies to such bodies, and a CCO would bear the liability on behalf of its individual providers.
Including CCOs as a local public body under the Oregon Tort Claims Act is an essential step in reaching Oregon’s broader health reform goals of improving access to care, reducing costs and improving health.
The state’s current system does nothing to improve patient care and drives up the overall cost of health care. Inclusion in the local public body will remove the incentive to practice defensive medicine, and more transparent relationships with patients will help improve care and health outcomes.
Our broken, inefficient medical liability system also threatens access to high quality medical care. Physicians have been forced to change how they practice medicine, and Oregon faces a provider shortage, particularly in rural areas. Meaningful reform will further incentivize physicians to care for Medicaid patients and participate in CCOs, and it will lessen the barriers to recruiting a more robust physician workforce throughout the state.
Lawmakers to Consider Oregon Health Policy Board CCO Proposal during February Session
On Jan. 24, the Oregon Health Policy Board voted to send their Coordinated Care Organization implementation proposal to state lawmakers for approval. This action is the latest step in Oregon’s health system transformation laid out in HB 3650, which the legislature passed in 2011. Under the legislation, CCOs will be local entities that deliver physical, mental and dental health care to Oregon Health Plan patients. The OHPB proposal lays out the governance, global budget and criteria for coordinated care organizations.
According to third-party analysis, the state could realize substantial cost savings through CCOs, with an estimated $3 billion in savings over five years.
The Oregon legislature must now consider the Board’s proposal for approval in the February session. If approved, CMS will review the CCO plan, and the first CCOs could begin operations by July 2012.
The OMA submitted comments on two rounds of draft CCO proposals, and we appreciate our members taking the time to do the same. Links to the OHPB proposal, OMA analysis and more are available below.
Links to the OHPB's draft proposals, an OMA summary and more are available below. For more information from the Oregon Health Policy Board, visit www.oregon.gov/OHA/OHPB.
- Oregon Health Policy Board First Draft CCO Proposal (December 15, 2011)
- Oregon Health Policy Board Revised Draft CCO Proposal (January 10, 2012)
- OMA Summary and Analysis of First Draft CCO Proposal (OMA Members only)
- OMA Comments to Legislators on CCO Implementation Plan (OMA Members only)
- CCO Implementation Timeline
CCOs Are Coming - Stay informed and get involved in your community
HB 3650, the Health System Transformation legislation passed by the Oregon Legislature in 2011, began the process of planning for and implementing Coordinated Care Organizations, a new delivery model that will initially serve Oregon Health Plan patients and may be expanded to other populations. The legislation created four work groups to plan different aspects of CCO creation: CCO Criteria; Global Budget Methodology; Outcomes, Quality and Efficiency Metrics; and Medicare-Medicaid Integration of Care and Services. The 133 governor-appointed members of these work groups, including several OMA members, represent government, the public, insurers, hospitals and physicians from health care sectors and communities across the state. The groups met several times between August and November to develop recommendations for the Oregon Health Policy Board, which will submit a legislative concept to the Legislature in February. With legislative approval the first CCOs could be up and running in July.
“In this world of stagnant budgets, this in an opportunity to change things and do them better,” says Bob Dannenhoffer, MD, a Roseburg pediatrician who served on the CCO Criteria work group and on the Governor’s Health System Transformation Team before that. Legislation calls for these community-based entities to integrate physical, dental, mental and behavioral health with the goal of improving the health of individuals and communities. In the current system, Dr. Dannenhoffer explains, “you care about your patients but have little sense of the population. The new system will have more focus on population health.”
William “Bud” Pierce, MD, an internist and oncologist in Salem, OMA President-Elect and a member of the CCO Criteria work group, also sees opportunity in this transformation. “CCOs have the potential to improve the structure of the health care delivery system and to better direct resources to areas of health care need,” Dr. Pierce says. He sees potential benefits in integrating care and technology among providers in a CCO as long as it helps and does not hinder the care of patients.
However, Dr. Pierce adds that “as physicians and PAs, we are aware of the promise of CCOs, but we are also aware of the dangers… In a time of constrained resources, we run the risk of having non-physicians/PAs dictate the care of our patients, not based upon the goal of healing and relief of pain and suffering, but rather based upon limiting the cost of medical services and ensuring the economic success of the delivery system.”
Dr. Dannenhoffer echoes this concern. There are “thousands of details to get straight” before CCOs swing into action, and it is unclear who will be “driving the bus.” He remains optimistic, however, due to the strong sense in the Criteria work group that CCO governing boards need to represent all sectors of the provider community with local community control, something he says you wouldn’t get with a big insurer. “Basically,” he explains, “they want local providers working together instead of a top-down approach.”
Among the other details that have yet to be addressed are the issues of cost and payment reform. The current CCO model does not include anything that will directly affect cost. Coordination of care will do more to improve care than to save money. Dr. Dannenhoffer explains that addressing payment issues and reducing cost will be the next step in the transformation process, and “the hope is that CCOs will come up with payment reform once they exist.”
To make sure CCO implementation improves the health care system, Drs. Dannenhoffer and Pierce recommend that physicians and PAs get involved in the transformation process in their local communities. Dr. Dannenhoffer reiterates that “not many physicians are happy with the current system, and this is our chance to make things better.” He recommends that OMA members pay attention to what is happening in their communities. “The system developed in Roseburg or Medford is going to look different than the one in Portland. This will be a community-driven event, and it would behoove physicians and PAs to know what’s happening and be sure they have some say.”
Dr. Pierce concluded that “By the nature of their commitment and training, physicians and PAs are the natural leaders of our current and future health care delivery systems. Our patients, present and future, are counting on us, and I know that we will not let them down.”
More information on CCOs, health reform in Oregon and these work groups is available at www.health.oregon.gov.
Health System Transformation Legislation
HB 3650-C, the Health System Transformation bill passed by the Oregon Legislature in 2011, begins the process of planning for and implementing Coordinated Care Organizations (CCOs) with the goal of controlling costs while providing top quality health care to Oregonians . The bill integrates physical, dental, mental and behavioral health into community-based organizations that would provide services using a global budget. CCOs will use alternative payment methodologies that incent healthy outcomes and quality and will make use of Patient Centered Primary Care Homes to serve the population. While they will serve Medicaid and Medicare dual eligible individuals, Medicaid long-term care services are excluded from the scope of the CCOs.
Members of the CCO will have a choice among participating providers. Among other things, participating providers will need to emphasize prevention, healthy lifestyle choices and evidence-based practices. The bill also allows for the creation of Community Health Workers and Personal Health Navigators who will help coordinate Member health.
In a small liability reform victory for physicians, the bill does require the Oregon Health Authority to draft legislative and administrative recommendations that will contain health care costs by reducing costs attributable to defensive medicine and the overutilization of health services and procedures.
There are a number of details of the proposal that have yet to be worked out, and the bill requires the Oregon Health Authority to use a meaningful public process to develop a number of recommendations this interim and then present those recommendations to the Legislature for approval in February of 2012. Some of those recommendations include:
- Qualification criteria for CCOs
- The global budgeting process for determining payments to CCOs
- A process for resolving a health care entity's refusal to contract with a CCO
- A process for financial reporting of CCOs
- Beginning the planning process to eventually have CCOs contract with the Public Employees' Benefit Board and the Oregon Educators Benefit Board
- Financial models and analyses to demonstrate the feasibility of a Coordinated Care Organization being able to realize health care cost savings
- A process for determining outcomes, quality and efficiency metrics
- The integration of Medicaid and Medicare care and services
- Cost containment proposals around defensive medicine and liability reform.
The OMA will be participating in the interim workgroup and discussions as the CCO proposal is refined and further developed.
Transformation Work Groups
HB 3650 created four work groups to plan the creation of CCOs: Medicare-Medicaid Integration of Care and Services; Global Budget Methodology; CCO Criteria; and Outcomes, Quality and Efficiency Metrics. On Aug. 3, Governor Kitzhaber announced the appointment of 133 members, including several OMA members, to these four groups, which represent health care sectors and communities across the state. The workgroups will meet between August and November and will inform the development of the final CCO plan sent to the legislature for approval in February 2012. OMA staff will be monitoring and providing comments during the work group process.
Meeting schedules and live streaming audio are available at http://health.oregon.gov/OHA/OHPB/health-reform/stakeholders.shtml, along with rosters and draft charters for each work group. Work group meetings are open to the public, but there will be no public comment or testimony taken during individual work group sessions. All comments and testimony are welcome at the Oregon Health Policy Board’s monthly meetings on the second Tuesday of every month. More details, fact sheets, FAQs and other information on health reform in Oregon are available at www.health.oregon.gov.