Two coordinated care organizations want to oversee the Oregon Health Plan in Clatsop, Columbia and Tillamook counties, raising questions about what the competition will mean for health care providers.
Columbia Pacific Coordinated Care Organization, which manages the three counties, and the newly-formed Northwest Coordinated Care Organization have submitted applications to the state to handle insurance functions for Medicaid patients.
The coordinated care concept was originally created to help simplify and administer physical, behavioral and oral health.
This year, the state began accepting applications for a new, five-year contract that will be guided by new requirements. The changes place a heavy emphasis on integrating behavioral health with physical health.
When the application process for the new contracts opened, Greater Oregon Behavioral Health Inc., which has been part of the Columbia Pacific Coordinated Care Organization, signaled to Columbia Pacific they were interested in working with a new insurance company.
GOBHI entered into an agreement with Portland-based Moda Inc. to form the Northwest Coordinated Care Organization. GOBHI and Moda currently have a partnership in a coordinated care organization in Eastern Oregon.
If both coordinated care organizations meet the state’s guidelines, it is possible both could serve the three counties, offering Oregon Health Plan patients a choice, said Allyson Hagen, a spokeswoman with the Oregon Health Authority.
But some are concerned the region does not have the population to support two coordinated care organizations, and fear having two competing networks doing the same kind of work could increase bureaucracy and drive up costs for health care providers.
“The implications from what our network of providers have told us is that we’re too small,” said Mimi Haley, the CEO of Columbia Pacific Coordinated Care Organization.
About 8,000 people in Clatsop County are enrolled in the Oregon Health Plan, Haley said.
With two coordinated care organizations, providers like Clatsop Behavioral Healthcare, the county’s mental health and substance abuse treatment contractor, would have to work with two different insurance administrators. That means complying with two different sets of coverage rules and two different ways of getting services authorized, Haley said.
“That’s twice as much work at the same clinic,” Haley said.
The county Board of Commissioners echoed similar concerns, writing a letter in April asking the state to consider awarding just one contract for the county.
“The county has concerns that by allowing for multiple CCO’s, the already limited resources available for these services would be further reduced by the need for increased administration staff simply to be able to process differing payment and contracting methodologies,” the letter stated.
The health authority will consider the feasibility of multiple coordinated care organizations, as well as evidence of community support, when evaluating the applications, Hagen said.
“Ultimately, our goal is to assure that we are transforming health care for every Oregonian by reducing costs, improving access to mental health services, rewarding providers for improving health outcomes, and addressing the issues outside the doctor’s office that impact health, such as access to housing,” Hagen said in an email. “Having community support will be a necessary piece of successful implementation of those goals.”
Kevin Campbell, the CEO of Greater Oregon Behavioral Health Inc., said, in his experience in rural Oregon, “local control has been something that people have strived for. And regionalization is always something that people at the local level never wanted coming from Salem.
“They don’t want to go top down.”
GOBHI points to its successful partnership with Moda in Eastern Oregon as a model.
“I think the value is that it’s local providers that are taking care of the folks right here in town,” said Bonnie Thompson, the director of health system improvements at GOBHI. “So you’re talking local caregivers that are involved. They have a voice. They have ownership in the CCO and they’re going to be able to really help drive what’s going to work for this community here locally.”
Columbia Pacific is moving toward a model to better integrate behavioral health with other health services. They hope it will remove barriers for patients and eventually lead to more ways to access mental health treatment outside of Clatsop Behavioral Healthcare.
“We are very, very excited about how we can better meet our patients needs through a much more coordinated model,” Haley said.
Contract proposals are being evaluated and will be awarded in July. Haley said regardless of any changes happening with coordinated care organizations, patients should expect the same level of care.
“No matter what, they will be taken care of,” she said.