Oregon Health Authority Health eNews | Updates from the Oregon Health Policy Board

MARCH 6, 2012

In this month's edition of Health News from OHA and OHPB:
Coordinated Care Organizations signed into law
Public comment period on CCO materials
Coordinated care in Oregon: Becky Wilkinson
Carla McKelvey, M.D., newest member of Oregon Health Policy Board
In the news

Coordinated Care Organizations signed into law

With strong bipartisan support, the Oregon Legislature and Governor Kitzhaber passed SB1580, establishing Coordinated Care Organizations (CCOs) and paving the way toward better health for Oregonians. CCOs will bring better care at lower costs to the more than 600,000 Oregonians served by the Oregon Health Plan (Medicaid) with a focus on improved wellness, prevention, and integration of behavioral, physical and ultimately dental health care.

The potential cost savings for Oregon are substantial — more than $3 billion over the next five years — and will ensure that our most vulnerable citizens maintain coverage, while freeing limited resources for other public priorities.

A timeline outlining the next steps toward the implementation of CCOs, including Oregon's request for required federal waivers, and the public comment period for the draft Request for Applications for CCOs, the process for temporary administrative rules, and Oregon's proposal to integrate services for individuals eligible for both Medicare and Medicaid can be found at www.health.oregon.gov.

Public comment period on CCO materials

Interested stakeholders are encouraged to visit www.health.oregon.gov to review and provide informal comment on documents related to the implementation of Coordinated Care Organizations. These include the draft Request for Applications and a draft CCO Core Contract, draft temporary administrative rules and the draft proposal for Oregon's Medicare-Medicaid Alignment Demonstration to submit to the Centers for Medicare and Medicaid Services (CMS). The site also contains Oregon's waiver request to the federal government for additional federal flexibilities. The Request for Amended Waiver was submitted to CMS March 1. The Oregon Health Authority gave a webinar presentation on the CMS waiver and next steps for CCO implementation on March 2.

The Oregon Health Authority is now accepting public comment on the following documents:

  • Request for Applications: Coordinated Care Organizations
    OHA is accepting public comment now through 5 p.m. March 13, 2012, on the draft Request for Applications (RFA), including timelines for the RFA process and a draft sample of a CCO contract. The RFA process will be the first step in becoming a Coordinated Care Organization. OHA will assess applications to become CCOs, certify these organizations as CCOs as appropriate and begin negotiating contracts. The first certified CCOs could be in place as early as August 2012.
  • Temporary administrative rules
    The draft temporary rules describe the administrative rule changes OHA needs to support CCO implementation. These draft temporary administrative rules are open for public comment now through 5 p.m. March 13, 2012.
  • Serving individuals eligible for both Medicare and Medicaid: Oregon's proposal
    In addition to services for people eligible for Medicaid alone, Oregon's CCOs will provide services to individuals dually eligible for Medicare and Medicaid. Oregon is proposing to participate in a CMS Financial Alignment Demonstration, which will include new, innovative three-way contracts among the state, CMS and CCOs for blended Medicare and Medicaid payments. This will allow CCOs to provide comprehensive, coordinated care for dually eligible individuals in a more cost-effective way, integrating the benefits and aligning requirements for both programs to offer seamless care for dually eligible individuals. This proposal is open for a 30-day public comment period, through 5 p.m. April 4, 2012.

We invite you to review these documents and provide comment. Please consider providing your name and the organization you represent with any comments.

Coordinated care in Oregon: Becky Wilkinson

Even as stakeholders, legislators and the Oregon Health Authority are working to establish CCOs in Oregon, plans, providers and communities around the state are already finding ways to provide better care and better health at lower costs. In February, the Oregonian's Bill Graves profiled Becky Wilkinson, one of four outreach workers on CareOregon's Community Care Team. The pilot project, which was launched five months ago, focuses on the 25 percent of CareOregon adult patients who accounted for the vast majority of spending in 2011. Wilkinson's goal is to help coordinate care for patients who are frequent hospital and emergency room users so that they can improve their health and stay out of the hospital as much as possible. She works with teams of primary care doctors to come up with treatment plans that best serve patients and help eliminate the costs of repeated, unnecessary hospital visits.

The Community Care Team is a great example of small-scale coordinated care already going on in Oregon. Wilkinson's story illustrates how a team-based, patient-centered approach can keep patients healthier, happier and in their homes, while eliminating the expensive costs of hospitalization and intensive care. It's time we scale up such efforts to a state wide level.

Carla McKelvey, M.D., newest member of Oregon Health Policy Board

Carla McKelvey, M.D.

We are pleased to announce that Carla McKelvey, M.D., of Coos Bay will fill the policy board seat vacated by Dr. Chuck Hofmann. Dr. McKelvey is a board certified pediatrician in private practice at North Bend Medical Center in Coos Bay. She is currently the President of the Oregon Medical Association. Previously, she served as medical director for Doctors of the Oregon Coast South, which manages the Oregon Health Plan for Coos County. Dr. McKelvey has a BA with honors in English from the University of Texas at Arlington. She completed her medical training at the University of Texas Health Science Center in San Antonio in 1993 and her pediatric residency there in 1996.

OHPB's next meeting

Tuesday, March 13, 8:30 a.m. to noon. Visit the board's website for Portland location and directions.

In the news

The Register-Guard
Oregon can save big with a more rational system

The Oregonian
Health reform in Oregon: Coordinated care could improve conditions for all

Central Oregonian
Central Oregon counties team up to improve healthcare

Mail Tribune
La Clinica health centers recognized by state

Associated Press
Oregon Gov. Kitzhaber signs health care overhaul bill; promises to improve care, reduce costs

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Send input and comments to OHPB at ohpb.info@state.or.us
View calendar of health reform meetings

OHA logo The Oregon Health Authority is overseen by the nine-member citizen Oregon Health Policy Board working toward comprehensive health and health care reform in our state.