Oregon has received national attention for its approach to health care reform. In a matter of months, all types of health care providers (physical, mental and dental) have come together to form 15 coordinated care organizations, which will manage the health care of more than 300,000 Oregonians who are covered through the Oregon Health Plan, as well as thousands who will become covered in the next few years through the Affordable Care Act. The Central Oregon Health Council is proud to be a pioneer in this new model of care.
However, there is a bill — HB 3309A — currently circulating through Salem that threatens to unravel the tremendous strides we have made in health care delivery. And, although it is proposed as a pilot project for Marion and Polk counties, it gives everyone who participates in coordinated care organizations great pause.
Establishing these CCOs was not an easy task. Each community experienced its own growing pains when shifting the way providers work together and provide services. One CCO in particular has had some trouble getting up and running, and there is a pending lawsuit between some of the CCO’s parties about how to best deliver and pay for care. In response, the Legislature has introduced a bill (HB 3309A) to try to provide a solution for this problem, misusing its power and undermining the flexibility of the health care system by usurping local control.
Also referred to as the “Bad Actor” or “Agree or Leave” bill, HB 3309A would allow for the removal of a CCO’s board member by a two-thirds vote (CCO boards are made up of representatives from the participating entities). This booted provider would not be allowed to contract with any CCO for five years, potentially limiting access to care for low-income Oregonians. The CCO can then pay this terminated entity a significantly reduced reimbursement rate — merely 58 percent of Medicare reimbursement rates.
At its core, HB 3309A usurps local control and decision making, which is the foundation for CCO operation and success. CCOs were created under the mantra of “local solutions for local issues,” and the Central Oregon Health Council has fully embraced this. Like us, each CCO has its own bylaws that address how its board should resolve differences. These bylaws were created through a collaborative process with all members of the CCO and are unique to fit the needs of each community and the patients it serves.
In anticipation of this bill, some key CCO participants, including St. Charles Health System, are beginning to consider leaving their CCO board in advance of the bill’s enactment, rather than risk being voted off at some future date for an unforeseen reason. Central Oregon Health Council leadership is developing contingency plans in the event the bill passes. Who would want to put their own organization at risk?
CCOs were created to integrate care from all the major health care providers in a local community and have those providers share in the financial risk and decision-making for the Medicaid population. We and some 96 other health care, public policy and business organizations in the state believe HB 3309A only serves to disrupt the continuity of care for beneficiaries of the Oregon Health Plan.
In the end, the Legislature hurts communities by misusing its power. The solution within HB 3309A for an isolated case could have a tremendous impact on all CCOs around the state for years to come. Our first rule in health care is to do no harm, and the Legislature should consider the same before it moves forward on HB 3309A.