Deschutes Medicaid enrollment surging

County looking to add more health staff as preventative care demand grows

By Elon Glucklich / The Bulletin / @EGlucklich

A surge in new Medicaid patients has caught Deschutes County and state health officials by surprise.

More than 10,000 Deschutes County residents joined the Oregon Health Plan in January and February, nearly twice the number the county first anticipated for all of 2014. The new enrollments are part of the federal reforms, which took effect Jan. 1, raising the income ceiling for Medicaid eligibility.

Local health officials say the surge isn’t a bad thing: The whole thrust of health care reform is to lower costs for everyone by reducing the number of emergency room visits by uninsured patients.

But the numbers are proving to be a logistical headache. After hiring two temporary clinicians in January, Deschutes County is looking to hire four more in the next few months, DeAnn Carr, deputy director of the county’s behavioral health division, said Thursday. Local governments have taken on more Medicaid patients in recent years as private clinicians have grown more hesitant to accept them as patients — a national trend.

“We’ve been doing additional planning around how we’re going to meet the community need,” Carr said.

Across the board, demand for services such as mental health assessments, youth wellness checks and dental appointments is on the rise, as more local families get health insurance.

To reduce health care costs, the state set up 17 coordinated care organizations — regional coalitions of public health officials and private physicians. The idea is to get patients medical attention at the primary care level, whether it’s with a physician or dentist, rather than waiting until the condition needs emergency care.

Oregon Gov. John Kitzhaber has bet big that the CCO model will reduce health care costs. The state received $2 billion in federal funds to set up the CCOs. But the state will have to repay the money over time unless the CCOs reduce the increase in Medicaid costs by 2 percentage points by the end of this year.

A February report by the Oregon Health Policy Board found the CCOs reduced costs by 1 percentage point in 2013.

Health officials said they were optimistic the cost-saving trend would continue. But that hinges on educating people about where to go when health problems flare up. It’s a tougher challenge than most might think.

Local physicians have a handful of Deschutes County residents are known to visit the emergency room dozens of times each year. At a health care forum in Bend last week, Kat Mastrangelo, executive director at Volunteers in Medicine Clinic of the Cascades, said one patient has visited the emergency room 100 times in a single year.

“A lot of people who have health care now have maybe never had it before, or maybe not had it in a long time,” said Patty Wentz, an Oregon Health Authority spokeswoman.

Wentz emphasized how young the CCO model still is, and how much of the state’s health care coordination efforts are still aimed at education.

The uninsured tend to wait until a condition reaches the point at which emergency care, rather than a basic doctor’s visit, becomes necessary.

“The health system as it’s built now is not built on health, it’s built on quantity,” Wentz said. “Every time someone goes to the emergency room, that’s a visit everyone pays for. What the government is trying to do with the coordinated care model is to change that, and make it so that the delivery system is designed to deliver better health care, not just more care.”

Deschutes County Commissioner Tammy Baney is chairwoman of the Central Oregon CCO’s governing body. Baney said she’s pleased with the region’s results so far. County health staffers are already doing more health assessments and follow-up visits for uninsured children and outreach to patients with mental illness.

The hope is for the increased assessments and follow-ups to improve access to care before small issues become major emergencies.

“In the short run, I see positive results,” Baney said. “We’re breaking down communication barriers and aligning care better. The proof will be in continuing to track our progress and benchmarking our outcomes.”

— Reporter: 541-617-7820, eglucklich@bendbulletin.com