Does your job not pay enough? Rent too expensive? Need a college degree? Where do you go for help?
If your answer was, “I will talk to my doctor.” Congratulations! You’re thinking just like the state of Oregon.
Under the 289-page proposed contracts with coordinated care organizations — the state’s method of delivering Medicaid — the Oregon Health Authority wants more state health care dollars go to fix societal problems involving behavior, jobs, education, inequity, the environment, housing and more.
Given how expensive and complicated health care delivery is already, does it make sense to spend limited resources on problems other than medical care? Doing so is highly questionable. It puts power to make important societal decisions and invest taxpayer dollars to carry them out in the hands of unelected officials who do not have the necessary expertise. It also has deep implications for patient privacy with CCOs collecting up all sorts of personal information.
Nobody debates that a patient’s education, job, neighborhood, housing and much more can be important social determinants of health. It’s completely appropriate for the health care system to assess if a patient has issues that hamper or hinder any treatment and make appropriate referrals. The proposed contracts encourage CCOs to do that or even go beyond and make “population level” interventions.
PacificSource provides CCO coverage for Central Oregon and won the state’s contract, again. It has in the past capped its profits at 2 percent and made investments with the remaining money in things such as helping with housing for the homeless and helping children get ready for kindergarten. These are good causes. But will health-care organizations improve public health and lower costs more effectively by spending money on social determinants or on their actual area of expertise: health care?
CCOs shouldn’t be treated like ATMs to fix societal problems. They should be treated like health care providers.