Published: Wednesday, April 04, 2012, 4:24 PM Updated: Wednesday, April 04, 2012, 6:47 PM
By Nick Budnick, The Oregonian
A new push to reshape health care in greater Portland is reminiscent, its biggest booster says, of the race to land a man on the moon.
Erstwhile health care competitors hope to set aside their differences to care for the region’s 200,000 Oregon Health Plan members, says Legacy Health CEO George Brown. The task is happening in a timeline — Brown snaps his fingers — “that’s like that long. It’s a moon shot for sure. What we’re trying to do, to my knowledge, has not been attempted any place in the country.”
While the space analogy might seem a stretch, it’s no exaggeration to say Brown’s effort faces steep challenges. He leads a loose group of medical and mental health providers from Clackamas, Washington and Multnomah counties that earlier this week notified the state of plans to join efforts to better manage Medicaid spending.
The group aims to have a more detailed application in to the state by the end of the month. However, several members of the group, such as Tuality and Providence, have also sent their own letters to the state, saying they will set up their own care organizations if this group does not come together as planned. In all, 68 private companies and nonprofits have notified the state of their desire to qualify under Oregon’s reforms.
The obstacles are many. In Portland, the goal of operating by August is a tight one. Other care organizations formed under the state law won’t have as many competitors joining up. Federal funding has not materialized either locally or statewide. And the goal – to use new concepts to save money and improve health for low-income people in the region – has not been applied on so grand a scale.
One obstacle the new coordinated care organization won’t have to face is the U.S. Supreme Court. While headlines lately have focused on a challenge to the new federal law focused on Medicare and commercial insurance, Oregon’s law is different, pushing providers into better coordinated care for state Medicaid recipients.
The carrot? A cut of whatever savings the new Oregon health provider groups can find by moving away from traditional fee-for-service care. There’s possible federal funding as well as access to a potentially lucrative market in the future: public employees. Over time, Gov. John Kitzhaber envisions the new coordinated care organizations as serving teachers and state workers.
Though managed care groups already operate in Oregon, the new ones may be larger. The Portland area group calls itself the TriCounty Medicaid Collaborative and includes Providence Health & Services, Oregon Health & Science University, Tuality Healthcare, Kaiser Permanente, Adventist Health, federally funded community health clinics and health departments of Clackamas, Multnomah and Washington counties.
The region’s largest Medicaid provider group, CareOregon, hopes to join the new group, though it won’t cast a final vote until later this month. “It’s an unproven area, and it’s scary,” says CareOregon CEO Dave Ford. “But it’s exciting. It’s going to be an unfolding drama”
In contrast, a competing provider network of 1,500 doctors and nurse practitioners that has participated in discussions expects to go its own way. “The darn thing is so nebulous you really don’t know what they’re doing,” says Jeff Hetherington of FamilyCare.
The would-be collaborative expects to hear any day on a $34-million grant it requested in federal startup funds. The grant application promises focused efforts on those eligible for both Medicare and Medicaid, meaning they are not only poor but elderly or otherwise disabled, about 16,000 in all. The group will encourage healthy lifestyles among all Oregon Health Plan members, not just those most in need of care.
Other money could become available, too. Oregon hopes to hear by August whether it will receive $2.5 billion in federal funds to support its reforms.
Brown says the ongoing discussions, conducted in private, could lead to a federally sanctioned nonprofit.
The new group is dominated by health plans. In theory, their hospitals have the most to lose fiscally from a healthier population. Does it make sense to put them in charge of the new reforms?
“I know that cynical view,” Ford says. “This is more than rhetoric. These guys are activating their organizations in ways I haven’t seen before.”
Brown, for his part, says serving Medicaid patients is not a profit center for hospitals, moreover, participants are setting aside self-interest. “It just absolutely is surprising to me. The greater good has been held out as the right thing to do and the path to follow.”