The large challenge of a CCO from a small town perspective
In downtown Grants Pass, not far from the banks of the wild and scenic Rogue River, you’ll find the office of the newly minted, conditionally approved Coordinated Care Organization (CCO) representing most of Southern Oregon: AllCare Health Plan, Inc.
Under AllCare, Southern Oregon’s physical, mental and oral health care will be administered under one management company in an effort to streamline costs, integrate treatment, improve access and most important, provide better care. The company represents 23,000 Oregon Health Plan members in Southern Oregon. It also contractswith 1,000 local health care providers (including roughly 95 percent of the area’s physicians) and works with five different hospital systems.
Like CCOs everywhere, AllCare is in the process of engineering a new health care delivery system. The emphasis will be on sharing treatment plans, exchanging information electronically, coordinating care, working in teams, incentivizing wellness and preventive medicine programs, reducing expensive non-emergency visits to emergency rooms and prioritizing primary care, says AllCare’s Medical Director, Lyle Jackson, MD. As OHSU President Joe Robertson said in a previous Q&A article, “the operative word is coordinated. When you’re creating the proverbial paradigm shift, you have to coordinate and collaborate.”
“Delivering medical care is now a team effort,” says Dr. Jackson, who started his private family medicine practice in Grants Pass in 1977 and cared for patients for 22 years before changing careers. “It’s a team of professionals working together to keep people healthy with the primary care doctor at the center. It’s a very good thing for Oregon.”
In the vanguard of reform
Like the CCO that OHSU belongs to—the Tri-County Medicaid Collaborative—AllCare is in the vanguard of state health care reform. It’s part of a statewide “boots on the ground” effort now underway that will remake how care is delivered to more than 650,000 low-income Oregonians on the Oregon Health Plan (Medicaid). The CCOs are expected to officially launch in August, although the TCMC recently announced it will be operational on Sept. 1.
AllCare is headquartered in Grants Pass, a town of 34,500 nestled in one of several mountain-river valleys that give Southern Oregon its rugged and beautiful topography. Though AllCare is located in a small town, it’s not behind the times. It has implemented managed care concepts, electronic health records and the primary care, patient-centered medical home for some time under the company’s former managed care model.
“Though we don’t have the large member numbers and the multiple large hospital systems like Portland, we’re similar in that we have to work with a variety of stakeholders who hold different philosophies,” says Dr. Jackson. “And for the most part, doctors, nurse practitioners, hospitals, A&D (alcohol and drug) services, safety net clinics and other stakeholders in this area are willing to take a leap together to make the CCO succeed. Ultimately, we all know CCOs can’t fail because there is no Plan B. There is no going back to the old system.”
Unique rural challenges
AllCare, like other Oregon CCOs, will be working to reduce levels of depression, anxiety, heart disease, rampant cavities and other health problems universal around the state. But it faces challenges unique to rural CCOs. One is long distances. “People here might live 30 or 40 miles from their care provider,” says Dr. Jackson. “When gasoline costs $4 a gallon, poor people literally can’t afford to get to a doctor’s office, especially for routine, non-emergency appointments. That’s a major challenge.”
The other is fewer providers. “As a result, we have to work very closely with the well-qualified providers who are in our area, build good relationships with them and become more efficient in utilizing those scarce services,” says Dr. Jackson. “We have to bring in other trained personnel such as counselors, midlevel nurse practitioners and physician assistants to extend our knowledge and care so we can touch more people. We have to be imaginative and flexible.”
Gov. Kitzhaber is promoting one imaginative idea that is particularly attractive to AllCare and other rural CCOs. Now being piloted at OHSU and other places, a health care or patient navigator is a non-clinician professional who is trained to understand all aspects of the local health care landscape and be a patient advocate. The navigator would steer a patient through the health care system, sometimes literally driving patients to and from appointments. They would schedule and coordinate care and ensure patients have access to decent housing, food and transportation. The navigator, the thinking goes, might be an employee of a CCO, clinic or other local entity, an interested family member or someone who has completed a certification program at a local community college.
“What we all know but which the system couldn’t address before is that good health is much broader than medicine,” says Dr. Jackson. “It’s about creating a healthy environment with good, adequate food, decent housing and transportation and access to social services.” A health care navigator could mean helping to link those things.
Educating a workforce for the CCO model
OHSU, for its part, has an important role to play in the success of Oregon’s CCOs and particularly those in rural communities, says Dr. Jackson. “OHSU has long been a national leader in having strong primary care educational programs,” says Dr. Jackson. “Now is the time to expand and improve upon those strengths. Doctors need to get used to working in teams, not as individuals. They need to interact well with mental health workers and therapists. They need knowledge of alcohol and drug dependency issues. OHSU students and residents need to experience caring for patients in a CCO network now so they learn this new model of care. It’s the future.”
Though health care reform is starting with the Oregon Health Plan, many experts agree it will eventually come to private, commercial insurance plans nationwide and government insurance plans such as Medicare. “We’re very proud of Oregon and the leadership the state has taken on how to transform health care,” said Dr. Jackson. “All Oregonians should be proud. The whole nation is looking to us to see how we do it. These are exciting times.”
Pictured: (top) Lyle Jackson, MD; (middle) Downtown Grants pass; (bottom) Sign in Grants Pass
Full disclosure: Writer Rachel Shafer is the daughter of Dr. Jackson.