Proposals laid out for Ore. health overhaul

No corner of Oregon would be left behind from sweeping changes to the Oregon Health Plan under proposals by groups that want a part of a redesigned healthcare system for low-income patients.The preliminary plans, laid out in letters to the state released this week, also show that some companies see Oregon's health overhaul as an opportunity to expand into new territories.

The letters provide the most comprehensive glimpse yet at the level of interest among doctors, hospitals, insurance companies, mental health providers and other elements of the health care system. The state Legislature signed off this year on Gov. John Kitzhaber's plan to create regional "coordinated care organizations" responsible for integrating mental and physical health care for low-income patients on the Oregon Health Plan, the state's version of Medicaid.

Groups in every county have said they want to be a new coordinated care organization, or CCO, charged with lowering costs and improving health care for Oregon Medicaid patients. It's unlikely that every group will ultimately submit an application and be certified by the state, but state officials said they're pleased that no region was left out.

"We were really pleased to see the strong interest and, most importantly, the tremendous level of collaboration around the state in a variety of communities," said Bruce Goldberg, director of the Oregon Health Authority.

Potential CCOs were required to send a letter by Monday declaring their intent to apply or miss out on the opportunity until next year.

The documents don't reveal a detailed picture of the changes that 600,000 Oregon Health Plan patients will see. But they do indicate that businesses see significant business challenges and opportunities.

Two companies that don't currently manage Oregon Medicaid patients, separately declared plans to create CCOs that would cover nearly the entire state.

Centene Corporation, a St. Louis-based company with health plans serving primarily Medicaid patients in 16 states, said it will apply to be a CCO covering 33 of Oregon's 36 counties. UnitedHealthcare, an insurance company that offers commercial insurance in Oregon, wants to cover Medicaid patients in 30 counties.

Other organizations that serve portions of Oregon have proposed expanding into other regions. One company, Correctional Health Partners, said it wants to work with the state Department of Corrections to manage hospitalizations for prison inmates and potentially former inmates on parole.

In the Portland area, a group of insurance plans, managed care organizations, doctors and hospitals have set aside their competitive differences and submitted a letter of intent to form a single CCO that would serve more than 200,000 patients. Goldberg cited the collaboration as a "good sign" that "bodes well for the future of health care in Oregon."

But the documents also show it's a tenuous relationship. Several organizations that are part of the collaborative submitted separate letters to leave open the opportunity to go it alone if the collaborative falls apart.

"Trying to do something that's not been done before carries inherent risks, and therefore I think people are cautious," said George Brown, president and chief executive of Legacy Health and the chair of the committee overseeing the Tri-County Medicaid Collaborative, the Portland-area group.

Officials say it's still early in the process and much will change before the first CCOs begin operating, potentially on Aug. 1. Some of the applications are placeholders intended to keep a foot in the door after this week's deadline.

Kitzhaber and other proponents hope the coordinated care organizations will lasso rapidly rising health care costs that limit money available for other government services like schools and police.

The goal, proponents say, is to cut down on expensive hospitalizations by aggressively managing chronic conditions and mental illnesses that account for a huge chunk of health spending. They envision a new emphasis on preventive care and caseworkers to ensure patients are keeping appointments and taking medications.

State health officials say the new CCOs will make it possible to pay for services that improve patient health and lower long-term costs but don't currently get funding. The CCOs will be paid a fixed price for each patient, rather than a fee for each service they provide.