Health Plan changes

Written by Chris Collins June 15, 2012 08:44 am

By Chris Collins

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Coordinated care organizations are being formed around the state as the core of improvements coming to the Oregon Health Plan later this year.

And Dr. Charles Hofmann, a Baker City internist who helped develop the system, is doing his best to help explain how the new system will work.

Hofmann has been meeting with the residents and medical providers of Eastern Oregon to explain the changes. He says they are designed to improve the health of recipients of the Oregon Health Plan (OHP) while cutting health-care costs and improving services. OHP is the state’s Medicaid program that provides health-care benefits to low-income residents.

For the past five years Hofmann has been involved at the state level in developing first a strategic plan, then an action plan and finally an implementation plan for the coordinated care program.

“I’m tired of planning — I’m ready for action,” Hofmann said with a characteristic burst of laughter during a recent interview at his 17th Street office.

Hofmann, who turns 60 on Sunday, asked that he not be reappointed to the Oregon Health Policy Board when his term expired in December 2011. He was one of nine members tapped by the governor to serve on the board, which sets policy and provides oversight for the Oregon Health Authority (OHA).

The OHA was established in 2009 to improve Oregon health care.

“After five years and 100,000 miles, enough is enough,”Hofmann says of the work that has required him to travel across the state regularly.

Despite stepping down from the health policy board, Hofmann has continued to log a significant number of miles traveling to drum up support for the coordinated care program and to explain how the system will work to better serve those who rely on the Oregon Health Plan.

“I want to be involved in making this work in Eastern Oregon,” he said. “I’ll be involved as much as I can to see it work.”

Hofmann notes that it’s unfortunate that the program must first be tested on the state’s most-vulnerable residents.

“But the stars have lined up — mostly dollar signs — that have forced us to do this,” he said.

The rising cost of the Oregon Health Plan and a projected $230 million funding shortfall in the next biennium demanded that changes be made, he says. In the past, the state has chosen to save money by cutting people from the program, reducing services or paying providers less.

“The old ways didn’t work,” Hofmann said.  “As federal and state government has tried to make things better, we’re suggesting we try something different — a better way to deliver health care.”

Hofmann said the obvious place to start was with those who place the heaviest burden on OHP.

“We have irrefutable data that says that 20 percent of Oregon Health Plan patients account for 80 percent of the costs,” he said.

Those costs come in the form of treating people with conditions such as diabetes, heart failure and mental illness, who don’t receive the preventive care or the disease management care they need and end up with serious conditions first in the emergency room and then as patients in the hospital.

“And we pay for acute care that costs oodles more,” Hofmann said.

As a first step, the state has given “provisional certification” to a newly formed Eastern Oregon Coordinated Care Organization to serve Baker, Union, Wallowa and Malheur counties. The EOCCO is a partnership between Oregon Dental Services, which is the current managed care and dental care provider for the area, and the Greater Oregon Behavioral Health Initiative, a regional mental health organization that currently manages mental health services in the area.

There are plans to add these Eastern Oregon counties to the EOCCO as well: Umatilla, Morrow, Grant, Harney, Wheeler, Gilliam, Sherman and Lake.

Other coordinated care organizations will serve the rest of the state.

Improvements to the state’s health-care program will come through a coordinated effort to serve the physical, mental and dental health needs and provide chemical dependency treatment for OHP recipients and to better manage care provided to those with chronic illnesses, Hofmann says.

Health-care access will be improved through the use of patient advocates and navigators who will direct patients to needed services.

And Hofmann points to Section 5a of Senate Bill 1580, which describes the patient’s responsibility to be an “active partner” rather than a “passive recipient of care.” The law encourages OHP patients to work with a team to address their “needs as a whole person,” including participation in wellness and prevention programs and to make “healthy lifestyle choices.”

Hofmann notes that Baker County has a leg up on some parts of the state because of prevention strategies developed over the years, but he says “there are areas we need to look at.”

“We need to figure out how to engage citizens,” he said, adding that a good start would be to convince people that they need to stop consuming large quantities of “sugar pop” and smoking cigarettes.

A study commissioned by the state expects a $3 billion savings from the coordinated care program over the next five years, Hofmann said.

In exchange for the projected savings, the U.S. Department of Health and Human Services has agreed to give Oregon $1.9 billion over the next five years. The first year the state will receive $610 million, which will be used to backfill the projected OHP shortfall, with the rest going to “kick-start” the coordinated care system, Hoffman said. The amount will be less in the following years.

“It only comes if we save the money,” at least 2 percent of the total Medicaid bill or about $1 billion, he said.

OHP serves 600,000 Oregonians — including 2,942 Baker County residents — living at or below 135 percent of the federal poverty level. If President Obama’s Affordable Health Care Act is allowed to proceed (the Supreme Court is weighing the law’s constitutionality), it will be extended to people living at up to 188 percent of the poverty level, which would add another 400,000 people to the Oregon Health Plan, Hofmann said.

And if the coordinated care system works, it might be extended to all Oregonians in the future.

“If it’s not a good thing it will never happen,” Hofmann  said. “If it is a good thing, it will already be tried and true.”

As the coordinated care organizations are established, they will be directed by a Community Health Improvement Plan, he said. That plan will be developed by local advisory councils made up of community residents and county officials who will tailor the plans to meet the needs of residents in their areas.

Hofmann’s efforts to improve health care and his community haven’t gone unnoticed. He has twice been honored by the Oregon Medical Association as its “Doctor Citizen of the Year” — in 1990 while he was serving as Baker City mayor and again in 2011.

He continues to serve as  chairman of the Oregon delegation to the American Medical Association and will be traveling to Chicago for a week in that role. And closer to home he is the current president of the Oregon Trail Electric Consumers Cooperative Board.

Hofmann will explain the coordinated care program to Baker County residents during a public meeting at 7 p.m. June 21 at Crossroads Carnegie Art Center, 2020 Auburn Ave. His presentation will be followed by a second public meeting from 8 a.m. to 9:30 a.m. June 22 at the Sunridge Inn. Representatives of the newly formed Eastern Oregon Coordinated Care Organization will speak at that session.