Columbia Pacific Coordinated Care Organization takes over North Coast Medicaid

Press release from the Columbia Pacific Coordinated Care Organization, about August 10, 2012

The Oregon Health Authority approved an application from Columbia Pacific Coordinated Care Organization to take over managing Medicaid mental and health plan services on the North Coast as of Sept. 1.

Columbia Pacific CCO will serve all of Columbia, Clatsop and Tillamook counties, as well as the coastal arm of Douglas County. Each CCO will receive a set budget to manage care for people on Medicaid and work with community-based governing boards and advisory councils to direct spending.

“It basically serves like a health plan function, but it works much more closely with the community,” said Patrick Curran, Columbia Pacific CCO board member and director of business integration for CareOregon. “[CCOs] will grow and change and improve based on the needs of that community.”

The establishment of CCOs around the state is part of the Oregon Health Policy Board’s health care reform efforts, which are centered on the “Triple Aim”:

  • Improve the lifelong health of all Oregonians;
  • Increase the quality, reliability and availability of care for all Oregonians;
  • Lower or contain the cost of care so it is affordable for everyone.

The idea behind CCOs is to improve communication among health care providers, hospitals, health plan and social agencies in order to reduce costs and improve the health outcomes for patients.

“If you look at the population on Medicaid, 20-percent of the people incur 80-percent of the cost,” Curran said.

That additional cost is often a result of preventable visits to urgent care or the emergency room by people with chronic health problems, Curran said.

“If we can better provide those services at an earlier time, we can achieve that triple aim,” Curran said.

Columbia Pacific CCO is a partnership between Greater Oregon Behavioral Health Inc. (GOHBI) and CareOregon, which is one of the current Medicare and Medicaid plans available to Columbia, Clatsop and Tillamook county residents.

Initially, the CCO will combine health and mental services under one insurance plan. By 2014, it will also incorporate dental services.

“By integrating medical care, behavioral health and eventually dental care, CCOs will meet the needs of the whole person, rather than treating mind separately from body and separating primary health needs from specialty and hospital care,” said GOHBI CEO Kevin Campbell.

Most plan members shouldn’t notice any change in service since the benefits and access to doctors won’t change. “The day-to-day will remain undisrupted… I think it’s fair to say that a lot of work will be happening behind the scene,” Curran said.

However, Curran anticipates that the CCO will assign an outreach worker to people with episodic (pregnancy) or chronic (diabetes) health issues to help them manage health issues and identify the best use of insurance funds.

“If you have a more coordinated effort… if you can provide preventative care to this person… the cost differential is tremendous,” said Jeanie Lunsford, communications manager for CareOregon.

“CCOs give communities an unprecedented opportunity to have ownership in the transformation of health care,” Campbell said. “With formation of the Columbia Pacific CCO, we have achieved our goal of making the CCO local enough to be relevant while still large enough to maintain solvency so we can continue to provide excellent health care services into the future.”

Residents in the Columbia Pacific CCO service area with current Medicaid plans will automatically be rolled over into the CCO plan. People with both Medicare and Medicaid coverage (dual-eligiblility) may chose to join the CCO or opt out, Curran said.