Guest Post: CareOregon

This Guest Post is from CareOregon, a Medicaid managed care plan serving over 95,000 Oregon Health Plan members in 16 counties across the state.

The Oregon Health Plan (OHP), as initially envisioned in 1987, was supposed to provide access to care for all Oregonians with all segments of society sharing in the cost. However, twenty years after the development of OHP, we do not have enough state general funds allocated to either cover the intended OHP population or maximize our federal match. That means that for every dollar the state is not spending on OHP, we give up $1.57 from the federal government. Not fully funding the OHP “Standard” population means there are more uninsured Oregonians. When the uninsured get care, providers, payors and health care consumers pay for this care.

In order to get the federal dollars we are entitled to, we need to allocate additional state general fund dollars to OHP. But let’s not just keep putting money into a system without thinking about whether the system is designed to give us what we want for our population. The primary care system is a good place to start since it will improve patient care and reduce costs. Another way to improve our “bang for the buck” is to think about how we deliver and pay for care.

We know that coordination of care at a primary care level can result in better health for people and save significant money in the whole system. Paying for nurses to provide some of these services, rather than doctors, would save dollars in the system and improve outcomes. If health plans and insurers had more flexibility in how clinicians are paid, the delivery system could be transformed to provide the care people need for less cost. In addition, information that compared outcomes across programs would allow us to see if the money we are spending is well used.

Hopefully, the Health Fund Board and its committees will look for as many opportunities as possible to provide that flexibility and to maximize the state’s federal matching dollars. It’s a shame to leave that money on the table.

Comments

[Jackie Childs]

Any commentary provided by CareOregon rings hollow when you consider the amount of money Dave Ford and his cronies waste on their own inflated salaries and frivolous employee perks (pool tables, free massages for employees, trips to Alaska for "research", extravagant parties, large christmas bonuses for all employees).

As a native Oregonian I find it offensive that CareOregon, which was orginally set up as a resource and benefit for some of our neediest citizens, ha been turned into a for-profit device with one agenda, skimming as much out of the OHP coffers with the least amount actually being put to its intended use of providing health care of low-income Oregonians.

The CEO and CFO, COO have no ties to Oregon, and in fact both only live in Oregon part time. They have no knowledge or concern for the communities that so desperatley need theit help. They simply show up, make as much money as they can and return to their real homes. Don't take my word for it, look into yourself. Pull a Careoregon financial report and compare Dave Fords salary with the latest Insurance executives salary info (try the OHF).

The fact of the matter is that over the past 4 years CareORegon has made more and more money each year. Yet they still only cover 95,000 members. When they were losing millions of dollars a year they actually covered more members. They have also cut back on the services they provide, and increased 10 fold the number of denials they proccess each month.

And yet no one questions their voracity, which beguiles me. Ron Wyden- PLEASE look into this! there is still a handful of OHP plans in the state who are honorable and underfunded. Wouldnt these OHP funds be better suited to those plans? I am active in the local Health Care community, and am experienced with both the local insurance market and the medicaid enviroment, and I have NEVER witnessed such an out and out display of SLEAZE around here.

[CareOregon Employee]

The massages are not free.
Membership is continually growing and if I am not mistaken will surpass 100,000 very soon (if not already). The trip to Alaska was to talk with healthcare professionals at the South Central Foundation: http://www.southcentralfoundation.com/valleypcc.cfm

Though I don't personally use the pool table or ping pong table I think it is very good for employee morale (I think that the majority of CareOregon employees are truly conscientous employees and believe in and practice habits that fall in line with CareOregon's vision and mission statements).

I believe in the company that I work for.

Nothing 'sleazy' about it. Sorry about your well intended but misguided perceptions.

[Jackie Childs]

Plane tickets to alaska vs a price of a phone call. That says it all. As the saftey net clinics struggle to keep their doors open maybe you can send them some ballons or something in between work-day massages.

[Jackie Childs]

You "beleive" in the company you work for? SERIOUSLY? If you enjoy working there and the way they treat you then say that, more power to you. But don't speak about your company like it is some honorable institution. Be honest for crying out loud- why lie?

CareOregon is a third party payor for the state, nothing more. It isnt a healthplan or even an insurer. And as such it is obligated to pass on the benefits the state has appropiated it in an appropiate manner. This business is filled with people working for the benefit of the machine- how about advocating for the citizen? Isnt THAT a reward worth attaining?