Klamath County still at odds over mental health care

By Diane Lund-Muzikant, The Lund Report, Dec. 5, 2012

A last-ditch effort is under way in Klamath County to mediate the dispute over mental health services for the nearly 13,000 people on the Oregon Health Plan.

State officials have intervened once again, sending in another mediator, while residents continue circulating petitions, asking the Oregon Health Authority to re-open the bidding process and allow a new coordinated care organization to emerge. But that won’t happen while the mediation process continues, according to Patty Wentz, spokesperson.

Two issues still separate county officials and Cascade Health Alliance, the physician-hospital owned group that’s attempting to become the CCO – the control of mental health services and representation on Cascade’s for-profit board of directors.

As the local mental health authority, the county is responsible for such services and has the ultimate contracting authority, but Cascade prefers to establish its own provider network.

Commission Chair Dennis Linthicum is willing to sign an agreement with GOBHI, a mental health group in 17 rural counties, but its CEO, Kevin Campbell, has been unsuccessful in reaching agreement with Cascade. “It could be a boost if they could be brought to the table,” Linthicum said.

For the time being, he’s not ruling anything out. “Right now everyone’s back at the negotiating table. If we can clean up those areas of hesitancy, we’d be more likely to sign an agreement. But if the public doesn’t have the ability to help direct those interests, it becomes problematic. Because of our statutory authority, this lands directly on the county’s shoulders.”

Neither Linthicum nor Bill Guest, CEO and president of Cascade, was willing to discuss details about the negotiations. “We’re not under a cloak of silence but would like to play our cards as close to the vest as possible,” Linthicum said. “I’m looking forward to seeing what the mediation process bears, and am hoping for results amenable to both sides.”

Cascade, which has been struggling to get the go-ahead as a CCO, is now saddled with a financial penalty imposed by the Oregon Health Authority and receiving 1 percent less in reimbursement, Guest said.

“We’re hoping the CCO can happen as soon as possible, and we’re going to abide by the original agreement with the county not to discuss the issues outside the mediation process” Guest said. “We’re working in a positive manner toward resolution with a state-appointed mediator.”

In earlier article about this situation, The Lund Report inadvertently said that Guest refused to comment on the situation. Instead, he had not responded by press time because of the Thanksgiving holiday.

Cascade, with 10,000 members, is managed by a nine-person board of directors – three primary care physicians, three specialists and three representatives from Skyline Hospital, and owned by its physicians and the hospital. The company also runs a Medicare Advantage Plan, known as Atrio, with 12,000 members.

“I really hope we have good news very shortly, and that the mediator is able to conclude the process successfully. It’s the first time we’ve been involved in the mediation process in our history,” Guest added.

It’s also premature, he said, to discuss the details about Cascade’s intention to integrate mental health care. “We’ve put together contracts with providers, and the first step is to do a memorandum of understanding with the county mental health authority.”

Earlier, GOBHI was rebuffed by Cascade after trying to buy into the company, according to Kevin Campbell, CEO. “It’s unfortunate that Cascade has a design plan in mind that is highly privatized and doesn’t see value in GOBHI being involved in the future. We’d like to be part of the solution, not the problem,” he said. “We’ve had tremendous success getting people out of the state hospital and into long-term care and community living.”

Campbell believes it’s beneficial for rural counties to join together and help move the system forward with a critical mass, rather than small counties going in different directions. “We’re willing to work with all providers if we get a chance to move forward,” he said.

He’s also interested in having a minority voice on Cascade’s board. “At the end of the day, decisions have to be made about whether to put money into public health or other preventive initiatives or pay dividends to shareholders.”

Campbell also questioned why Cascade intends to split adult and children’s services into two programs. “That’s a mystery to me. You don’t spend a million dollars on children just to have them go into the adult program and be ignored and end up in prison. You need to wrap services around so people know the services are there, whether they’re 18, 25 or 55.”

No matter what transpires, GOBHI is likely to become the go-between for mental health services until new contracts are in place since the county’s relationship with Jefferson Behavioral Health’s ends in January, Linthicum said.

Jefferson Behavioral Health is evaluating its future role, said its chief operating officer, Bob Furlough. “We’re continuing to work with our board of directors to identify what activities we’ll be involved with.” Currently his organization has contracts with the state for acute care indigent services and developmental disabilities services.