From the Portland Business Journal, September 1, 2012
The state’s largest Coordinated Care Organization will officially launch its services Saturday.
READ – Health Share of Oregon (formerly Tri-County Medicaid Collaborative) [temporary site]
READ – about Oregon Coordinated Care Organizations
READ – a message for members of the Oregon Health Plan
VISIT – CareOregon was the Medicaid provider for Oregon. Are they out of business? Who knows?
Health Share of Oregon, formerly known as the Tri-County Medicaid Collaborative, is set to begin providing treatment to Medicaid patients covered by the Oregon Health Plan.
Health Share of Oregon includes Adventist Health, CareOregon, Central City Concern, Kaiser Permanente, Legacy Health, Oregon Health & Science University, Providence Health & Services and Tuality Healthcare under a single umbrella organization for OHP services.
CCOs offer wide-ranging care, on a continuum of treatment plans, to Medicaid patients. The state won a $1.9 billion grant to demonstrate to federal officials that the program could save billions in future medical costs.
Health Share is one of four groups that’ll kick off its CCO services Sept. 1. Among them, Columbia Pacific Coordinated Care Organization LLC will serve several coastal counties while the Eastern Oregon Coordinated Care Organization will provide services on the east side of the Cascades.
Eight CCOs, including Trillium Community Health Plan in Lane County and FamilyCare Inc. in Portland began offering their services on Aug. 1.
The CCOs will eventually be accountable for health outcomes of their patient population. According to a primer issued by Health Share, they will operate from one budget that grows at a fixed rate for mental, physical and ultimately dental care.
The CCO treatments themselves will be offered by provider teams that work “through common interventions, health home development and shared electronic health records.”
Dr. George Brown, the CEO of Legacy Health who’s leading the Health Share efforts, said providers are raring to go. Medicaid recipients may not notice any immediate changes in terms of billing or back-office systems, he said.
The health plans and providers are determining ways that CCOs can at first address treatments for patients with serious and chronic conditions.
“Those efforts are centered on, how do we keep people healthier, educate them in terms of how they participate in their own health care,” Brown said. “The significant different with (CCOs) is that there’s a level of accountability, and that’s precedent-setting.”
Brown acknowledged that his Health Share duties have become a second full-time job.
“These are great organizations working for the greater good,” he said. “Sometimes, the goals of the organizations aren’t in complete alignment, and this is a grand experiment where there are risks involved. We don’t have all the answers, and this is new. But we’re doing the right thing, and we’ll continue to do so until we’re successful.”
Tri-County Medicaid Collaborative Names Board of Directors
Posted on August 2, 2012
Tri-County Medicaid Collaborative (TCMC), which received certification from the Oregon Health Authority on July 31, 2012, has seated its entire voluntary board of directors as of August 1.
TCMC, which is the state’s largest Coordinated Care Organization (CCO) and serves Clackamas, Multnomah and Washington counties, has a broadly scoped board. In addition to the 11 founding members, nine additional clinical and community representatives joined the board today.
“Our goal is to enhance the health care experience for all members, improve health outcomes for individuals and the community, and spend health care funding wisely,” says Dr. George Brown, TCMC’s board chair. “By involving local caregivers and community members, transformation will be grounded in community goals.”
Board members of Health Share of Oregon include:
Community-At-Large:
Mel Rader – Co-Executive Director, Upstream Public Health
Ramsey Weit – Executive Director, Community Housing Fund
Chair of Community Advisory Council:
Stephen Weiss – Chair of the Elders in Action Commission of Multnomah County, Current Board President of Independent Living Resources, the Community Alliance of Tenants, and the Oregon State Council for Retired Citizens
Dentist – Michael Biermann, DMD – Pediatric Dentist, Owner, Co-Chair, Oregon Head Start Dental Home Project
Mental Health Provider – Mary Monnat – President and CEO, LifeWorks NW
Addictions Provider – Jacqueline Mercer – CEO, Native American Rehabilitation Association of the Northwest, Inc.
RN/NP – Jean-Claude Provost – Lead Clinician/Family Nurse Practitioner, Housecall Providers, Inc., Chair-Elect, Nurse Practitioners of Oregon
Primary Care Physician – Jill Ginsberg, MD – Retired, Northwest Permanente, Founding Board Member, North by Northeast Community Health Center
Specialty Care Physician – Walter Hoffman – Member, Past President, Practicing OB/GYN, Women’s HealthCare Associates, LLC
In addition, the founding members include:
George J. Brown, MD, FACP, Chair, Legacy Health
Cindy Becker, Clackamas County Health , Housing & Human Services
Ed Blackburn, Central City Concern
Rod Branyan, Washington County Dept. of Health & Human Services
David E. Ford, CareOregon
Andrew R. McCulloch, Kaiser Permanente
Joseph E. Robertson, Jr., MD, OHSU
Thomas Russell, Adventist Medical Center
Lillian Shirley, Multnomah County Health Department
Dick Stenson, Tuality Healthcare
Greg Van Pelt, Providence Health & Systems
Interim Health Share leadership team
Interim Executive Director: Janet Meyer janet@tricountycollaborative.org, (503) 416-1798
Janet Meyer has been the Chief Operating Officer of the Tuality Health Alliance since 2006. Prior to joining Tuality, she worked in the managed care industry for twenty years in Colorado and Oregon. Janet is currently the Interim Chief Executive Officer of the Tri-County Medicaid Collaborative, whose mission is to be an integrated community delivery system that achieves better care, better health, and lower costs for the Medicaid population and the Tri-County Community.
Janet earned her M.H.A. from The University of Michigan in 1989 after completing her B.S. in Public Administration at The University of Oregon. Janet is currently active on numerous State and Community Workgroups and is on the Board of Directors for Centro Cultural.
Interim Medical Officer: David Labby, MD david@tricountycollaborative.org, (503) 416-1425
Interim Operations Director: Jon Hersen jon@tricountycollaborative.org, (503) 416-1753
Interim Information Systems Director: Daniel Dean daniel@tricountycollaborative.org, (503) 416-8063
Interim Health Strategy Director: Rosa Klein rosa@tricountycollaborative.org, (503) 416-1761
Interim Director of Government Relations & Public Policy: Erin Fair erin@tricountycollaborative.org, (503)416-1797
Interim Communications Manager: Jeanie Lunsford jeanie@tricountycollaborative.org, (503) 416-3626
TCMC STAFF:
Alpesh Parikh, Senior IT Business Analyst, alpesh@tricountycollaborative.org
Alyssa Craigie, Interim Project Director, alyssa@tricountycollaborative.org
Dina Kalmeta, Administrative Assistant, dina@tricountycollaborative.org
Jacob Figas, Community Engagement Program Coordinator, jacob@tricountycollaborative.org
Office Manager/Operations
Kathy Schuler, IT Project Manager, kathy@tricountycollaborative.org
Merrin Permut, Interim Project Director, merrin@tricountycollaborative.org
Sandra Clark, Project Director for Community Health Strategies, sandra@tricountycollaborative.org
In February 2012 I chewed 120 clonazepam prescribed by Nick Drakos of NARA, and prayed not to wake up.
I had never before been suicidal.
I had been trying to reach Drakos and my physician for weeks. I was hallucinating, in a state of near constant panic, recovering from CO poisoning, confused, suffering blackouts, aggressive, my heartrate wildly irregular, too dizzy to go to the grocery store. My calls were not returned. I was hung up on repeatedly by NARA staffers.
I was referred urgently into Adult Protective Services, who also tried without result to reach my doctors. I went to the ER multiple times, only to be told to contact my PCP. I left explicit messages for Drakos and staff: “I am hallucinating. I can’t care for myself. I am afraid I am going to harm myself. I need medical attention.”
When Drakos finally returned my call, I reiterated. I asked for help. I asked to be admitted to hospital or rehab, or ANY form of supervised care. I repeated: I am hallucinating. I am afraid I am going to harm myself. Drakos told me I was “outside the scope of NARA’s practice”. He stated he did not believe I had sustained CO poisoning. When I said it was documented in the ER with a blood test, he said, “Well, whatever. We’re not giving you any more clonazepam.” I hadn’t asked for any. I didn’t want any. I knew I was in trouble. Help me. Admit me. I pleaded.
“Goodbye, Lisa,” He said, and hung up on me.
Crisis line workers and a triage staffer from a rehab program had to call 911 for me, and finesse my transport to hospital. Nearly a year later, my health is destroyed and I am afraid to leave my house, let alone seek the medical attention I need.
And now I find out that NARA’s Jackie Mercer is the addictions director of the Oregon Medicaid conglomerate… the very conglomerate tasked with improving wrap around medical and psychological support for Oregon’s disabled Medicaid recipients?? Ms. Mercer’s own organisation kicked me to the curb when my disability became complex enough, and my distress urgent enough to provoke a credible suicide attempt. But Ms. Mercer is tasked with promulgating a Tri-County “wrap-around” cooperative effort targetted at better serving patients like me?
And having already been depicted and discarded as a refractory and noncompliant patient, how likely am I to receive appropriate care and intervention from an organisation headed by the CEO of one that discarded me? Especially since now the bulk of the injuries I battle were either caused or magnified by NARA?
The conflict of interest seems patent and the intrinsic ethical dilemma unavoidable: So-called collaborative care organisations cannot police themselves and it is ludicrous to expect them to. If NARA’s response to failure in my case was to discard me, rather than address the issue…then how on earth can a “Tri-Counties” group, comprising exponentially more complex and numerous practitioners, demographics, organisational biases and conflicting interests,do better?
If the benefit did not accrue to the patient in a small integrated setting, then how can the promulgation of the selfsame care model prove beneficial to the same patient in a large “integrated” setting?
And having been ostracized, injured, maligned and discarded by one prominent player in the Tri-Counties CCO, how can I hope to find competent care anywhere in same CCO? I am faced with having to move out of state just to get appropriate medical care.
Yet thanks to NARA I am now too frightened, injured and ill to confidently leave my house.
If anyone wants to talk to me about this, you can email. This is the first time I’ve even been able to write it down, I’m so traumatized.