Health care reform
Taking the lead
Trillium, a health plan provider in Eugene,is
spearheading reform efforts in Oregon
Trillium, a health plan provider in Eugene,is spearheading reform efforts in Oregon
Appeared in print: Monday, July 23, 2012, page A1
As Oregon launches a statewide effort to reform health care, there’s a lot riding locally on the shoulders of one company, Trillium Community Health Plan.
Oregon recently received the go-ahead from the federal government to come up with its own plan to help low-income Oregonians stay healthy and to treat them when they are sick or injured, while keeping a lid on costs.
Trillium, which is owned by a group of 300 doctors, has stepped up to partner with Lane County in establishing a new way to provide health care to people covered by the Oregon Health Plan — Oregon’s version of Medicaid, the government insurance that is mainly for low-income residents.
Trillium is spearheading the new coordinated care organization, or CCO, in Lane County, which plans to provide better health care at lower cost by focusing on prevention; by getting patients’ doctors, dentists and therapists talking more to each other; and by using people such as community health workers to work with patients and help motivate them to meet their health goals.
CCO supporters say that all of these efforts should cut down on expensive trips to the Emergency Room and the hospital, and help avoid duplication of services, such as lab tests.
If the new plan works, it would be revolutionary, and a model for health care reform that could spread into private insurance and to the rest of the nation, health care experts say.
Trillium and Lane County made a high-stakes bet when they pooled their know-how and financial reserves to create the CCO. Lane County is putting up $5 million and Trillium is putting up $15 million in reserve funds that could be tapped if the new CCO’s budget of $270 million doesn’t stretch far enough next year to pay the medical bills for the 55,000 Oregon Health Plan members in Lane County.
“This is really a community partnership that we’ve never had before,” Trillium CEO Terry Coplin said.
“We didn’t know if this is going to work,” said Bruce Abel, program manager of LaneCare, a public insurance company that has managed mental health services for Oregon Health Plan members in the county since 1997.
Starting Aug. 1, Trillium will serve LaneCare’s 55,000 clients, which overlap with the 50,000 clients whose medical benefits had been managed for years by Trillium’s sister company, Lane Individual Practice Association, or LIPA. LIPA’s patients and reserves are being moved to Trillium, and LIPA will no longer have a contract with the state to manage Medicaid services, Coplin said.
“We’re putting all our chips on the table, but there’s no other way forward,” said Abel, who is one of 20 members on the board that will run the Lane County CCO.
Two committees will advise this board: a 17-member panel of doctors, mental health therapists and other health professionals, and a 20-member community advisory council, which includes 11 Oregon Health Plan members, or parents of members.
With escalating Oregon Health Plan costs eating up more and more of the state budget, state lawmakers passed legislation to create CCOs, with the hope that they could curb costs without hurting quality.
Now Coplin, Abel and Karen Gaffney, assistant director of Lane County Health & Human Services — each with more than two decades of experience in health care — say they’re facing the biggest change yet in their careers.
They’re holding hands with doctors, hospital administrators and others, and collectively taking this leap of faith.
“You’re looking at a group that has an equal amount of excitement and apprehension,” Coplin said. “We can’t go to the literature and find examples of when this has worked or not worked.”
Unlike some other counties, whose CCOs have struggled to get out of the starting gates, Lane County’s CCO will be among the first to open its doors, on Aug. 1.
Heads of key organizations that serve Oregon Health Plan members in Lane County have been meeting and brainstorming for the past 2½ years, Coplin said. They realized that they largely served the same group of people, and it made no sense for one health plan and its doctors to care for a patient’s physical health, and a different plan and group of doctors and therapists to care for that same patient’s behavioral health, with little communication or coordination between the two groups.
“In a way we’ve had a head start on the rest of the state,” Coplin said. “We were working on a ‘CCO’ before we heard the words ‘coordinated care organization.’ ”
The lines of communication among different agencies, doctors and others already are open, Abel said.
“I’m hearing we are different,” Abel said. “When I talk to my peers in other counties there is a bit of envy.”
But even with a head start, the local CCO has some challenging years ahead.
“Every component of this has a measure of complexity and problems that we haven’t figured out yet,” Coplin said.
Bringing together physical and behavioral health services, for example, “is going to take a lot of time because it really is looking at things in a different way,” he said.
And the community’s shortage of family doctors and psychiatrists “to cover the population we’re trying to cover,” nags at Coplin.
Some Oregon Health Plan members are understandably anxious about the changes underway.
Springfield resident Sherry Ledbetter said her benefits have been cut over the past few years, and she worries that the switch to CCOs might further reduce them.
“I don’t know what else I might lose,” Ledbetter said. “I’m on oxygen 24-7. I can’t afford to pay for all this oxygen.”
Oregon Health Plan medical benefits are not changing, and most members won’t see much change, except for better management of chronic conditions, according to the Oregon Health Authority.
In general, when Oregon Health plan members heard the shift is aimed at cutting costs, they worried that would mean less or poorer care for them, said Bob Joondeph, executive director of Disability Rights Oregon, a nonprofit advocacy group based in Portland for people with developmental disabilities and people with mental illness. Many of the group’s members receive Oregon Health Plan benefits.
But “there’s also a certain amount of hopefulness,” he said, that CCOs will help avoid unnecessary hospital stays; better coordinate care for patients; offer more help in navigating the system; provide more flexibility in covering services — including community health workers — that weren’t covered before; and provide more opportunities for members to be heard through Community Advisory Councils.
Jose Soto, executive director, of NAMI Lane County, a mental illness education and advocacy group, complimented LaneCare and Trillium for reaching out to and getting feedback from many parts of the community as part of setting up the CCO.
“The transition to Trillium, we’ll have to see how that goes. But up to now I have nothing but good things to say about the process,” Soto said.
One of the hallmarks of CCOs is a “global budget.” Instead of state and federal dollars coming into the county through separate channels — mental health, physical health and substance abuse treatment — those streams will be combined, with all the money going to the CCO.
That raises the concern that money previously earmarked for mental health or substance abuse treatment might be diverted to cover other ailments or injuries.
“It is what has happened elsewhere when other similar experiments have been tried,” Abel said.
That concern motivated Abel to become involved with Lane County’s CCO right from the start. “I wanted to be involved because I wanted to (prevent) that,” he said.
The CCO sees behavioral health as a key medical service, and behavioral health and physical health have equal weight on the decision-making board, Abel said.
As a result, “I don’t carry that anxiety as much as I used to,” he said.
To gear up for its leading role in the CCO, Trillium is hiring and looking for more space near the 27,350-square-foot building owned by its corporate parent Agate Healthcare at 1800 Millrace Drive in the Riverfront Research Park, near the University of Oregon campus.
Trillium has 130 employees and plans to add 15 more in the next six months, including nurses, computer specialists and claims reviewers, Coplin said.
“This is really a community partnership that we’ve never had before.”
<div class="QuickFacts" id="DTElementID-40291358"> <p class="QuickFacts-QuickFacts_Head"> Trillium Community Health Plan </p> <p class="QuickFacts-QuickFacts_Text_Bold_Nested"> Business: A private company that provides government insurance plans, including Medicaid, Medicare and Sprout Healthy KidsConnect </p> <p class="QuickFacts-QuickFacts_Text_Bold_Nested"> Address: 1800 Millrace Drive </p> <p class="QuickFacts-QuickFacts_Text_Bold_Nested"> Founded: 1997 </p> <p class="QuickFacts-QuickFacts_Text_Bold_Nested"> Owner: Agate Healthcare, a group of 300 doctors </p> <p class="QuickFacts-QuickFacts_Text_Bold_Nested"> Employees: 130 </p> </div>