Not so long ago, the state of Oregon was facing a $1.9 billion deficit that was largely driven by overspending on its Medicaid program, says Jim Rickards, M.D., senior medical director at Portland, Ore.-based health insurance company Moda Health.
Typically when states address these budget shortfalls as it relates to healthcare and Medicaid spending, Rickards says they will deploy some sort of combination of: decreasing provider reimbursement, decreasing the number of individuals who are eligible to receive Medicaid benefits, and decreasing the number of covered services. But in Oregon, these options were not viable for various reasons. As such, a new model of care for delivering benefits emerged—one that centered on community-governed Medicaid managed care plans.
Indeed, Rickards, a radiologist, helped develop one of the first coordinated care models on the West Coast, called Yamhill Community Care, an Oregon coordinated care organization (CCO) that was established by the Oregon Health Authority (OHA) in 2012. The CCOs in the state aim to network of all types of healthcare providers (physical healthcare, addictions and mental healthcare and dental care providers) who work together in their local communities to serve people who receive healthcare coverage under the Oregon Health Plan (Medicaid). Today, there are 16 CCOs operating in communities around Oregon.
Jim Rickards, M.D.
CCOs focus on prevention and helping people manage chronic conditions with the aim to reduce spending by cutting unnecessary ER visits and giving people better support to be healthy, for example. According to the OHA’s website, “CCOs are local. They have one budget that grows at a fixed rate for mental, physical and ultimately dental care. CCOs are accountable for health outcomes of the population they serve. They are governed by a partnership among healthcare providers, community members, and stakeholders in the health systems that have financial responsibility and risk.”
Rickards says that when helping form the CCO, he realized, for instance, that “just 10 percent of our overall health is impacted by the medical care we get, and the rest of the determinants are things like our behaviors, socioeconomic status, genetics, and access to transportation. So we have all of these resources that could affect and improve someone’s health in these other areas, but those other resources are not coordinated with the medical care we provide,” he says.
On the podcast, Rickards discusses the formation of Yamhill Community Care, lessons learned to date, how health IT has been leveraged, and why these types of care models are so important in their efforts to improve the health of its members.
Rickards also just released a book about the entire experience (from his grassroots efforts all the way to the courts) titled Our Health Plan: Community Governed Healthcare That Works.
This podcast runs about 24 minutes in length and keep in mind, you can listen to all Healthcare Informatics podcasts right here.