CCO 2.0 General Feedback Survey #2 Survey Period: June 18 – August 1 Open-Ended Comments
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CCO 2.0 General Feedback Survey #2 Survey period: June 18 – August 1 Open-Ended Comments Comments submitted have not been edited except to remove any personally identifiable information. QUESTION: IS THERE ANYTHING ELSE YOU’D LIKE TO SHARE WITH US ABOUT THESE IDEAS TO IMPROVE THE OREGON HEALTH PLAN? # Comment 1 Re #8: I thought the idea was to have the CAC reflect the community, not the governing board. One concern with having the CACs reflect the communities they serve is that they could become less diverse than they are now. Some CACs have intentional over-representation of historically marginalized communities. If it is really about governing boards, then this could be a dangerous policy. Governing boards need to include individuals who understand and can be held liable for the business of the CCO. Medicaid financing and regulation is complex. It makes more sense to empower the CACs and ensure the CACs reflect the communities the CCO serves and bring that representation to the governing bodies and staff leadership of CCOs in a meaningful way. 2 The CCO should also include public health and local hospital representation on their boards for better collaboration among prevention specialists and providers. 3 CCO's are not the problem. It's out of control pharmaceuticals, providers doing unnecessary care, members who have no out of pocket cost and couldn't care less about the cost of healthcare, and the complete lack of payment integrity activities at OHA, which leads to providers wastefully and fraudulently getting paid 4 CCOs are an absolute joke and waste of money. For instance, Advantage Dental in Florence OR is awful in every way but that's the one the CCO requires. We'd be better without them and require all medical providers in Oregon to have a percentage of their practice be Medicaid. 5 I believe the OHP should provide funding to Clubhouse Model programs--programs that are focused on psychiatric rehabilitation instead of clinical interventions, recovery and community integration instead of stabilization. Clubhouse programs can be the "next step" after stabilization for people seeking genuine recovery (see the Clubhouse International website). 6 Question 7 fails to consider that much of the OHP population have chronic conditions that don't improve. Their condition would significantly decline without the supports necessary to keep the individual at the highest level of function achievable. Individuals, who are currently stabilized, are being discharged without these supports under the current single-minded emphasis on improvement. Preventing and decreasing the rate of decline for this population is just as important as improvement. Using a single approach creates discrimination for those who can improve, and leaves those who can't improve in dire straights. 7 Change having MODA Health be in charge of EOCCO, they have poor customer service, poor Provider Relations and Appeals Departments, and poor policies. They are the number one insurance company that causes problems with billing in my small physician office. # Comment 8 OHP should pay for alternative care. Listen to the clients needs and provide services that help keep the person healthy that helps keep cost down. 9 It is critical to improve transparency and accountability - making financial information public to the extent possible, for example. I also think CCOs should be required explicitly to partner with the local health department in addressing social factors and eliminating health inequities. 10 Provide more access to things like kris, scans, quality meds, and things that actually fit the patient, like knee braces or orthotics. Increase the list of ailments that are coveredto include things that a lot of aging people get that are not treated at all. Like plantar fasciitis. Stay away from cutting chronic pain patients off opioids just to appease the CDC opiods recommendations. These people are suffering and dying. 11 I find it very frustrating that naturopaths are accepted providers in the OHP system. They do not provide the same standard of care as medical professionals, but are given equal treatment. For example, our first assigned primary care provider (through the Yamhill CCO) was a naturopath. Although I was able to switch to a doctor, if I had not known that naturopaths do not receive the same training that doctors and nurses receive, I could have mistakenly placed my trust in someone without the expertise and oversight I thought I had been promised (as my assigned primary care provider). If chiropractors, naturopaths or acupuncturist must be included as providers, they should, at the very least, not be assigned as PCPs. And it would be great if you could provide some real information to the public on the difference between a true medical education and medical board oversight versus non- medical educations and other types of oversight. I feel this could help people make more informed decisions, which could decrease overall costs. 12 I hope that every DCO (dental care org) has provisions to provide dentists and hygienists that can serve patients outside of the traditional brick and mortar practice....do house calls for the homebound. There are homebound patients that cannot get out and about easily and they are not able to access their dental benefits due to no provision for mobile dentists/hygienists that are enrolled in their DCO. We need to ensure that all enrolled can have access to care, regardless of mobility or lack thereof. 13 I dotn think the OHP should pay for anyting that is not medically necessary. Hormone treatments for transitions or gender changes are not medically needy. Birth control, hysterectomies and vasectomies are however. 14 Mental and Behavioral Healthcare Services must be addressed. Make CCO board meetings more transparent and consider requiring seats for 1 provider OR Hospital from EACH county serve on the boards. Add more OHP members to the LCACs instead. Design a PMPM payment model such as EOCCO has (and has been successful at) along with a voluntary risk pool to reward providers and hospitals for achieving goals. Requiring CCOs to pay for housing/food will only take away from other important areas - require smaller investments in this area over the next five years to measure the impact before requiring a large investment that will rob Peter to pat for Paul. MOST IMPORTANT- REQUIRE EACH CCO TO PAY PROVIDERS FOR BEING A PCPCH LOOK AT THE EOCCO MODEL. IF YOU WANT PROVIDERS TO INVEST AND PROVIDE PATIENT CENTERED CARE , HELP THEM TO COVER SOME OF THOSE EXPENSES. # Comment 15 CCOs funneling their cost savings back into primary care, dental, mental health and substance abuse treatment. OHP including both dental coverage, mental health and substance use treatment. OHA putting more pressure on CCO re sharing cost savings with provider entities. OHA putting more pressure on CCO to share their data with health centers, OHA and public, particularly around shared cost savings. OHA requiring CCO to collect information /data on social determinants of health of their members + requiring CCOs to use their dollars to implement interventions to intervene on better health outcomes. Lastly, requiring CCOs and DCOs to reduce the barrier of dental care by providing patients with choice in securing dental care! 16 I am a retired physician. I like what CCOs have done to coordinate care and keep costs from escalating like they were. I am very concerned about what Trillium did (underserve its patients while raking in egregious profits) and want CCO board meetings to be open to the public to oversee decisions on use of public money. Any excess income for a CCO should be placed into an escrow trust managed by the public and usable only for patient benefit. 17 I believe moving towards value based pay is crucial, however, this must be done in a mindful way. If you don't adjust for patient complexity and social determinants of health, you will not actually be paying for value. 18 The Oregon Health Plan should not become involved in housing, etc. It would to broad a scope to manage well. Focus dollars on healthcare, including oral and mental health. #8 could be negative or positive. Set some varied board seat requirements and have others be at large to get a good representation; however, if the board is too large it becomes ineffective and does not function well. 19 The raise in minimum wage has increased the cost of doing business in the healthcare industry to the point that as providers we are barely scraping by financially. Making a couple of dollars above minimum wage when you have a college degree is insulting; every time minimum wage goes up members of the community are encouraged to stay away from educational institutions to better themselves. 20 Access to care is the problem in smaller communities. I don't know if there is a way to resolve that problem. 21 Prioritize oral health! 22 A big problem is the number of providers who accept OHP, it needs to increase because there's not enough providers that are available and limited options for people. Investigate why this is a problem... what are the barriers for providers and why don't they want to work with OHP. (i.e. is it the reimbursement, paperwork like for referrals, etc.) 23 A focus on transitions of care and support for systems that integrate care and information sharing across health care settings to support and improve care at the lowest cost (i.e. Primary care) rather than Emergency Department/hospitalizations for preventable conditions if pt was seen in primary care setting. 24 Working with more specialists (Neurology,Neurosurgeon,Orthopedic ) that takes OHP and work with patients that have OHP. # Comment 25 OHP should allow moderate income Oregonians to buy into OHP even if they are over the current income limit of 300% Federal poverty rate.