CCOs Make Critical Early Payments to Providers & Hospitals

Last week, we reported on the early release of 2019 incentive dollars to Coordinated Care Organizations (CCOs). Following this early release, COHO CCOs have been working hard to allocate these funds quickly and responsibly while keeping their members at the center of all decisions.

First, we should talk about what incentive funds are. Each year, the Oregon Health Authority (OHA) withholds a portion of CCOs’ global budget, which can be earned back based on achieving positive health metrics for members they serve. Incentive dollars are allocated by CCOs’ boards through a rigorous process and primarily go to hospitals, clinics, and other providers as part of value-based contracts (think of it like a bonus for helping meet aggressive preventive care goals determined by the state).

The incentive dollars that were released at the end of March were earned in 2019 by the hardworking providers contracted with CCOs to serve Oregon Health Plan members. In fact, many providers that work with CCOs have this incentive pool “bonus” built into their contracts—meaning that many of the dollars that are being released early will go to providers and health systems that are badly in need of financial support.

In normal times, a portion of these funds would also go toward community-driven programs and health innovation. CCOs are quickly pivoting to ensure funds are dedicated to supporting community needs related to COVID-19. This may include rental assistance for members, delivering groceries and supplies, and securing Personal Protective Equipment (PPE), among other things.

With all the needs related to COVID-19, what will our CCOs invest in, and how will they make every dollar count? We look forward to sharing more success stories in the weeks ahead. We are also partnering with OHA on policy adjustments to protect providers and ensure community investments can continue. Stay tuned.

Gov. Brown to Announce Bridge Loan Program for Certain Health Care Providers

You may think that hospitals and health care providers are incredibly busy caring for those that have contracted the novel coronavirus, but in our state where only 303 patients are currently hospitalized for COVID-19, this pandemic has actually increased costs and decreased revenue, causing a major cash crunch across our health care system.

The cash flow issue stems from added costs of increasing emergency department capacity and ensuring extra staff are available if a hospital surge occurs. Meanwhile, the cancellation of all elective and non-emergency surgeries has decreased revenue, pushing some hospitals and health care providers into dangerous financial territory.

We know that hospitals’ and providers’ ability to keep their doors open and serve Oregonians is critical not only during this pandemic, but also to preserve our health care delivery system. In southern and rural Oregon where there is less access to providers, clinics, and hospitals, existing hospital and health systems remaining open is paramount.

For these reasons, Governor Brown and her policy experts are crafting a bridge loan program for 24 critical access hospitals across the state. This loan program is still in the beginning stages of drafting, but it’s clear the Governor has heard the concern from hospital and provider systems about cashflow and intends to do something about it.

The legislation proposed to deliver aid to these critical access hospitals appropriates $50 million dollars to this program and indicates that the source of the capital would be the dollars given to Oregon through the federal CARES Act relief package. And while this program is dedicated to bailing out hospitals that are currently in financial dire straits, it does require those health systems to pay back the state at a low interest rate of zero to one percent. There are also requirements in the legislation around hospital staffing and labor.

Currently, the Governor’s office and other stakeholders are working diligently to ensure that critical access hospitals and other providers have the financial resources they need to continue the battle against COVID-19 while still ensuring that the state maintains a balanced budget.

How to Use Oregon’s COVID-19 Symptom Checker

Are you worried that you might have the novel coronavirus, but think you might not meet the criteria to be officially tested? Last week, the State of Oregon launched a “Coronavirus Checker” online program that checks your symptoms and gives you advice based on clinical best practices, current CDC guidelines, illness severity, and risk factors like age and underlying medical conditions.

The website, c19oregon.com, will direct you to a hospital with enough capacity to treat you, if it determines you need emergency care. If you don’t have severe symptoms, it will direct you to continue to maintain your social distance but recommend that you call a health care provider. During the season change that causes symptoms fairly like those of COVID-19, this tool will be a very helpful device in calming concern that you may have caught the virus.

Once you’ve clicked the link above, it will take you to the home page, which has a “Get Started” bar.

  1. Click the “Get Started” Bar

Once clicked, the site guides you to a second page, which explains that this does not replace or constitute the practice of medicine—as always, if you believe that someone in your care is incredibly sick, call a health care professional. If you scroll to the bottom of the page, it requests that you accept terms and conditions.

  1. Accept the Terms & Conditions

Next, in order to gather accurate data about you, the website requests your age.

  1. Enter your age into the empty field provided, then click “Next”

Then, it asks your location.

  1. Enter your zip code in the empty field, and click “Next”

Next, it requests information on your symptoms. The options are fever, cough, shortness of breath, fatigue, body aches, headache, diarrhea, sore throat, loss of sense of smell or taste, or none of the above.

  1. Choose all the symptoms you currently have, then click “Next”

Next, it asks if you have had any life-threatening signs since you became sick. Some options include a very hard time breathing, unable to keep down food or drink for 12 hours, feeling lightheaded, or having altered or slurred speech.

  1. If you have experienced any of those symptoms, choose them, then click “Next”

Do you have any underlying medical conditions? This website wants to know. The website gives a list of common pre-existing conditions, and requests that you choose all the conditions you have been diagnosed with.

  1. Choose your underlying conditions and click “Next”

Once you have completed these steps, you should find yourself at the final page, which gives you a summary of what you reported, as well as recommendations for reaching out to a health care provider, or for immediately seeking emergency help. The website also offers information on how to protect yourself, as well as up-to-date information from the CDC about how the virus spreads.

For more resources and information, you can also visit the Coalition for a Healthy Oregon’s resource page, which is updated weekly.

COVID-19 Testing and Capacity for Providers

Health care providers know that when facing a pandemic like the novel coronavirus, the more we test Oregonians for it, the clearer the picture is for what our state needs to prepare for. However, creating the type of accurate modeling needed to give public health officials a clear answer is made more difficult by the fact that there is not widespread availability of the rapid in-clinic testing, and the PCR testing that has been used by health care providers up until now is only accurate 85 percent of the time.

If Oregon lawmakers push for making the rapid in-clinic test widely available, we might be able to create a much more accurate model of this pandemic. In the next few weeks, there will also be widespread deployment of antibody tests that can determine whether a person had the virus, recovered, and built up an immune response, making them less likely to contract the disease again.

Will Oregon lawmakers push for making the rapid in-clinic testing widely available? The House Republican page on COVID-19 updates mentions the rapid testing but says that supplies to run the test are short at this time. Widely testing residents has been a clear desire of the legislators on the Joint Coronavirus Response Committee, as they made clear to the Oregon Health Authority during their sessions last month. Could a more accurate model allow our state to get back to work sooner?

From a scientific standpoint: yes. Scientists believe that we need at least six more weeks of social distancing. If our state is able to procure wide enough testing that almost every single person currently in Oregon can get tested, while continuing these aggressive social distancing measures for the next six weeks, we might be able to create quarantine-like policies that provide specific guidance for populations based on the result of their test. This would allow folks who test negative, or those who are immune but not a contagious carrier, to return to work.

If we can achieve this level of stability, our state could work full force on manufacturing PPE, getting aid to other states, and helping to end this more quickly for our entire country. We wouldn’t need to worry about overly extensive economic fallout from the shuttering of our businesses.

However, from a political standpoint: unless California and Washington join us, and the science agrees, we will not be able to reopen as quickly. With President Trump announcing his “Council to Reopen the U.S. Economy,” several states, including New York, which carries more than 32 percent of the country’s COVID-19 cases, have banded together to coordinate their re-openings together. This move by Democratic governors across the nation is a signal to the Trump Administration that they will only be open for business when it is safe.

Indeed, on Tuesday morning, Governor Brown hosted a press conference in which she addressed the future systematic re-opening of Oregon’s many restaurants, bars, clothing stores, etc. In her comments about the framework of this reopening, she said “The best path forward is a cautious one. A path that proceeds gradually, incrementally, and carefully. A path that relies on science and facts to determine each step forward.”

Governor Brown is incredibly committed to not moving forward unless the science is strong enough to signal that it is safe to begin incrementally opening our state back up. Until then, we will be FaceTiming our family and friends, sitting outside but only in our backyards, and typing up articles like this on my kitchen table.

CCOs Receive Incentive Metric Payments, Increase Community Investments

With the creation of Coordinated Care Organizations (CCOs) came regulations to ensure progress toward the Triple Aim:better health, better care, and lower cost for Oregonians enrolled in the Oregon Health Plan. One of the ways to hold CCOs accountable for positive health outcomes was to provide “health metrics” tied to a financial incentive for CCOs, which can in turn be used to reward providers for helping meet these population health goals.

Each year, the Oregon Health Authority (OHA) withholds a portion of CCOs’ global budget, which can be earned back based on achieving these health metrics. This mechanism is one way that CCOs are held responsible for tracking and improving preventive care, with the ultimate goal of keeping people healthier and out of the emergency department.

Each metric is carefully chosen by OHA’s Metrics and Scoring Committee, and metrics are revised ever year. Once all the CCOs have established systems that have proven effective in addressing a specific metric, that metric is retired, and a new one is created. CCOs have flexibility in what they can do with this money when they receive it on a normal schedule, allowing them to pass a bonus on to their providers and other stakeholders.

With the outbreak of the novel coronavirus creating a cash crunch across the health care system, OHA made the decision to release 60 percent of these payments to CCOs by March 31, a couple months earlier than normal. This allows CCOs to respond to the emergency by making community investments that are directly related to COVID-19.

So, what will our state’s CCOs do with this money, and how will it be regulated? Once the OHA shared that these payments would be released to CCOs, they quickly followed with a requirement that CCOs complete a document discussing the different COVID-19 community investments that they will be making over the course of this pandemic that was due back to the authority by April 10.

COHO CCOs got to work making hard decisions about what community needs were greatest, and what needs would continue to pop up over the next several months as the virus progresses. OHA encouraged CCOs to focus on COVID-19 related areas of need, and requested that each CCO provide an overview of the methodology used to distribute the funds, information on entities receiving the funds, an estimate or range of the expected distribution, a summary of the extent to which distributions were based on previous contracts, a summary of the extent to which distributions were based solely due to COVID-19, a timeline of when distributions were made if possible, and an estimate of any money not distributed and the reason why.

By the end of June 2020, each CCO will also be responsible for providing a final accounting of the distribution of these funds into their community, including explanations for major deviations from the plans provided to the OHA in April.

COHO CCOs worked in collaboration with their Community Advisory Councils, board members, providers, and other members of the community in order to make these incredibly important decisions about where in the community these funds will be invested.

While we don’t have a complete list available of where our CCOs will be investing their money, we know they are doing what is best for their communities! In a few weeks, we look forward to publishing an article that details several of the investments made by CCOs using these funds.

CCO Highlight: Trillium Community Health Plan

All our member CCOs are doing a fantastic job filling gaps for their members during this critical time, and this week, we decided to highlight an exciting pilot project by Trillium Community Health Plan!

Through this crisis, we know every single Oregonian will be affected in one way or another. The difficult part is identifying those who are most in need and finding a solution to serve them. In one of its many initiatives, Trillium Community Health Plan is focusing on an at-risk population that we haven’t heard much about: pregnant women and people.

Just like those who are immune-compromised, pregnant women and those less than two weeks postpartum are at incredibly high risk for contracting COVID-19 and developing medical complications. Women’s Care, one of Trillium’s provider partners, reached out to explore ways they could work together to reduce pregnant Oregonians’ exposure to COVID-19, while still ensuring they are receiving essential health services, like doctor’s visits.

Part of Trillium’s mission during this COVID-19 crisis is to keep its members as safe as possible. So, Trillium launched a project in partnership with Women’s Care to identify reasons that pregnant people go to the doctor, to find creative ways to decrease doctor visits. Women’s Care was able to pinpoint that it is crucial for pregnant people to get their blood pressure checked often for gestational hypertension, chronic hypertension, or preeclampsia. Often, blood pressure checks generally happen in-person at the doctor’s office or a local pharmacy.

In order to keep pregnant patients away from pharmacies, grocery stores, and doctor’s offices, where their chance of contracting COVID-19 is high, Trillium provided 105 blood pressure cuffs to Women’s Care, so members can check their own blood pressure at home. This decision on Trillium’s part further ensures the safety of their member, and their newborn.

Not only did Trillium help identify and provide a solution to the need discussed above, it was also able to fulfill a request from Lane County Public Health to procure much-needed Personal Protective Equipment (PPE). Trillium procured 5,000 N95 masks, 96 face shields, and 150 gowns by working with its corporate partners and shipped this critical PPE directly to Lane County Public Health.

Trillium Community Health wants you to remember that we’re all in this together. A sentiment we’ve heard often during this outbreak, and we feel is especially true for CCOs, providers, and the community members we serve.

Thank you, Trillium Community Health Plan, for your commitment to serving your community.

You’re right—We ARE all in this together!

Will COVID-19 change how Oregon approaches Health Policy?

For years, health care reform has been a major platform for many candidates running for public office, as well as a key legislative priority for many Oregon legislators. Whether it’s decreasing the prices of pharmaceutical drugs, increasing the number of insured Oregonians, or ensuring underrepresented communities receive the care that they need, we have been fighting for some time to address these issues within our health systems.

As the novel coronavirus spreads through our communities, it has exposed weaknesses in our health delivery system, as well as the structures that govern those systems. It has also shown how Coordinated Care Organizations (CCOs) are able to deploy resources quickly to provide basic resources and keep people out of the hospital.

Indeed, one of the most important lessons we will learn from this pandemic is that our health care system was not fully equipped to handle it. How do we create a system that is able to respond more cohesively and comprehensively in a crisis?

One of the first steps taken during this pandemic was the collaboration of publicly owned hospitals and health systems with those that are privately owned. In every major health industry, public and private businesses and health care providers are coming together to ensure that we decrease the effects of this crisis. In the pharmaceutical industry, corporations and public health entities are working together to find a vaccine or therapy for the virus. Hospitals are coordinating so that public hospitals can discharge patients from their emergency department (ED) for care at private hospitals that may have more capacity. Will this willingness and ability to collaborate make these groups more inclined to compromise on health care transformation?

Another step that was quickly taken by officials was to increase access to telemedicine, by decreasing the barriers to this care. By relaxing rules around privacy (known as HIPAA laws), providers of all types may utilize FaceTime, Google Hangouts, and Skype. Not only were restrictions removed in many states including Oregon, providers will now be reimbursed at the same rate as providers seeing patients in person. Before this move, telemedicine was not something widely utilized in Oregon.

With the uptick in Oregonians projected to utilize OHP and our state’s CCOs rising to the challenge, will more legislators be interested in utilizing OHP at a higher rate, or expanding the coordinated care system? Oregon has never shied away from having the universal health care conversation, but what’s always been missing is how exactly we will achieve that goal. Will some of the changes made during this pandemic answer questions our legislators have previously had about how to deliver universal coverage for all?

We don’t know if any of these changes will stick, but we do know that Oregon’s CCOs have been leading the way in deploying resources to their communities in an unprecedented fashion, allowing them to serve their communities at a much faster rate.

OHP Utilization Increase

With 92,700 Oregonians filing for unemployment in a single week, many people may not have access to the health insurance they need during a pandemic. With the expansion of unemployment insurance (UI) benefits, as well as the federal allowance to provide broadened eligibility to state Medicaid programs, we know many people will likely be filing for Oregon Health Plan (OHP) benefits as well.

Currently, one in four Oregonians are served by OHP, the state-based Medicaid program that delivers care through coordinated care organizations (CCOs). In a report completed by Health Management Associates, as many as 430,000 Oregonians could lose their health coverage, and most of those people—about 320,000—would turn to OHP coverage. This report lays out three different scenarios, and even the least destructive scenario in the report projects that 149,000 more people will apply for OHP coverage.

Health Management Associates produced studies on how this will affect Medicaid in every state, and found that lower- and moderate-income people are the most likely to lose their jobs and employer-sponsored health insurance. This economic downturn will disproportionately affect younger individuals who earn less than $50,000 annually.

Will the CCOs that serve our state be able to rise to the challenge of this explosion in OHP enrollment? In short, they’re working incredibly hard to.

COHO has been working collaboratively with the Oregon Health Authority (OHA) to provide solutions and recommendations that would allow CCOs to increase access to health care and expand their capacities. Due to this collaboration, OHA has extended report deadlines, paused rulemaking and the rollout of some new programs, and released 100% of the quality pool money that is normally doled out based on positive health outcomes.

The release of quality pool money is to enable CCOs to invest in resources that their community needs right now, like food, rent assistance, housing, increased mental health services, and providing capital to keep rural clinics and other systems afloat, just to name a few.

This quality pool money isn’t just a blank check though – CCOs are required to provide documentation about planned community investments to ensure this release is going strictly to COVID-19-related investments.

Other than working with OHA to increase capital and decrease administrative reporting, our CCOs are working around the clock to launch call centers, provide food resources to children and elderly adults, and others in need. CCOs are also reinventing current programs in new and creative ways. For example, some CCOs are utilizing their Non-Emergent Medical Transport (NEMT) independent contractors who normally drive patients to doctor’s appointments to deliver food to those that may be medically fragile.

Our state’s work to provide resources and work with our CCOs, as well as the current success of aggressive social distancing measures, make us feel hopeful that our CCOs will have enough capacity to serve increase a greater number of Oregonians through this time.

Do you have ideas on how your COHO CCO could invest in your community? Share them with us here.

Governor Brown Aids New York

With 360,901 identified cases of the novel coronavirus in our country, the state of New York has been identified as the epicenter of the outbreak and carries more than 130,000 confirmed cases. For weeks, New York Governor Andrew Cuomo has been calling on President Trump to use the Defense Production Act to secure more medical equipment and has also requested that the federal government release the 20,000 ventilators in stockpile to New York.

Despite his many calls for help, New York received only 400 ventilators from the Federal Emergency Management Agency (FEMA). The state is now due to run out of ventilators as early as this week.

Oregon Governor Kate Brown heard his concerns and decided to act.

Thanks to Oregon’s aggressive social distancing measures, Oregon is on the right path to “flattening the curve,” leaving our state in a good position to aid other states that need assistance.

In an official statement, the Governor’s office said, “If Oregon later finds itself in need of ventilators, New York and other states will respond to our call for assistance.” Governor Brown in a later tweet said, “Oregon doesn’t have everything we need to fight COVID-19 – we need more PPE and testing – but we can help today with ventilators. We are all in this together.”

Currently, with the outbreak at its peak in New York, there are more than 15,000 people hospitalized, with more then 4,100 of those people not only in critical care, but also needing access to ventilators.

This unprecedented step taken by Governor Brown to aid another state doesn’t seem to be the last act of good our states will be taking. Shortly after Governor Brown made her decision to send ventilators to New York, Governor Gavin Newsom of California decided to take similar steps by loaning ventilators to states where COVID-19 is taking a heavier toll, like the state of New York.

Not only are our states working together to get each other much-needed ventilators, Governor Newsom announced yesterday that the State of California just inked new deals to manufacture 200 billion N95 masks per month. This huge increase in masks will not only meet the needs of Californians but could help other states with their shortage of personal protective equipment as well.

Resources

What should I do if I lose my job?

Due to the Covid-19 outbreak, our unemployment benefits are quickly being expanded to include those that are out of work due to the virus. If you would like to apply for unemployment benefits, you can do so here. If you are still employed, but need sick time, here is a resource to walk you through your rights to sick time.

What should I do if I lose my health insurance?

If you have been laid off, you may be eligible for Medicaid, a government-funded insurance plan. You can apply for those Oregon Health Plan benefits here.

What should I do if I need access to mental health services?

If you are enrolled in the Oregon Health Plan, you should have access to a mental health provider, but we recognize that sometimes wait times or lack of providers taking new patients might be a concern. Here are some more resources:

What should I do if I believe my family needs food assistance?

If you are concerned about where you next meal may come from, or think your family might need SNAP assistance, you can apply for those benefits here. Here are some more food resources:

What should I do if I am concerned that someone isn’t following the Executive Order?

Governor Brown’s executive order of “Stay Home, Save Lives”, is enforced through a complaint system, in which Oregonians hold each other accountable for not leaving their homes, and operating their businesses in a fashion that follows this order. However, if you’re interested in reporting someone that may not be complying with the order, please do not call 911. You can file a report by calling the police non-emergency line. That number is: (503)823-3333.

I’ve heard rumors that gas stations are moving to self-service only, is this true?

Long story short, no, the rumors aren’t true. Our state clarified the temporary suspension of full-service gas pumping, saying that self-service is not mandatory. This policy was put into place as gas station owners struggle to fully staff their businesses, due to illness, childcare issues, and safety concerns. The only time self-service gas will be mandatory is if the state’s gas station workforce continues to dwindle, and you happen to get gas from a station that does not have enough staff to complete full-service gas requirements. Don’t know how to pump gas? Learn here.