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Oregon Transformed Health System to Include Key Mental Health Support

By Mental Health Weekly�� March 13, 2012

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Oregon is preparing to transform the delivery of its health care system to become more patient-centered and team-focused through the establishment of coordinated care organizations (CCOs) that will integrate mental, addictions, and physical health care services in a move that they hope will mean improved care and lower costs, said state officials.

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Gov. John Kitzhaber, on March 2 signed Senate Bill 1580, a new law that creates CCOs, which will be locally governed entities that would deliver health care coverage to 600,000 Medicaid enrollees and on the Oregon Health Plan and 59,000 Medicaid and Medicare enrollees.

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CCOs are projected to save the state some $3 billion over five years by reducing waste and inefficiency and increasing front-end prevention, according to a press release from the governor’s office.

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The fully integrated health care delivery system will include mental health and addiction services, physical health care and dental care. Formal establishment of the CCOs under the Oregon Health Plan is scheduled to take effect by July 1, 2012.

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“Oregon has had a managed care system since the mid-1990s,” Madelyn Olson, deputy director of mental health for the Oregon Health Authority, told MHW. “This takes it to a new level.”

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“The CCOs will have responsibility for mental health treatment for all covered populations,” said Olson. During this month’s bill signing, Olson said she overheard one physician from the western part of the state discussing plans to bring together as quickly as possible all local mental health and addictions providers as a group to form a CCO.

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“The transformation is aimed at improving access and the quality of care people receive and at the same time containing costs,” she said. “We’re seeking more flexibility in how payments are made to CCOs.”

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The state wants to fully integrate care for people with mental health and addiction disorders, so that there will be a single point of accountability for all of their care, said Olson. “Much of the early deaths [associated with behavioral health disorders] are caused by chronic medical conditions,” she said. The governor wants to take the preventive approach to all these disorders,” she said.

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Officials want to ensure the conditions are treated concurrently, Olson noted. Implementing a CCO that can truly integrate care and achieve better outcomes, will allow CCOs to provide innovative early identification and early treatment services, said Olson. “We envision working with peer recovery specialists, who will help consumers navigate support services in the medical arena,” added Olson.

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Over the last five to seven years, the state has carved out its mental health services, and provided outreach, wrap-around services, and community- and home-based services for consumers, said Olson. “That learning and expertise will benefit the physical health side as [they] set up person-centered medical homes,” she said.

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The skill sets developed by the mental health community over the last several years in community and home settings will be very beneficial in CCO implementation, Olson said.

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CCO implementation

Meanwhile, the Oregon Health Authority is preparing for emerging CCOs to apply for approval and certification from the state. Greater Oregon

Behavioral Healthcare Inc. (GOBHI) a nonprofit managed care entity is set to take the lead role among mental health organizations and healthcare entities in establishing a CCO as the state shifts to an integrated care model under the Oregon Health Plan.

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Shortly after the governor’s election in November 2010 and knowing that integration was part of Kitzhaber’s agenda, GOBHI began its planning

process to achieve the efficiencies that the state would be looking for under a more integrated approach (see MHW, Dec. 5, 2011).

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“We’re forming a coordinated care organization that will cover 17 counties in Oregon,” GOBHI chief executive Kevin Campbell, told MHW. Behavioral health treatment providers, hospitals, independent physician associations, federally qualified health centers (FQHCs), and rural health clinics will all be involved in the integrated approach called for in the establishment of GOBHI’s CCO, Campbell said.

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“We’re working toward a recovery-based model,” he said. “We can use wrap-around services to meet the needs of individuals.” GOBHI wants to be “deeply invested” in early assessment, said Campbell. “We’re aggressively building alternatives to institutions for people recovering from mental illness.”

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GOBHI wants to ensure all children born in rural Oregon have full access to good, preventive health care, said Campbell, who also intends to work to avoid cases of neglect, quickly identify trauma and intervene promptly.

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“Over the last 17 years we paid [for services] using a risk-based subcapitated model where the risk is borne by the community,” said Campbell. “We found that worked very well in providing better care, better accountability and containing costs. We want to expand that into physical health.”

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Campbell said he does anticipate that the integrated approach will call for an increase in the behavioral workforce, although much of it could be with paraprofessionals and peer and support workers who will help with the wraparound services, he said.

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“We’re very optimistic,” said Campbell. “We believe rural Oregon can take the lead nationally in community behavioral health care reform that’s both affordable and accountable.” GOBHI’s CCO will be effective August 1, he said.

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“Our goal is to achieve a triple aim: better health, better health care, and lower costs,” said Campbell.

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Community response

The Association of Oregon Community Mental Health Programs is pleased with the CCO concept, said executive director Cherryl Ramirez. “Our hope is that behavioral health gets the attention it deserves and needs in order for people to [achieve] significantly better health outcomes,” Ramirez told MHW.

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While the state had carved out mental health services previously, we are carving behavioral health back in to integrate with physical health care,

said Ramirez. “We’re putting it altogether. That premise will be good for mental health outcomes.”

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Ramirez said she doesn’t anticipate much savings from the plan in the first or second year. “You need to develop new programs and train health navigators to provide outreach to consumers who have no idea what a coordinated care organization is all about,” she said. Longterm health outcomes will end up saving the state money.”

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Mental health advocates in the state say they would like to see more information about the state’s plans to move forward with the CCOs, said Debbie Child, executive director of the Mental Health Association of Oregon. “We’re cautiously optimistic,” Child told MHW. “Resources for people with mental illness are [sorely] needed, but we still have concerns. Changing practices is not the same as changing policy.”

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“How do we ensure people do not fall through the cracks,” she said. “We haven’t seen enough details about the [new] plan and how to communicate the changes to people who will use the services,” said Child. “How effective will this plan be for the end user? We hope it’s going in the right direction.” •