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Health System Transformation Update

Health Care Stakeholders Around Oregon Prepare for August 1st Launch of Coordinated Care Organizations

In 2011, at the request of Governor Kitzhaber, the legislature passed a bill envisioning a new way of delivering health care for Oregon’s Medicaid patients. Earlier this year, the legislature passed additional legislation creating the framework for the new system of Coordinated Care Organizations (CCOs).

Similar to federal health care reform’s goals of transitioning away from a "sick care” model, to a care delivery system that incentivizes primary and preventive care to keep people healthy, Health Systems Transformation in Oregon aims to improve patient outcomes, experiences, and lower costs. The Governor believes we can realize significant savings by coordinating mental and physical health care and focusing on chronic disease management and prevention which will keep patients out of expensive emergency rooms.

The triple aim; improving outcomes, patient experiences, and lowering costs, is at the core of the Health Systems Transformation, and is a set of principles that is easy to support. That being said, Oregon has undertaken a very ambitious project, and—as usual—the devil is in the details. While in some cases implementation is just days away, there will doubtlessly be opportunities for fine tuning and adjustments in the months and years ahead, and we’ll continue to work to ensure that the new system is as good in reality as it sounds on paper.

Here’s an update on some major milestones as Oregon prepares to launch the first Coordinated Care Organizations, on August 1.

In June, Governor Kitzhaber announced that Oregon reached an agreement with the Obama Administration in which the Federal Government will give Oregon $1.9 billion over the next five years to help establish our health systems transformation. In return, Oregon has pledged to save $11 billion over the next decade in state and federal Medicaid spending.

In order to launch, each proposed CCO—which generally represents a geographic area and is made up of hospitals, provider groups, and counties—must be certified by the state. Eight CCOs have been certified to begin enrolling patients on August 1. Six more—including the Tri-County Medicaid Collaborative for Washington, Clackamas, and Multnomah County—are provisionally certified to begin operating on September 1st. In the coming weeks we expect to see more CCOs earn provisional certification and then certification to begin operating later this fall.

Additionally, the state has just published proposed rules for implementation of the CCOs. We’re in the process of reviewing them and preparing comments.

ONA will continue to be engaged and work with developing CCOs and our members to ensure that nursing’s and nurses’ roles are defined and supported in this new system. Here are a few key issues and principles related to implementation of the emerging CCOs.

  1. Nurses as decision makers: Providers and consumers should be making key decisions. As front line workers in our health care system, and the largest portion of Oregon’s health care work force, Nurses and Nurse Practitioners know what works and what doesn’t. RNs and NPs should serve on the governing boards of CCOs, as well as on provider advisory committees.
  2. Care Coordination: The main difference between the CCOs and our current delivery system is that the CCOs will coordinate physical and mental health services, and will emphasize preventive care and chronic disease management. The value of the CCOs will be realized only when this coordination is seamless and effective, and when the CCO functions as a connector to the various settings where care is delivered. The role of the care coordinator is a critical piece in this puzzle, and is a role that nurses are trained and licensed to fill.
  3. Reimbursement and Provider non-discrimination: Oregon Nurse Practitioners are a critical component of our primary care work force. CCOs should embrace NPs and NP run patient centered primary care homes as full providers in the CCOs, and should reimburse NPs the same rate as physicians when the same services are provided. Click here to read the ANA Whitepaper on RNs as Care Coordinators.
  4. Resources should be prioritized to support patient care, not administrative overhead.
  5. Oregon should be a model for the nation: While there will certainly be bumps along the way, Oregon has an opportunity to be a national model, demonstrating how to better care for a specific population in a less expensive and more effective way.

Throughout the state ONA and NPO members are watching CCOs develop and, in many cases, are actively participating in these conversations. If this new system accomplishes its goals for the Medicaid population, we will likely see it expand to cover public employees and potentially other groups in the future. This shift has the potential to profoundly impact health care delivery in Oregon, and by extension, nurses and nursing practice. If we truly manage to provide adequate primary and preventive care and chronic disease management outside of an acute care setting, hospitals will need less staff and will treat fewer patients. This workforce shift would be balanced out by an increased demand for nurses in primary care and community based settings.

ONA is committed to being a voice for nurses in the transformation process. From advocating for you at the legislature and in the rulemaking process and in the boardrooms of emerging CCOs, to offering CE opportunities to help prepare you for this transition, we will be your partner each step of the way.

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Oregon Nurses Association
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