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Ore. COO offers to settle dispute with state


An Oregon Coordinated Care Organization (COO) (similar to an Accountable Care Organization) that has been in a long dispute with the Oregon Health Authority says it’s ready to settle.

The statement by FamilyCare followed  the state’s threat to end  its relationship with the organization over alleged overpayments to the COO.

FamilyCare is one of 16 COOs in Oregon and serves nearly 130,000 Oregon Health Plan patients in the Portland area and Marion County.

The organization said it’s prepared to give the state $47.3 million in overpayments. The Oregon Health Authority  demands $55 million. FamilyCare also said it wanted a rate increase for this year, saying that  under current rates it would lose $31.6 million this year. “The increase would be fully funded by the federal government and have no impact on the state general fund,” FamilyCare asserted.

A spokeswoman for the Oregon Health Authority said state officials are reviewing the proposal.



Some high marks for Oregon’s CCOs


Mt. Hood, in Oregon.

Oregon coordinated care organizations cut admissions and emergency department use for several costly conditions, according to a new report from the Oregon Health Authority that examined the outcomes of 16 CCOs.

Oregon’s CCOs are networks of healthcare providers  that work together to serve patients covered under the Oregon Health Plan (Medicaid). They focus their efforts on prevention and helping patients manage chronic conditions like diabetes.

The latest report examined outcomes between July 2014 and June 30, 2015. It found:

  • The all-cause readmissions rate fell to less than 10 percent from  nearly 13 percent in 2011; that’s below the state’s 10.5 percent benchmark.
  • Use of emergency rooms fell 23 percent from 2011’s baseline.
  • Admissions for short-term diabetes complications fell 32 percent.
  • Admissions for chronic obstructive pulmonary disease in patients 40 and older plunged 68 percent.

But as FierceHealthcare noted: “Among Medicaid beneficiaries with severe mental illnesses, ED use remains far higher than the declining statewide rate of overall ED use.”

“Oregon will continue to monitor this metric to determine if additional community services made possible by recent investments lead to a decreased utilization of emergency departments for individuals with severe and persistent mental illness,” the report states.

Fierce also noted that ED use “remained higher than statewide averages for disabled patients in general, mirroring the national trend, which the report suggests can be improved through timely follow-up after hospitalization.”


State, Ore. Medicaid provider duking it out


Seemingly tranquil Portland.

There’s a bitter contract dispute underway between the State of Oregon and FamilyCare Inc., a company providing medical care via Medicaid to 128,000 Oregon Health Plan members in the Portland area.

The (Portland) Oregonian reported that Oregon Health Authority Director Lynne Saxton wrote on Dec. 1 to other healthcare groups serving the Oregon Health Plan, which serves low-income people, “inviting them to apply for members served by FamilyCare, Inc. as a ‘precautionary’ move.” This suggests that the two organizations might soon part ways.

“The firm is one of 16 organizations and companies that serve the Oregon Health Plan, managing a slice of the state’s Medicaid budget to care for about one in four Oregonians.”

The Oregonian said that “The Oregon Health Authority and FamilyCare disagree over its 2015 reimbursement rates for services, and the state’s effort to retroactively lower them. The two sides are now in court and FamilyCare also has gone to lawmakers for help, according to the The Lund Report, a health care news Web site. The state’s proposed 2016 reimbursement rates are based on the rates currently in dispute.”

In Oregon, new ways to treat back pain


This story is part of a partnership that includes Oregon Public Broadcasting, NPR and Kaiser Health News. 

When Portland resident Doris Keene raised her four children, she walked everywhere and stayed active. But when she turned 59, she says, everything fell apart.

“My leg started bothering me. First it was my knees.” She ignored the pain, and thinks now it was it the sciatic nerve acting up, all along. “I just tried to deal with it,” Keene says.

But eventually, she went to a doctor who prescribed Vicodin and muscle relaxants. In 2012, about one in four Oregonians received an opioid prescription – more than 900,000 people. The state currently leads the nation in nonmedical use of opioids. And about a third of the hospitalizations related to drug abuse in Oregon are because of opioids.

“My body was saying, ‘Well, if I take another one, maybe it’ll work.’ So, I mean, that’s just human nature. Especially when you’re in the kind of pain I was in. You get to the point after months and months of pain where you’re begging for anything – anything — to relieve the pain,” she says.

In the end, Keene says, she became addicted. Her doctor ended up cutting off her supply of pills.

“I got very upset. I said, ‘What do you mean? You gave them to me. Why’d you give them to me and then tell me that I couldn’t have them?’ I was begging,” she says.

Then Keene went to the Quest Center for Integrative Health, a pain management center in Portland.

Lying on a fold-out chair in a darkened room with several other people, Keene has about a dozen acupuncture needles in place.

“I come in here wearing back braces, and knee braces and a crutch, and Dr. Dave told me, ‘Get rid of them! They’re just weakening your muscles,’ ” Keene says. “And when I could walk out of here after the first acupuncture [treatment], I wanted to grab him and kiss him.”

David Eisen is Keene’s “Dr. Dave,” and executive director of the Quest Center. He is board certified in traditional Chinese medicine and acupuncture, and says doctors need to stop thinking of opioids as a first line of defense against pain.

“There should be an array of things for people to choose from,” Eisen says, “whether it be chiropractic care, or naturopathic care, or acupuncture, nutrition, massage. Try thosethings — and if they don’t work, you use opioids as a last resort.”

“The only thing that might have been covered in the past was narcotics,” Taray says. “But treatments such as acupuncture, chiropractor, massage therapy, physical therapy and rehab would never have been covered.”Oregon wants more patients to take this approach. Denise Taray, coordinator of the Oregon Pain Management Commission, says Medicaid’s traditional way of dealing with back pain involved advising bed rest and prescribing painkillers.

But starting in January 2016, the state will fund many of these back-pain treatments for patients who get their health care via Oregon’s version of Medicaid — the Oregon Health Plan. While the treatments may cost more than a course of pain pills, the hope is that money will be saved by reducing the number of people who become addicted to opioids or abuse them. And pills aren’t always as effective as some people assume.

“Research is out there that suggests that with back conditions we’re spending a lot of money on health care treatments and services that aren’t improving outcomes,” Taray says.

Oregon also has not found overwhelming evidence that acupuncture, yoga or spinal manipulation work better than other options. But, as Taray points out, these alternatives don’t involve drugs.


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