Health System Transformation
As the debate on health care reform continues across the country, people are looking to Oregon as a model for how reform could look, and in turn, Oregon is looking at clinics like Virginia Garcia. Central to discussions of health care reform is primary care, prevention, and disease management and all eyes are on the medical home. Health care experts see the team-based medical home model as the most comprehensive and ultimately cost effective way to deliver health care. Virginia Garcia was one of the first safety net clinics in Oregon to introduce the medical home.
“Virginia Garcia is right in the middle of this discussion,” said Gil Muñoz, CEO, Virginia Garcia Memorial Health Center (Virginia Garcia). “We have been developing and improving our medical home and are now looking at how our system will engage with other health care delivery systems.”
Muñoz is participating in a Tri-County Medicaid Collaborative (Multnomah, Washington, Clackamas) that is developing a new health care delivery system to address changes in the Oregon Health Plan (OHP). In February, the Oregon Legislature passed House Bill 3650 that changes how health care will be delivered to the approximate 600,000 Oregonians covered under OHP (Oregon’s Medicaid population) The Tri-County Medicaid Collaborative is designing a system called a ‘Coordinated Care Organization’ that will coordinate benefits and services for OHP patients across the tri-county (approx. 250,000). A Coordinated Care Organization (CCO) is a network of health care providers who have agreed to work together to provide care for OHP patients. The current system separates physical, behavioral and other types of care, making it difficult for patients and providers and more expensive for the state. CCOs will support the kind of comprehensive, team-based care that Virginia Garcia has championed. “Under the CCO system, OHP members will need a robust medical home,” said Muñoz, “and we’re already pretty far down that road. It’s not a leap for us at Virginia Garcia to see how this new system of coordinated care can work to the benefit of all.”
CCOs will be local and have the flexibility to focus on prevention, chronic disease management and patient-centered care. They will have a budget that grows at a fixed rate for physical, mental and ultimately dental care. CCOs will be accountable for the health outcomes of the population they serve and be governed by a partnership of health care providers, community members and the health systems that have the financial responsibility. The CCO legislation also directs CCOs to look at an alternative payment methodology. Virginia Garcia is participating in a three year pilot to look at reimbursement for patient and population health outcomes rather than for individual provider visits (see APM article). “It’s clear that we will need to expand our primary care capacity for CCOs to work,” said Muñoz. “Primary care is key in developing a sustainable future for OHP members.”
The Tri-County Medicaid Collaborative is looking at the summer of 2012 to begin operations under the new CCO and has applied for federal grant monies to support the transition. “Governor Kitzhaber is working on a commitment from the Centers for Medicare and Medicaid Services to help implement the new system,” said Muñoz. If CCOs are successful, the model can be expanded to include other large groups like state employees and teachers. “As we shift toward patient centered medical homes, providers in the private sector are looking to learn from Virginia Garcia. And with the focus increasingly on local control and innovation, we have a lot to offer.”