The state of Oregon recently reported that the 380,000 of its citizens who are newly enrolled in Medicaid are younger and healthier than previously expected. For this reason, the coordinated-care system did not adversely impact the ability to meet the targeted savings of $11 billion over 10 years.
There was a 21 percent decline in emergency department visits for patients served by the coordinated-care organizations in Oregon since 2011. In addition, the state reported there was a 48 percent decrease in hospital admissions related to chronic obstructive pulmonary disease and a decrease of 9.3 percent in hospital admissions that were linked to short-term diabetes problems. Furthermore, reports show that Oregon Health Plan members had lower utilization rates than existing members in the plan and inpatient costs have fallen since 2011.
In 2012, there was an Oregon Medicaid reform initiative that started after the CMS provided a $1.9 billion grant. There are now 990,000 enrollees on the Oregon Health Plan managed by 16 CCOs. These CCOs can earn incentive payments if they meet or exceed 17 performance-measure targets. This has, in turn, helped improve patient care while giving CCOs the ability to be proactive in how they care for people’s overall health.
There have been other motivations for improvement as well, including the ability that CCOs have been given to be innovative and creative in how they help control patient care.
Cynthia Ackerman, a nurse and vice president of community engagement and government programs for the AllCare CCO says that nurses and social workers especially are motivated to go after the “social determinants” of health that negatively impact individual’s health and lifestyle, but their cures are not necessarily medical.
Ackerman shares an example of a man who lived with mental illness and wouldn’t bathe. The staff at his medical office was uncomfortable when he came in and he was banned from other locations in the community. But when the care coordinator found out the reason for not bathing was because he didn’t have hot water in his home, a plumber was brought in to fix it. He started bathing again, and soon began to reintegrate and socialize with the community around him. That situation was solved simply and wasn’t medical in nature, yet it significantly affected a patient that a CCO had direct contact with.
Sometimes medical answers aren’t always the solution. When care coordinators are motivated to simply listen to the concerns and struggles of patients, the cost of emergency room visits and medical treatment can go down drastically.
“You really have to drink the Kool-Aid and not be so rigid and think that a doctor’s office or an ER has all the answers to a person’s health problems,” said Ackerman.