Social capital | Diane Lund | Medicaid FFS

A central purpose of State of Reform is to help foster the social capital needed to support system reform. Think of social capital as the trust, relationships, and collaborative spirit needed to allow diverse parties to take risk together to improve things.

We try to create the platform but it takes the authentic thought leadership from senior executives like you to actually aggregate the capital in the system.

So, this month, we focus on social capital, the thought leaders shaping the discussion, and the backlash when efforts don’t match expectations.  Here are 5 Things We’re Watching in Oregon health care for April, 2017.

1.  Creating a new model for behavioral health?

The OHA’s Behavioral Health Collaborative released a report with four recommendations that Lynne Saxton says will help to move the behavioral health system “toward a coordinated care model, and create a financially sustainable, results-driven model.” One of the recommendations is to create a new “regional governance model” separate from but not duplicative of the existing CCO infrastructure.

CCOs have openly struggled to fully integrate behavioral health care into their care coordination model. It’s hard to not see this report within that context, and the recommendation to create a new administrative layer for behavioral health as something of a recognition that the CCO community hasn’t been successful enough at this element of transformation.

2. 2012 v 2017: The missing social capital

I’ve been reflecting on the challenges facing Oregon’s Medicaid market – from the current fiscal threats to the disruption of the next procurement. And, I’ve been reviewing the success of the 2012 CCO legislation, procurement and implementation – all which took place in about 7 months.  2017 is a far more anxious time than 2012 in the Oregon Medicaid world, it seems.

Why is that? There are a few obvious things, but I think the real answer is more subtle. In this post, I argue there is less social capital in Oregon health care today than in 2012. There is less trust, fewer relationships, and a narrower set of shared experiences in spite of the vision of integration.

I think this lack of social capital sets Oregon up for a contentious procurement process, one that may include lawsuits and significant election activism by stakeholders. The primary tool Oregon has – OHA and stakeholders – to mitigate this is through increased stakeholdering, creating opportunities for input, and fostering the sense of ownership that was built under Governors Kulongoski and Kitzhaber when the CCO model was put together.

3.  Video: Charles Tveit: CEO Lake District Hospital

Charles Tveit is the CEO of Lake Hospital District in rural southwest Oregon. He’s one of Oregon’s savvy hospital operators, and is thinking about population health and workforce differently. It’s the kind of innovation that is driven by running a hospital in a town of 2,300.

In this edition of “What They’re Watching,” Charles talks through the challenges of running a rural hospital in Oregon today. “Our primary care doctors see patients in the clinic, they manage the patients in the hospital, they work in the ER, and they deliver babies. And not everybody wants to do that.”

4.  FFS Medicaid at almost 200k enrollees

Some CCO leaders have expressed a concern to me that the OHA isn’t migrating enough FFS Medicaid beneficiaries to CCOs. OHA provided this slide that shows FFS enrollee numbers are relatively flat at just under 200,000. I extrapolated some numbers thinking that I might find an uptick in recent months, but I was wrong: FFS as a share of overall Medicaid enrollment was down from summer highs last year.

The last legislative report from January said about 25% of these “open card” FFS beneficiaries could migrate to CCOs, a number I’m sure many wish was lower but one that doesn’t seem unreasonable on a total Medicaid population of about 1m lives.

The updated numbers are out in the next few weeks in an updated legislative report. The question will be about the trend. Hopefully things are getting better with re-determinations and a reduction of FFS that can go to CCOs.


5. Diane Lund retires, Martin Taylor to ONA

Few personalities are as well known in Oregon health care as Diane Lund. She has her fans and her detractors but few question her commitment to driving transparency in Oregon’s health care system. She has announced she is stepping down from The Lund Report, leaving the organization in the hands of Courtney Sherwood, her long time reporter and editor. We had an extended interview with Diane from 2014 that gives you a sense of the person behind the decades of muckraking.

Martin Taylor is leaving CareOregon to lead the Oregon Nurses Association, an organization where he formerly served as the head of policy. It’s a nice step up for Martin, who is one of Oregon health care’s most active and thoughtful advocates and strategists. Expect ONA to elevate its already sophisticated role in the broader public policy conversation.