What They’re Watching: Art Suchorzewski

Art Suchorzewski is the Director of Government Affairs at FamilyCare Health. He joins us in this edition of “What They’re Watching” to discuss transparency in Medicaid and interpreting financial data.

 

 

“Oregon’s Medicaid system is primarily at the CCO level – so, we’re talking about unpackaging some of the financials that are reported to the Oregon Health Authority and also the cost and utilization that’s been reported since the CCO model was stood up. From a consumer standpoint, it might be difficult for them to interpret that kind of information, but there are certainly people that can.

Interestingly, some of my conversations at a national level, there’s really no state that’s really taken up that mantle of transparency within Medicaid, and [looked at] how do we make sure costs are under control and how are they managed within the system? For example, are they concentrated within hospitals or are we really putting resources into primary care?

We heard about the all-payer claims database — that’s a very useful tool but it’s very limited and you don’t have the breakout among insurers or CCOs. And our view is that because this is public data, these are public dollars and there should be extra scrutiny over that and how we’re allocating those resources. So, the agency has a lot of information that it has gathered over the many years it’s been regulating the Oregon Health Plan. What we envision is greater visibility into that. Perhaps the agency can contract with someone and have someone come in and stand up a system where some of that information can be shared. And then, you know, researchers from OHSU or Johns Hopkins can come in and really see where the CCO model was successful and where we’ve kind of dropped the ball.

I do think mental health and prescription drug costs are two areas where we really haven’t seen the needle move much. Mental health integration is something that we really tried to innovate on at FamilyCare. You know, we were known to offer higher reimbursements in that area for mental health. And specifically, mental health prevention. Not just at a crisis but getting that prevention money in early so that people don’t fall into that crisis.”