Guest Viewpoint: New guidelines needed to protect health funds

Guest Viewpoint: New guidelines needed to protect health funds
Posted on 07/07/2016

By Michael Reaves

For The Register-Guard

The Register-Guard’s June 23 article, “Agate sale made insiders rich,” brought many memories to mind. Those memories began in 1996 when the state of Oregon decided to have managed care Medicaid services for the Oregon Health Plan. The Lane Independent Practice Association was established as a for-profit organization to administer money, services and contracts for physical health and substance abuse benefits for OHP members in Lane County.

The state had a separate allotment of Medicaid funds for mental health services, alternately called behavioral health services.

Lane County Health and Human Services and the Lane County Mental Health Clinic (now known as Lane County Behavioral Health Services) led a community- wide effort to establish a government organization (which by its very nature is not-for-profit) to provide the administrative services for the behavioral health funds.

I was one of many who worked on this project. We represented the 30-plus government and nonprofit organizations that provided behavioral health services to thousands of people who had serious mental health concerns and very few financial or social resources to help them battle these issues.

An extraordinary amount of time and energy went into this organizational effort. Leaders of nonprofit agencies (ShelterCare, Laurel Hill Center, The Child Center, Looking Glass, PeaceHealth Behavioral Health, South Lane Mental Health, White Bird, and many more) contributed to a plan to satisfy the state’s requirements.

We were invested in establishing a successful locally controlled organization to oversee the provision of services to those insured by Medicaid, and we wanted to limit the possibility of an outside insurance company taking Medicaid “profits” out of local hands. Our goal was to reinvest any revenue over expenses (“profits” in the business world) in Medicaid services.

In 1997 Lane County Health and Human Services, with the help of Peace-Health, was awarded the contract from the state, and LaneCare was established as the organization to administer OHP mental health services in Lane County. There were no shareholders or profits in this organization.

LaneCare’s mission was to provide resources for the most robust behavioral health services possible for Lane County residents with Medicaid insurance. The Medicaid allotment of money was meager, given the tremendous need for services in the population served by LaneCare providers, but we worked hard every day to make the most of the resources available. From 1997 until 2012, LaneCare put substantial money into the system. Lane-Care provided funds for numerous innovative projects such as adolescent suicide prevention; consumer groups for adults, adolescents and families with children in services; respite shelters for adults and adolescents, and many more projects. We also worked very closely with numerous local nonprofit groups that provided services and were able to support them in many ways, including occasionally raising the very low Medicaid reimbursement rates these agencies received.

In 2012, the state of Oregon established the criteria for Community Care Organizations, which would receive all the Medicaid monies for physical health, substance abuse and behavioral health. There are positive aspects to CCOs, including the involvement of many community organizations such as hospitals, county public health departments, the United Way, groups of primary care providers, etc.

LaneCare and Trillium attempted to form a partnership to combine Trillium, LaneCare and services from Lane County Public Health, but attorneys were not able to find a way to combine a for-profit company, Trillium/Agate, and a government organization, Lane County. Lane County eventually became a subcontractor to Trillium, and LaneCare’s name was changed to Trillium Behavioral Health. Trillium CCO then received all the OHP Medicaid funding for Lane County.

Following state and federal Medicaid guidelines, Trillium CCO (and Agate, the holding company that owned Trillium) provided oversight and administration of Medicaid funds while simultaneously implementing a for-profit business model. That business model led to the eventual sale of Agate to Centene, a Fortune 500 company, as noted in the June 23 Register- Guard article.

Until state and federal Medicaid guidelines are changed to prevent for-profit companies from taking taxpayers’ money designated for critical health care services, we will continue to have windfall gains for a few individuals and fewer services for the multitude of poor among us.

Twenty years after the Lane County community of Medicaid behavioral health providers attempted to establish a mechanism to keep the maximum amount of essential resources to improve the health of OHP patients in our community, we discover that Agate has maneuvered to benefit their shareholders and turn a Lane County community effort over to Centene.

We have the exact outcome that we feared and attempted to avoid.

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