According to a new study (pdf), Oregon’s efforts to transform health care are not yet delivering on their potential to improve the consumer experience. The Consumer Confidence Project, a volunteer-led effort overseen by the Oregon Public Health Institute, with support from OSPIRG Foundation, has released a review that raises tough questions about the state’s approach to holding the health care industry accountable to the needs of consumers.
We all know that health care still costs too much and delivers too little. To their credit, Oregon policymakers have taken important steps in recent years to contain costs and improve quality, led by landmark reforms to the Oregon Health Plan, the state’s Medicaid program. These reforms created Oregon’s Coordinated Care Organizations (CCOs), with financial incentives designed to cut waste, spend tax dollars more efficiently and encourage the development of new ways of delivering care focusing on prevention and keeping people healthy.
To ensure that CCOs deliver cost savings without sacrificing patient care, the state regularly measures their performance using a set of accountability metrics. On that score, the news to date is mostly good: State data suggest that many CCOs are succeeding keeping costs down and improving quality in key areas like reducing unnecessary ER visits.
However, to serve their members and their public mission, CCOs also have an obligation to help their members navigate the health care system and provide accurate and complete information about how the CCO is structured and how decisions are made. If CCOs do not live up to their promise in these areas, progress in other areas may come at the expense of the consumer experience of care, and the public may have no way of knowing whether CCOs are using public dollars wisely.
Unfortunately, the state doesn’t measure and track CCO performance along these lines. To fill this void, the Consumer Confidence Project reviewed the publicly available information, both printed and online, and found that Oregon’s 16 CCOs are doing an uneven job at best of empowering their members and informing the public about their operations.
For example, they found that CCO websites and member handbooks have only incomplete information about a CCO’s benefits and services, and that members would generally have to consult both to get the full picture, a lengthy and frustrating task. This has been the focus of much of the media coverage of the findings so far.
More troublingly, though, the report found that Oregon’s CCOs are largely failing to provide meaningful transparency. CCOs, through providing Oregon Health Plan benefits at a local level instead of centralizing all decisions at the state level, were meant to be closer and more accountable to their members and the communities they serve, but few CCOs appear to be making an adequate effort to provide information about their decision-making processes and opportunities for the public to weigh in. For example, no CCOs provided any information about how members or the public could bring issues of concern before the governing board of the CCO, and few provided adequate information about their Community Advisory Councils. These councils were created to give local communities an opportunity to have a say in decisions that affect their health and how their tax dollars are spent, but that only works if the public knows about them.
Oregon deserves better. While these issues are of special concern to Oregon Health Plan members, CCOs are funded by public dollars, and all Oregonians should have the right to know how their hard-earned tax dollars are being spent. We urge all 16 CCOs, and state policymakers, to take a close look at the Consumer Confidence Project findings and work together to deliver better results.