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Doctors group gets green light to form CCO

AllCare Health Plan Inc., a physicians group that serves Jackson and Josephine counties, was tentatively given the go-head to create a coordinated care organization as part of the state's massive Oregon Health Plan overhaul.

The group still has a long way to go before final approval. However, the Oregon Health Authority's tight deadline to get the CCOs up and running is Aug. 1, according to Freddy Sennhauser, the director of marketing for AllCare Health Plan.

"It is a very arduous process," Sennhauser said. "Just because we have achieved this initial certification doesn't mean we will get a contract with the state."

The idea behind the CCOs is to close loopholes in the state's Oregon Health Plan, which serves mostly low-income residents on Medicaid.

The goal is to coordinate physical, mental and dental health services so that each group will communicate with the others as a patient passes through the health care system.

The overhaul was pushed by Gov. John Kitzhaber and the Oregon Health Authority. They believe that by not having mental and physical health services interact and coordinate care, less expensive solutions are missed and patients sometimes to see multiple doctors unnecessarily.

Kitzhaber recently returned from Washington, D.C., with authorization to use nearly $2 billion in Medicaid funding from the federal government to operate the program.

Sennhauser said the path to becoming a CCO has not been a smooth one.

AllCare Health Plan was one of 11 groups out of 14 applicants statewide that was given the tentative certification.

The group will meet with state health officials in the coming weeks to determine if it is ready to meet the criteria of what a CCO should be, Sennhauser said.

Until now, the group was not responsible for providing mental or dental care, but must add these services if it is given CCO status.

The group comprises approximately 75 physicians, Sennhauser said.

"It's new for us, but it is exciting," he said. "This only works if you can pull all the strings together."

Sennhauser said a CCO's mission is to become a community-focused provider that meets the specific needs of the area in which it serves.

"We are a local company owned by local physicians," he said.

Sennhauser said the group was troubled recently when it learned that its Medicaid reimbursements as a CCO would come in 14 percent lower than first estimated.

The decline was due to the state's continuing budget crisis.

The hope is the system will reduce medical costs throughout the state, thereby helping save money over the long term.

Sennhauser said the group could be given a contract by the end of June and could be up and running by the state's deadline of Aug. 1.

He said current Oregon Health Plan patients should not notice any change of service as the group pursues CCO status. The CCO process will not affect patients who are not on the state plan.

Reach reporter Chris Conrad at 541-776-4471; or email cconrad@mailtribune.com.