 |
 |
 |
 |
 |
 |
|
|
 July Providence switches mental health, chemical dependency benefits to PacifiCare In a very unusual move, Providence Health Plans has decided to turn over the medical management and administration of its mental health and chemical dependency benefits to a for-profit insurer, PacifiCare of Oregon. All told, 794,820 Providence members will be impacted - 238,959 in its HMO, 52,472 on Medicare, 460,794 on its PPO and 42,595 on the Oregon Health Plan. Providence will continue to manage Oregon Health Plan mental health, but not chemical dependency benefits. A tree-year rist contract is expected to be signed in late July, with PacifiCare taking over next January. "We're one of the few HMOs to run our own mental health and chemical dependency program," said Jack Friedman, executive director of Providence Health Plan. "The reason we're making this move is we're not getting the results in terms of cost savings on the medical and administrative side." Providence has been running two mental health programs following the purchase of SelectCare, which has been cumbersome. "The two programs didn't talk to each other," Freidman said. Debbie Origer, formerly CEO of PacifiCare, who now works for Providence as regional strategic development officer, didn't make the decision, but helped review proposals from several vendors, including Value Options and Magellan Behavioral Health. Oregon Health Forum, Oregon Public Broadcasting produce television show Because of a generous grant from Northwest Health Foundation, Oregon Health Fourm is embarking on a television project with Oregon Public Broadcasting. In early 2001, "Taking the Pulse," a program devoted to educating the public about critical health policy and public health issues, will begin airing on OPB. The three-part series will focus on the Oregon Health Plan and teen suicide, featuring policy makers, health care gurus and consumers. The program will be modeled on such popular public broadcasting shows as "The NewsHour with Jim Lehrer." Its content will be determined by co-executive producers Diane Lune, editor of Oregon Health Forum , and Morgan Holm, director of news and public affairs at OPB. Andrew Holtz, a former CNN correspondent who anchored discussions on genetic research and Alzheimer's disease, will moderate the program. "We're extremely excited about being part of this pilot to bring awareness to the public about important health policy issues that impact all of us," said Thomas Aschenbrenner, president of Northwest Health Foundation, who announced the $52,000 grant. "This program is a long time coming, and we're confident it will be successful." Safety net clinics have become an endangered species The nation's "safety-net" health care system is an endangered species in need of immediate intervention, according to a report issued recently by the Washington, D.C.-based Institute of Medicine (IOM) of the National Academics. A 15-member committee organized by the institute and made up of health care experts from around the country spent almost two years assessing the clinics, hospitals and other institutions that provide health care for the country's uninsured patients. Its findings and conclusions were published in a report titled "America's Health Care Safety Net: Intact but Endangered." "We had a difficult job defining the safety net and what was happening around the country," said committee member Mary Lou Hennrich, CEO of CareOregon, which serves Oregon Health Plan members. "In some places it is public hospitals, in others it's clinics or country hospitals, in others it's clinics or county hospitals. And it's a patchwork of different fundings. We wanted to know what the whole elephant looked like, not just the trunk or the ear. We wanted to know what kind of policies to recommend at the national level." Drug industry faces increased scrutiny To determine the effectiveness of new drug therapies, the Health Resources Commission appears headed in a historical direction. Its chairman, Dr. Frank Baumeister, is interested in the TAP approach - where technical advisory panels make recommendations about specific drugs. Such panels have delved into anti-depression and anti-psychotics . "These panels had a certain credibility and could be duplicated for other classes of drugs," Baumeister told his fellow commissioners on July 10. The drug manufacturers also seem eager to embrace the concept. "There's great merit with the TAP analysis," said Jim Gardner, legal counsel for PhRMA. "We favor a scientific-based analysis of new technology." Baumeister suggested these panels focus on "high-ticket items where there's controversy. We need to come up with objective information." But Dr. John Santa expressed doubts. While working for Regence HMO Oregon and HealthFirst, he tried, unsuccessfully, to convince insurers, hospitals and physicians to follow the panel's recommendations. "I've not found anything that's been uniformly adopted," said Santa, administrator of the Office of the Oregon Health Plan Policy and Research. "There needs to be an effector arm." Mental health consultants absorb more than $100,000 Blending mental health and chemical dependency services under one umbrella may become more than a dream for Accountable Behavioral Health. With 23,000 OHP members in five rural counties, ABHA submitted such a proposal to state officials 18 months ago. But its executive director, Barbara Trione, isn't just interested in having more money. "We want to bring about administrative efficiencies," she said. Such a system would enable people with a dual diagnosis to receive care from one provider. And, ABHA would only have to submit one financial report, one clinical record and one encounter data submission. Outreach and preventive services could also be enhanced, Trione said. However, some health plans, which receive money for chemical dependency, are fearful of such a move. "The big fear is mental health will siphon off money from chemical dependency, but it's really the other way around. The mental health system often responds to chemical dependency needs," Trione said. InterCommunity Health Network, with 5,550 members in Benton County, doesn't want to give up its chemical dependency dollars, said Kelley Kaiser, COO. "We've made changes in our program and want to see the outcomes; we're confident about what we're doing," she said. Emergency rooms in southern Oregon experience a surge of OHP patients In Jackson County, Oregon Health Plan (OHP) members are pouring into hospital emergency rooms. Community clinics and doctors offices, near overload from taking new patients, are turning others away. In December, after two HMOs pulled out of Jackson County, visits to Rogue Valley Medical Center's (RVMC) emergency department jumped 26 percent from the previous year. Since then, the number of visits has risen by 11.6 percent. Hospital officials believe at least 5 percent of the increase is due to the OHP. RVMC is losing $15,000 a month treating the low-income population. "From our perspective, the more important issue than finances is to say that the emergency department is not the place to deliver primary care," said Bob Doolen, vice president of finance and administration for Asante Health System, which owns RVMC. "Technically speaking," said Roseanne McLaren, vice president of RVMC, "we have become the physician's office." Providence Medical Center isn't seeing the same surge in emergency room patients, but its group practice offices are seeing a steady flow of new OHP clients. Meanwhile, Ashland Community Hospital's emergency room visits are up 17 percent. "A big chunk of my 17 percent, about 11 percent, is OHP," said hospital chief Jim Watson. An article in the August 2000 issue, Oregon Health Forum indicated that the joint heart program between Rogue Valley Medical Center and Providence Health System was stalled. The two hospitals are working to develop a partnership. Oregon Health Forum regrets the error. Also in this issue...
|
|
 |
