Health care reform gets serious

The next month will be critical for the Oregon Health Plan.

Companies wanting to qualify as coordinated care organizations must file the first of two applications by April 30. The second application, focused on finances, is due May 14. The Oregon Health Authority then will take two weeks to decide which applications to approve.

More than 40 providers have submitted nonbinding letters of intent to the authority. The public debate over who should be approved already has started, highlighted by suspicion of two large national health care companies — Centene Corp. and United Healthcare — who want to be part of Oregon's health plan overhaul.

Rep. Mitch Greenlick, D-Portland, is among those questioning whether drawing such companies "was the intent of the legislation." Greenlick acknowledges that his discomfort is driven largely by Centene and United being for-profit public companies.

The approval of companies to participate in care organizations is critical and deserves the utmost attention. But it's also important that attention be placed on the right issues. Where companies are based, their ownership, and how long they have operated in Oregon are relevant questions, but they are largely side issues.

The question that should drive the Oregon Health Authority is simple: Can companies seeking to operate coordinated care organizations demonstrate adequate resources in Oregon and sufficient knowledge of Oregon to meet the financial and quality-of-service goals of the Oregon Health Plan?

The health plan overhaul approved by the state Legislature requires a local governing board and establishes benchmarks for that board. In addition to other requirements, the board must include at least two local health care providers in active practice, at least two community members and at least one member of a separate Community Advisory Council.

It's certainly possible that a company with ownership outside Oregon could meet those requirements. But it's reasonable to ask how much local understanding a company with no previous operations in Oregon could develop in the four months before the state's health reforms go into effect in August.

Centene and United Healthcare should not be disqualified simply because they are out-of-state or for-profit companies. But we do see a high burden of proof on any company — local or out-of-state, new or old — that wants to be a coordinated care organization in Oregon.

The Oregon Health Authority has the responsibility to approve applications, and to make sure successful applicants follow the rules. Authority director Bruce Goldberg said the panel that will approve providers has not been selected but will include high-ranking individuals within the authority as well as outsiders.

He said applicants will "have to meet technical requirements and legislative intent."

We think the interpretation of that intent should be pretty simple: Would the company be responsive to the needs of patients in Oregon?

Share This Story