The Oregon Health Authority (OHA) shared late last week that they submitted a Section 1115 Waiver to the Centers for Medicare and Medicaid Services (CMS) to request a COVID-19 Disaster Relief Fund. This waiver, like the one that OHA previously submitted (detailed here), are generally used during emergencies like the current COVID-19 pandemic.

In OHA’s waiver request, they reference that while Oregon is lucky to have a lower COVID-19 caseload then other states, our adherence to aggressive social distancing and the cancellation of elective procedures is creating a huge financial strain on our health systems. This move would increase flexibility for how federally matched payments can be used with Medicaid being the payer of last resort. While this could bring in federal resources for some COVID-19 spending, the Oregon Health Plan faces a budget shortfall that General Fund dollars may not be able to fill.

This waiver, submitted by the state’s Medicaid Director, Lori Coyner, is dated April 17, but as far as we know, the state has not yet received approval from the Federal Government.

Without federal dollars to help our health systems, we will lose our ability to preserve access to care. CCOs have done a great job keeping people out of the hospitals, but the cancelation of nonemergency procedures has led to decreased revenues for hospitals and other providers.

At the same time, hospitals are incurring new costs related to COVID-19, including telehealth platforms, bed reconfiguration, off-site screening venues, and quarantine/post-acute care sites. The result is a need to cut costs, including staff reductions, which poses a threat to Oregon’s health care delivery system.

It is common knowledge that other medical technology like ventilators, respirators, and personal protective equipment (PPE) is in high demand and very short supply. OHA expressed doubts as to whether CARES Act funding would meet specific needs of Medicaid providers, so the Disaster Relief Fund is needed to help cover critical expenses.

Under the proposal, health systems would likely need to first seek support through other public and private means, so that Medicaid is the payer of last resort, and any dollars paid out would be subject to audit.

We will keep you updated on the status of this request.

All our member CCOs are doing a wonderful job filling gaps and providing services to their members, and this week we are focusing on Cascade Health Alliance of Klamath Falls, Oregon.

Late last week, Cascade Health Alliance (CHA) got an email from Basin Transit, alerting them to the fact that starting now, no one will be allowed on public transit in Klamath Falls without a face mask. This could be detrimental to some OHP members if they do not have the ability to buy or make their own face masks, as many OHP members travel using public transit.

This concern over their member’s safety while using public transit was a catalyst for CHA. They sprang to action to ensure that their OHP members, employees, and their employees’ families have access to face masks—especially those being made and sold locally.

Because so many Oregonians are currently out of work, CHA’s team started looking for a local supplier so the money they spend on face masks could go directly back into the community and help other Oregonians pay their bills.

With some luck, a lot of hard work, and a couple community asks, CHA was able to find a local supplier of face masks who used to run a different small business. This community member re-tooled her shop to make and sell reusable, COVID-19 safe facemasks to those who need them. With the income earned from selling masks, the local supplier was able to hire three more neighbors who had also been laid off due to COVID-19.

To be sure the masks were COVID-19 safe for their members, Cascade Health Alliance had a trusted provider of 25 years, Dr. Raul Mirande, a general surgeon, check that the masks were up to snuff.

Once they got approval from Dr. Mirande, CHA was thrilled to collaborate with these amazing Oregonians who were already making masks for their neighbors and friends! Cascade Health Alliance commissioned 2,500 masks from their community partner, which is the largest order the small business in Klamath Falls had ever received!

These face masks will be delivered weekly to OHP members and CHA employees through no-contact delivery, or during a non-emergent medical transport.

Now, while running errands, riding the bus, or going to work, OHP members served by the Cascade Health Alliance, and CHA employees will be able to keep themselves safe.

People of Klamath Falls, we have good news! Cascade Health Alliance literally has you covered!

Thank you CHA for your hard work and commitment caring for people in the Basin and for quickly and thoughtfully addressing this problem.

In Portland every night at 7:00 p.m., Oregonians gather on their porches and front lawns to bang together pots and pans, play their drums or other instruments, and cheer for health care providers working to keep our communities safe during this pandemic.

Do health care workers and providers hear our cheers and thanks? What do they think about the state’s response to COVID? Do they need more Personal Protective Equipment (PPE)? Do they have any advice or thoughts about what regular people like you and I should be doing?

Most importantly: if we could speak with a health care provider about what it’s like to be working during COVID-19, what would they say?

We had the opportunity to sit down with a Certified Nurse Assistant (CNA) named Emily who works for an Oregon-based company that provides daily medical assistance and other necessary health services to folks on Medicaid and Medicare.

In a normal shift, Emily cares for Oregonians in hospice care, may be paraplegic, have at least one underlying health issue, if not several, and need help with daily tasks. She is responsible for helping her patients with wound care, personal hygiene, and grocery shopping.

When asked about what PPE she has access to daily, Emily shared that she has a single surgical mask that does not have the ability to stop the novel coronavirus the way an N95 mask would— and she reuses it every shift. Gloves provided by her company are either not available or they rip. She tries to keep a personal stash of gloves but says they are nearly impossible to find.

We talked about how it feels as a frontline health care worker to help her clients with wound care when her medical education tells her that the efficacy of her mask decreases by the hour.

Not only is Emily serving her community as a CNA, she is only weeks away from graduating nursing school, and taking the NCLEX. Unfortunately, the novel coronavirus has also thrown a wrench into completing the NCLEX for her license, because completing it is impossible while social distancing.

Despite all the challenges and lack of PPE, Emily shared with me that she is happy to be helping in the face of a pandemic. She knows that the State of Oregon is working hard to ensure that frontline workers have access to PPE and expanded testing to keep her and her patients safe.

When asked how she felt the state was responding to this crisis, she shared that the expansion of unemployment benefits, Oregon Health Plan (OHP) benefits, the Governor’s decision to send ventilators to another state in need, and many other actions feel very citizen-oriented, and she feels as though we are headed in the right direction. Emily also mentioned that despite her current cheer to serve those in need, she may be feeling the emotional effects of working through this pandemic for quite some time.

Emily’s point makes us stop and consider: what mental health supports are we providing our health care workers? How can we better support them in this area?

Emily, thank you for your hard work and dedication to Oregonians in need during this critical time. You are genuinely appreciated.

Last week, we reported on the early release of 2019 incentive dollars to Coordinated Care Organizations (CCOs). Following this early release, COHO CCOs have been working hard to allocate these funds quickly and responsibly while keeping their members at the center of all decisions.

First, we should talk about what incentive funds are. Each year, the Oregon Health Authority (OHA) withholds a portion of CCOs’ global budget, which can be earned back based on achieving positive health metrics for members they serve. Incentive dollars are allocated by CCOs’ boards through a rigorous process and primarily go to hospitals, clinics, and other providers as part of value-based contracts (think of it like a bonus for helping meet aggressive preventive care goals determined by the state).

The incentive dollars that were released at the end of March were earned in 2019 by the hardworking providers contracted with CCOs to serve Oregon Health Plan members. In fact, many providers that work with CCOs have this incentive pool “bonus” built into their contracts—meaning that many of the dollars that are being released early will go to providers and health systems that are badly in need of financial support.

In normal times, a portion of these funds would also go toward community-driven programs and health innovation. CCOs are quickly pivoting to ensure funds are dedicated to supporting community needs related to COVID-19. This may include rental assistance for members, delivering groceries and supplies, and securing Personal Protective Equipment (PPE), among other things.

With all the needs related to COVID-19, what will our CCOs invest in, and how will they make every dollar count? We look forward to sharing more success stories in the weeks ahead. We are also partnering with OHA on policy adjustments to protect providers and ensure community investments can continue. Stay tuned.

You may think that hospitals and health care providers are incredibly busy caring for those that have contracted the novel coronavirus, but in our state where only 303 patients are currently hospitalized for COVID-19, this pandemic has actually increased costs and decreased revenue, causing a major cash crunch across our health care system.

The cash flow issue stems from added costs of increasing emergency department capacity and ensuring extra staff are available if a hospital surge occurs. Meanwhile, the cancellation of all elective and non-emergency surgeries has decreased revenue, pushing some hospitals and health care providers into dangerous financial territory.

We know that hospitals’ and providers’ ability to keep their doors open and serve Oregonians is critical not only during this pandemic, but also to preserve our health care delivery system. In southern and rural Oregon where there is less access to providers, clinics, and hospitals, existing hospital and health systems remaining open is paramount.

For these reasons, Governor Brown and her policy experts are crafting a bridge loan program for 24 critical access hospitals across the state. This loan program is still in the beginning stages of drafting, but it’s clear the Governor has heard the concern from hospital and provider systems about cashflow and intends to do something about it.

The legislation proposed to deliver aid to these critical access hospitals appropriates $50 million dollars to this program and indicates that the source of the capital would be the dollars given to Oregon through the federal CARES Act relief package. And while this program is dedicated to bailing out hospitals that are currently in financial dire straits, it does require those health systems to pay back the state at a low interest rate of zero to one percent. There are also requirements in the legislation around hospital staffing and labor.

Currently, the Governor’s office and other stakeholders are working diligently to ensure that critical access hospitals and other providers have the financial resources they need to continue the battle against COVID-19 while still ensuring that the state maintains a balanced budget.

Are you worried that you might have the novel coronavirus, but think you might not meet the criteria to be officially tested? Last week, the State of Oregon launched a “Coronavirus Checker” online program that checks your symptoms and gives you advice based on clinical best practices, current CDC guidelines, illness severity, and risk factors like age and underlying medical conditions.

The website, c19oregon.com, will direct you to a hospital with enough capacity to treat you, if it determines you need emergency care. If you don’t have severe symptoms, it will direct you to continue to maintain your social distance but recommend that you call a health care provider. During the season change that causes symptoms fairly like those of COVID-19, this tool will be a very helpful device in calming concern that you may have caught the virus.

Once you’ve clicked the link above, it will take you to the home page, which has a “Get Started” bar.

  1. Click the “Get Started” Bar

Once clicked, the site guides you to a second page, which explains that this does not replace or constitute the practice of medicine—as always, if you believe that someone in your care is incredibly sick, call a health care professional. If you scroll to the bottom of the page, it requests that you accept terms and conditions.

  1. Accept the Terms & Conditions

Next, in order to gather accurate data about you, the website requests your age.

  1. Enter your age into the empty field provided, then click “Next”

Then, it asks your location.

  1. Enter your zip code in the empty field, and click “Next”

Next, it requests information on your symptoms. The options are fever, cough, shortness of breath, fatigue, body aches, headache, diarrhea, sore throat, loss of sense of smell or taste, or none of the above.

  1. Choose all the symptoms you currently have, then click “Next”

Next, it asks if you have had any life-threatening signs since you became sick. Some options include a very hard time breathing, unable to keep down food or drink for 12 hours, feeling lightheaded, or having altered or slurred speech.

  1. If you have experienced any of those symptoms, choose them, then click “Next”

Do you have any underlying medical conditions? This website wants to know. The website gives a list of common pre-existing conditions, and requests that you choose all the conditions you have been diagnosed with.

  1. Choose your underlying conditions and click “Next”

Once you have completed these steps, you should find yourself at the final page, which gives you a summary of what you reported, as well as recommendations for reaching out to a health care provider, or for immediately seeking emergency help. The website also offers information on how to protect yourself, as well as up-to-date information from the CDC about how the virus spreads.

For more resources and information, you can also visit the Coalition for a Healthy Oregon’s resource page, which is updated weekly.

Health care providers know that when facing a pandemic like the novel coronavirus, the more we test Oregonians for it, the clearer the picture is for what our state needs to prepare for. However, creating the type of accurate modeling needed to give public health officials a clear answer is made more difficult by the fact that there is not widespread availability of the rapid in-clinic testing, and the PCR testing that has been used by health care providers up until now is only accurate 85 percent of the time.

If Oregon lawmakers push for making the rapid in-clinic test widely available, we might be able to create a much more accurate model of this pandemic. In the next few weeks, there will also be widespread deployment of antibody tests that can determine whether a person had the virus, recovered, and built up an immune response, making them less likely to contract the disease again.

Will Oregon lawmakers push for making the rapid in-clinic testing widely available? The House Republican page on COVID-19 updates mentions the rapid testing but says that supplies to run the test are short at this time. Widely testing residents has been a clear desire of the legislators on the Joint Coronavirus Response Committee, as they made clear to the Oregon Health Authority during their sessions last month. Could a more accurate model allow our state to get back to work sooner?

From a scientific standpoint: yes. Scientists believe that we need at least six more weeks of social distancing. If our state is able to procure wide enough testing that almost every single person currently in Oregon can get tested, while continuing these aggressive social distancing measures for the next six weeks, we might be able to create quarantine-like policies that provide specific guidance for populations based on the result of their test. This would allow folks who test negative, or those who are immune but not a contagious carrier, to return to work.

If we can achieve this level of stability, our state could work full force on manufacturing PPE, getting aid to other states, and helping to end this more quickly for our entire country. We wouldn’t need to worry about overly extensive economic fallout from the shuttering of our businesses.

However, from a political standpoint: unless California and Washington join us, and the science agrees, we will not be able to reopen as quickly. With President Trump announcing his “Council to Reopen the U.S. Economy,” several states, including New York, which carries more than 32 percent of the country’s COVID-19 cases, have banded together to coordinate their re-openings together. This move by Democratic governors across the nation is a signal to the Trump Administration that they will only be open for business when it is safe.

Indeed, on Tuesday morning, Governor Brown hosted a press conference in which she addressed the future systematic re-opening of Oregon’s many restaurants, bars, clothing stores, etc. In her comments about the framework of this reopening, she said “The best path forward is a cautious one. A path that proceeds gradually, incrementally, and carefully. A path that relies on science and facts to determine each step forward.”

Governor Brown is incredibly committed to not moving forward unless the science is strong enough to signal that it is safe to begin incrementally opening our state back up. Until then, we will be FaceTiming our family and friends, sitting outside but only in our backyards, and typing up articles like this on my kitchen table.

With the creation of Coordinated Care Organizations (CCOs) came regulations to ensure progress toward the Triple Aim:better health, better care, and lower cost for Oregonians enrolled in the Oregon Health Plan. One of the ways to hold CCOs accountable for positive health outcomes was to provide “health metrics” tied to a financial incentive for CCOs, which can in turn be used to reward providers for helping meet these population health goals.

Each year, the Oregon Health Authority (OHA) withholds a portion of CCOs global budget, which can be earned back based on achieving these health metrics. This mechanism is one way that CCOs are held responsible for tracking and improving preventive care, with the ultimate goal of keeping people healthier and out of the emergency department.

Each metric is carefully chosen by OHA’s Metrics and Scoring Committee, and metrics are revised ever year. Once all the CCOs have established systems that have proven effective in addressing a specific metric, that metric is retired, and a new one is created. CCOs have flexibility in what they can do with this money when they receive it on a normal schedule, allowing them to pass a bonus on to their providers and other stakeholders.

With the outbreak of the novel coronavirus creating a cash crunch across the health care system, OHA made the decision to release 60 percent of these payments to CCOs by March 31, a couple months earlier than normal. This allows CCOs to respond to the emergency by making community investments that are directly related to COVID-19.

So, what will our state’s CCOs do with this money, and how will it be regulated? Once the OHA shared that these payments would be released to CCOs, they quickly followed with a requirement that CCOs complete a document discussing the different COVID-19 community investments that they will be making over the course of this pandemic that was due back to the authority by April 10.

COHO CCOs got to work making hard decisions about what community needs were greatest, and what needs would continue to pop up over the next several months as the virus progresses. OHA encouraged CCOs to focus on COVID-19 related areas of need, and requested that each CCO provide an overview of the methodology used to distribute the funds, information on entities receiving the funds, an estimate or range of the expected distribution, a summary of the extent to which distributions were based on previous contracts, a summary of the extent to which distributions were based solely due to COVID-19, a timeline of when distributions were made if possible, and an estimate of any money not distributed and the reason why.

By the end of June 2020, each CCO will also be responsible for providing a final accounting of the distribution of these funds into their community, including explanations for major deviations from the plans provided to the OHA in April.

COHO CCOs worked in collaboration with their Community Advisory Councils, board members, providers, and other members of the community in order to make these incredibly important decisions about where in the community these funds will be invested.

While we don’t have a complete list available of where our CCOs will be investing their money, we know they are doing what is best for their communities! In a few weeks, we look forward to publishing an article that details several of the investments made by CCOs using these funds.

All our member CCOs are doing a fantastic job filling gaps for their members during this critical time, and this week, we decided to highlight an exciting pilot project by Trillium Community Health Plan!

Through this crisis, we know every single Oregonian will be affected in one way or another. The difficult part is identifying those who are most in need and finding a solution to serve them. In one of its many initiatives, Trillium Community Health Plan is focusing on an at-risk population that we haven’t heard much about: pregnant women and people.

Just like those who are immune-compromised, pregnant women and those less than two weeks postpartum are at incredibly high risk for contracting COVID-19 and developing medical complications. Women’s Care, one of Trillium’s provider partners, reached out to explore ways they could work together to reduce pregnant Oregonians’ exposure to COVID-19, while still ensuring they are receiving essential health services, like doctor’s visits.

Part of Trillium’s mission during this COVID-19 crisis is to keep its members as safe as possible. So, Trillium launched a project in partnership with Women’s Care to identify reasons that pregnant people go to the doctor, to find creative ways to decrease doctor visits. Women’s Care was able to pinpoint that it is crucial for pregnant people to get their blood pressure checked often for gestational hypertension, chronic hypertension, or preeclampsia. Often, blood pressure checks generally happen in-person at the doctor’s office or a local pharmacy.

In order to keep pregnant patients away from pharmacies, grocery stores, and doctor’s offices, where their chance of contracting COVID-19 is high, Trillium provided 105 blood pressure cuffs to Women’s Care, so members can check their own blood pressure at home. This decision on Trillium’s part further ensures the safety of their member, and their newborn.

Not only did Trillium help identify and provide a solution to the need discussed above, it was also able to fulfill a request from Lane County Public Health to procure much-needed Personal Protective Equipment (PPE). Trillium procured 5,000 N95 masks, 96 face shields, and 150 gowns by working with its corporate partners and shipped this critical PPE directly to Lane County Public Health.

Trillium Community Health wants you to remember that we’re all in this together. A sentiment we’ve heard often during this outbreak, and we feel is especially true for CCOs, providers, and the community members we serve.

Thank you, Trillium Community Health Plan, for your commitment to serving your community.

You’re right—We ARE all in this together!

For years, health care reform has been a major platform for many candidates running for public office, as well as a key legislative priority for many Oregon legislators. Whether it’s decreasing the prices of pharmaceutical drugs, increasing the number of insured Oregonians, or ensuring underrepresented communities receive the care that they need, we have been fighting for some time to address these issues within our health systems.

As the novel coronavirus spreads through our communities, it has exposed weaknesses in our health delivery system, as well as the structures that govern those systems. It has also shown how Coordinated Care Organizations (CCOs) are able to deploy resources quickly to provide basic resources and keep people out of the hospital.

Indeed, one of the most important lessons we will learn from this pandemic is that our health care system was not fully equipped to handle it. How do we create a system that is able to respond more cohesively and comprehensively in a crisis?

One of the first steps taken during this pandemic was the collaboration of publicly owned hospitals and health systems with those that are privately owned. In every major health industry, public and private businesses and health care providers are coming together to ensure that we decrease the effects of this crisis. In the pharmaceutical industry, corporations and public health entities are working together to find a vaccine or therapy for the virus. Hospitals are coordinating so that public hospitals can discharge patients from their emergency department (ED) for care at private hospitals that may have more capacity. Will this willingness and ability to collaborate make these groups more inclined to compromise on health care transformation?

Another step that was quickly taken by officials was to increase access to telemedicine, by decreasing the barriers to this care. By relaxing rules around privacy (known as HIPAA laws), providers of all types may utilize FaceTime, Google Hangouts, and Skype. Not only were restrictions removed in many states including Oregon, providers will now be reimbursed at the same rate as providers seeing patients in person. Before this move, telemedicine was not something widely utilized in Oregon.

With the uptick in Oregonians projected to utilize OHP and our state’s CCOs rising to the challenge, will more legislators be interested in utilizing OHP at a higher rate, or expanding the coordinated care system? Oregon has never shied away from having the universal health care conversation, but what’s always been missing is how exactly we will achieve that goal. Will some of the changes made during this pandemic answer questions our legislators have previously had about how to deliver universal coverage for all?

We don’t know if any of these changes will stick, but we do know that Oregon’s CCOs have been leading the way in deploying resources to their communities in an unprecedented fashion, allowing them to serve their communities at a much faster rate.