The Shift to Community Health Care

Share this article!

A conversation with Patrick Curran, CEO of CareOregon

Patrick Curran is chief executive officer of CareOregon, a nonprofit health plan providing coverage to Medicaid and Medicare members. Curran talked about CareOregon’s efforts to address the root causes of health problems in the community.

How the Affordable Care Act has affected your business approach

The first thing that is really important about it is how dramatic it was in reducing the number of uninsured in Oregon. Since we work primarily in Medicaid, our membership through Medicaid grew by about 45%. So it almost increased by half the total number of people that we serve. It is a dramatic increase in membership, but it also comes at a time when Oregon has gone through a lot of state health reform with the coordinated care organizations, or CCOs, which we actively participate in.

New community efforts to improve health care

When you look at how [Medicaid] is structured — rather than being a health plan that takes the insurance risk, gets the dollars and then pays providers — what CCOs try to do is maximize the benefits that each component of the system is bringing. Our CCO boards have members on them. So imagine a CCO board meeting where you have a member who is receiving care through this program sitting next to the chief financial officer of a hospital, sitting next to a primary care clinic that may be a rural health center, sitting next to a community member. Those people are all [asking] how we can improve the health care we are giving. It is almost like a health economy.

The changing competitive landscape for health plan providers

What the Affordable Care Act did is by reducing the number of uninsured, you now have through the exchange a developing marketplace. That is where we could see some significant change.

New entrepreneurial businesses capturing the large number of new insured

There have already been some entrepreneurial enterprises that have begun, and that will continue. One is the issue of transparency and the creation of tools that individuals can use to better understand their health care costs. Since most of our members don’t pay premiums, it is not just about benefit design but about making it more transparent. There have been and will continue to be entrepreneurial efforts in that area. The other area is information exchange. There are a lot of regulatory, privacy and security components — how we nimbly give members and individuals the information they need to help them manage their care. That is an area where there is a lot of opportunity.

Impact of Oregon’s health co-ops on more established health plans

A disclaimer is that we helped set up the Oregon Health Co-Op. We helped form it, but now it is on its own. We don’t work with the Oregon Health co-op anymore. It was an amicable parting. I think there is a pretty valid question that since Oregon has a lot of nonprofit insurers, how many is the right number? By adding two health co-ops — both of which are doing interesting and good work — are there really meaningful differences in the product among the 13 different health plans? In many states, the health insurance exchange has maybe three to five health plans. The competition and choice has real merit, but is it meaningful? [Health Republic, one of the Oregon co-ops, announced it would shut down in 2016.]

How the Affordable Care Act is affecting the kinds of services you provide

It is not just the Affordable Care Act. It is not about the health care members are receiving. It is about unstable housing, it is about education levels, it is about lack of employment and financial insecurity, it is about the environment people live in — whether this is an apartment building where there is a lot of mold that leads to asthma, or living in a high-crime neighborhood. These environmental factors have a tremendous impact on health. We are trying to build our care models to address those. An example is we have people who are working in low-income housing where members live, and they try to address their needs. We also have a program called the Health Resilience Program — it is addressing people who are high cost and have a lot of needs.

The future role of primary-care services

It is not just about primary-care physicians; it is also about nurse care managers, nurse practitioners. It is naturopathic physicians providing primary care to people in the community. It is the broad sense of people in primary care in the community and really focusing on prevention and meeting people where they are.

What this means for job creation and education in primary health care

I think it is still a challenge in that primary care tends to not be as well compensated as other specialties. It is hard to be a primary-care physician. They put in a lot of hours. We are trying to work with primary care and invest in the capacity of primary care to deliver better. This means investing in the infrastructure, in the expertise of their team and in leadership training. I would like to think that is an area of the future, that it will have a greater emphasis.

How the health-plan sector will evolve over the next decade

I hope it will be a continuation of what we are already starting: what we are calling virtual integration with the network. Traditionally, health plans were very separate. They provided the insurance coverage, they had contracts with doctors and hospitals, and they paid them for the services. This sometimes sets up an adversarial relationship. What we will see is a more mutually beneficial relationship where what a health plan does is more aligned with what a provider does. It is about discussing where we need to collectively invest our dollars to improve health. The health plan can play an important convener role to do that. We don’t have all the answers.