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AllCare: Not enough patients were getting mental health care

Mail Tribune - 2/26/2017

Feb. 26--AllCare Health representatives said Jackson County Mental Health is providing quality services, but wait times have been too long and not enough patients were getting care.

AllCare explained its reasoning for pulling back on its partnership with the county during community forums in Medford and Ashland on Saturday. AllCare is a coordinated care organization that manages the physical, mental and dental health needs of many Oregon Health Plan patients in the county.

Jackson Care Connect, the other coordinated care organization serving OHP members in the county, started an 18-month transition away from most Jackson County Mental Health Services in January. Patients are being shifted to other providers in the community.

Patients, their family members and providers have raised alarms about whether there are enough other mental health providers to handle AllCare and Jackson Care Connect patients.

AllCare and Jackson County remain in negotiations over a transition plan, with AllCare offering to continue during the transition on a fee-for-services basis. The time frame for the transition is still being negotiated, said AllCare Chief Medical Officer Mark Bradshaw.

The current contract ends March 31.

"Our intention is to get as long as we can to transition our patients," Bradshaw said.

Talks originally broke down after Jackson County refused an $8 million offer to provide services -- a cut from the $13 million it has been receiving per year.

AllCare says the county would have been providing fewer services for the reduced amount, while Jackson County officials contend they were asked to do more for $5 million less.

AllCare wanted to use the $5 million to provide an array of additional services and increase the number of mental health providers in other settings, such as schools and doctors' offices were people are already going.

If both coordinated care organizations pull out of partnerships with Jackson County, the county will lay off 200 workers, county officials have said.

County Administrator Danny Jordan said last week 65 employees have already left or given notice that they will leave -- eroding the county's ability to provide care.

At the root of the problem, AllCare says Jackson County ranked 33rd out of 36 Oregon counties in 2015 when it came to Oregon Health Plan patient utilization of mental health services.

In that year, 9.8 percent of patients used mental health care, compared to 11.4 percent in Josephine County. Lane County had the most utilization, at 16.4 percent, while Wheeler County had the least at 6.9 percent, AllCare said.

Lane County has a decentralized system for care, rather than concentrating its mental health services with the county government, said AllCare Vice President of Government Relations and Health Policy Josh Balloch.

Balloch said Oregon is being closely scrutinized by the federal government and needs to provide more access to mental health care.

Bradshaw said mental health service use rates have improved since 2015 in Jackson County but still remain too low.

He said patients also experienced delays in getting care, with the average wait being 42 days to get an appointment.

AllCare is turning to Josephine County-based Options for Southern Oregon to provide some of the mental health services.

Options Chief Operating Officer Shelly Uhrig said her organization was able to cut its wait times from 20 to nine days by targeting the problem. Options also provides urgent care access with same-day or next-day appointments for people who need help right away.

However, an audience member at the Medford forum questioned whether everyone gets in quickly. She said her friend in Josephine County was told her child would have to wait four months for an appointment.

Other audience members questioned how patients could be seen promptly if AllCare has to find replacement providers as it shifts away from Jackson County Mental Health.

Susan Sanchez, a registered nurse with Providence Medford Medical Center who helps patients transition out of the hospital, said Jackson County Mental Health workers are supportive and loving toward patients, and have stood by them through mental health crises. She said she is saddened that the employees' livelihoods are threatened, but is most concerned about patients.

"These frightened patients are at the center of this," she said.

Adding to the uncertainty, President Donald Trump has vowed to repeal and replace the 2010 Affordable Care Act, dubbed Obamacare.

The act substantially increased the number of people on the Oregon Health Plan, with one in three Jackson County residents now receiving the health insurance that is subsidized by the state and federal governments.

"If the Affordable Care Act changes, we'll definitely be affected," Bradshaw said.

Oregon is facing a $900 billion budget hole from the costs of the expansion, even with the federal government picking up the majority of the tab.

Patients could be cut from the Oregon Health Plan if state legislators can't cut costs elsewhere and find new revenue, such as by raising taxes.

Staff reporter Vickie Aldous can be reached at 541-776-4486 or valdous@mailtribune.com. Follow her at www.twitter.com/VickieAldous.

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(c)2017 the Mail Tribune (Medford, Ore.)

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