Among the reforms Governor John Kitzhaber and the Oregon Legislature unleashed with the Oregon Health Plan (OHP, Oregon’s Medicaid program) are the creation of Coordinated Care Organizations (CCOs): local health entities that will integrate a patient’s physical, mental, and dental health via a team of doctors. The idea is to save money by focusing on prevention and more efficient and effective care.
Naturopaths are known for their focus on preventive medicine. Yet only a handful of naturopaths who were part of OHP’s “managed care organizations” have been grandfathered in to the CCO model. And even these—a total of nine, so far—are limited to naturopaths who work alongside MDs at special low-income clinics such as Outside In, says Laura Farr, executive director of the Oregon Association of Naturopathic Physicians. In November, none of the 15 CCOs across the state had contracted with individual acupuncturists, naturopathic physicians, or chiropractors—many of whom served as primary care providers for OHP patients—despite clear “non-discrimination” language in Oregon Senate Bill 1509, which states that CCOs aren’t allowed to discriminate against any health care provider acting within the scope of their license.
“Hundreds of patients are poised to lose their primary care doctors,” says Farr, who guesses that anywhere from 500 to 1,000 patients will lose access to their naturopathic physician.
The Oregon Health Authority (OHA) has stepped in and now requires CCOs to allow patients under a naturopath’s care to continue seeing that ND for at least 90 days. If the CCO still refuses to credential a provider, there is a multiple-appeal process for naturopaths, chiropractors, and acupuncturists, says Jeremy Vandehey, OHA legislative director.
But Vandehey thinks the CCOs will come around. “The oldest one is only 90 days old,” he says. “The important thing is the ongoing conversation.”
As President Obama’s Affordable Care Act is implemented and many Oregonians without insurance join the health care system, the state will be facing a shortage of primary care physicians. Eventually, Kitzhaber hopes that the CCO model will manage care for all public employees, and not just Oregon’s Medicaid population. Thus Farr urgently believes, “Oregon needs to use every available provider in order to meet the needs of the giant influx of people the Affordable Care Act will bring to the system.”