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Oregon Health Coverage

Nov 8, 2013|

A discussion with Dr. Ralph Prows, the CEO of Oregon’s Health CO-OP, about the options available to Oregon citizens in a post-Affordable Care Act world, including the ground-breaking strides the CO-OP is taking to further redefine the idea of what health insurance can be. www.ohcoop.org

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Automatically Generated Transcript (may not be 100% accurate)

You're listening to mattress goes -- series of interviews with people of interest in northwest Oregon and southwest Washington. I'm your host -- ten Douglas if you're a regular listener to the show you've probably noticed that my voice sounds a little bit different. I'm a bit under the weather then go through some very flu like some symptoms. As my guest here told me off the hair and he is the perfect person to do that he is a doctor Ralph. Crowds this Eric. Okay Garrett he is the CEO of organs -- co op. Now this is part of everything that's going -- right now the health care change the sort of talk a little bit about the Affordable Care Act for a talk a little about how that's affecting people here in orient. And now with the good folks at organs health co op can possibly do for you. I think you so much been on the show today doctor. Arnold. So let's get things kicked up -- let her listeners know a little bit about yourself and how you came to beat. With organs health co -- Thank you I am a tradition and an intranet actually got training and -- in turn helped turn out her around or try appears. And oddly enough I've managed spent about half that through -- years. On the patient care delivery side of health care that's actually seen patients over -- Medical actually traction that sort of thing. And the other half tried quite by accident. Actually. Seen medical director or chief medical officer or Chief Executive Officer of health plan. And -- roamed from our country engaged in the war on each. -- we can't achieve practitioner in San Antonio. To help plan and -- cheese's. Choose the -- clinic here in origin. And then that in two regions -- shield and then. Now to co -- and that's how I'm opportunity came about me -- eighteen months ago. -- not really Affordable Care Act term. The Supreme Court upheld that act yen -- I was offered this position and if I would be really exciting news being choose to do well I was. Captured by the decision to help plan that would be a non conference process and actually driven by operated by and to rectify the members who only insurance shall have to be sort of democracy in action. Direct expression it would forego millions wanted to see in health care that seemed cool different and exciting to me so I can't -- Fantastic. Eight -- -- actually get into this thing that has been. The subject of so much debate and so much confusion. By the Affordable Care Act itself flat as you said it was -- and act that went through endless upheld by the Supreme Court. That's all it is the law of the land we're just starting to see the the law actually. I'm starting to take hold at this point. And I think that's where a lot of confusion began so let's do just kind of been very brief idea very simple idea of what is the Affordable Care Act. We'll be Affordable Care Act that passed in -- twenty hitters did a lot of it. Attempts to do several things primarily I think first and foremost. About its really an insurance reform. As everybody's aware. Health insurance cross country has been. Problematic for many many reasons yeah he has let people uninsured poll because it -- pre existing conditions. Some health plans every ended coverage and people because. A claim learned a potential place that's -- The insurer -- what adverse. And and didn't want to get more pay for it. Just millions and millions of factions in health insurance. Over the years say as well as the spiraling costs. And just enjoyed plenty an American public. Appeal arm. Uncertainty apprehensive. I'm an insecure about their health care coverage and access to care. And I -- of course we had we we've had fifteen million or so uninsured Americans altogether. Who have no access to health care end. Medical costs have been warned leading the reasons why Shanley an individual has had to file bankruptcy shall I -- that altogether. I'm has put that in the context for the rest the world where most countries have. Have a government based health care system that. In general delivers a more reliable quality of care and and general access to care says. He exceeds what we've been able to do in this country and had put that altogether and come up what led to the Affordable Care Act being drafted. And pastor to try and solve the access problems. I try to delivers. Insurance a way to cover. I'm all Americans are nearly all Americans and the affordable price. And delivers some sense of financial security and health security to people that they didn't have before. Right it seems it over the decades -- through various Steve regulations and then. It's -- like. The power is kind of shifted from the people using insurance to the insurance companies themselves and they were able to kind of hedged their bets submit. And and end up making a lots and lots more money makes total sense from company's standpoint but for the health of our country not so much. So here we are traded to make this better so how does the organ health co -- it's fallen to this new. Regime -- new world of of health insurance. Well I think took a brief chat history lesson would be helpful -- Going back into 2009. As. This whole formal care act is under discussion. Very politically charged habitual today. Many many Americans look around the world and said you know why don't we have a Medicare for all program. A single Payer system a public option being nature and we're used. To describe and. And efforts were very strong to try to shoot lights you Affordable Care Act are in such way that it would create this sort of single Payer. Medicare for all our options that the political. Power would not bear to see that happen. Instead they're armed senator Kent Conrad from North Dakota. Who had on the Senate Finance Committee Max Baucus. Came up with something of a hybrid or compromised model that -- deliberate in that -- care act in this how coop were created. The idea. The -- is that term -- talk co -- stand for. He could stand for consumer operated and oriented players. And the idea here was to create something of a public option. I helped plan an insurance option for people to actually. Create operate in drive and insurance plan the way they wanted to see. As opposed to the traditional who helped -- her in the markets today people. And so that's apparently were created. They are unique. In that they are all call when he treat them in the country are all these non profit in -- You know and I are selling car will be telling your insurance program. On -- mosque and state and the federal health insurance exchanges. In competition in which all of the other health plans are there. And each co -- after he enrolled members. You must elect a board of directors. -- comprised in the majority from among the members that are insured and I -- mechanism. They will continue to come. Providing insurance products programs. And touched that reflect with the people in their markets actually want. Rather than what the traditional insurance executives. And leave the other companies those half. That's totally comfortable -- nonprofit consumer operated and oriented where he could focus must be on its membership. So this is something that. You know where where like I had somebody on recently. Representative from cover organ and so there and that's kind of the in the road here to find organizations like yours that you wanna get coverage for a -- correct. Are not necessarily -- terrorists who looks and let's be clear here on the understood I'm distinguishing. Cover organ from -- walked a lot of people get confused about their ticket number one in the same we're not. Cover -- happens to be then corporations. That operate. Or again insurance exchange. And that our current core Intel co op on the other hand -- they've freestanding. Nonprofit. Insurance companies. And as an insurance company we sell insurance. On the cover organ exchange. We also sell aren't -- opt to exchange so anything you don't know I'm not tax cuts. Key feature -- a key feature that people leaders and I think Al cover organ. Exchange. Is that if you think your income level. Is. Below 400%. Of the federal poverty line then you may be eligible for. I tax credits and subsidies and car sharing. But you can only get those tax credits -- shares and subsidies through cover organ. You -- you won't get damage you and roll with oracle co op opt exchange. Bombed you really have to go to cover or did get asked. Cabinet did that's just seeing kind of the is the -- the road the road in do you guys you have to go through there to get those subsidies. If you're not worried about those subsidies and go directly to you. That's right. Or you go through a broker agent mutual. Catcher so let's let's talk a little bit about do what you guys have there are unique offerings outside of when you might find from typical insurance company. Glad it is that we cut an awful lot -- this notion of co op and are realized that they shouldn't be up puke. Administration here to determine what he's helped benefit plans really should look like or -- question what would make -- unique. But actually the challenge what would make actually Nicole what would make -- unique would be if we in fact really hatred of the old vision and mission and and went out power to millions -- they wanted. And -- -- those things could be heard and our unique that's what would. Actually British ambassador and be different about a -- against. Last year we sort of focus groups and all the major metropolitan areas of origins. The renowned and I listened to near Eudora coming into -- focus groups or -- into words are uninsured. Or going into war insurer either individually or through their employers. Oregon into war on Medicaid. Or don't seem to -- influential result health care such as -- Human resource directors and managers. See those business owners and those console as well as brokers and agents shall we try to cover and as many potential. Purchasers are influencers of health care as we could in the focus skirts. Well what we learned. Is what we then translated. In -- our insurance programs and don't make it unique. First saw this would cardinals surprised anybody people are and have been. Really confused about their coverage. Insurance it's so darn complicated the kind of designs are so darn complicated. People had over and over again they never really knew what -- console gonna be some -- it's been really understood a mile course. But cocaine or co insurance -- deductibles. Out of pocket maximum. Individual and family -- -- in the network out of network limited network large network I mean. -- real people just glaze over on the soda pop want what. For grown into really do it on a tight budgets and they want to know with certainty what. They're out of pocket expenses going to be and if at all possible not happy -- -- actually go get care so they can make wise choice and Republicans do. Yeah. So what we did -- that was to create. Benefit plans we call them are simple plans. That -- we got rid of most all of that stuff. We got rid of all of those cottages. To what you see on these benefits plans is -- can you triple cocaine. And not multiple co payments -- Hugo. You know your doctor and the doctors CG UN. He orders a lab test right ex trader and not trust not gonna get hit which street or co pay attention to change the ancient oak okay. The primary care visit let's say it couldn't be sure he tried books which is a specialist in 97 books -- that's good it's all Enders don't consciously or not. So we greatly simplified district you can no certainty. What it's gonna cost -- ego and didn't see a doctor so that was that was one of mosquitoes trapped. But that's and that's a huge wondering that for me that is my primary issue with. You know than the health insurance that we've had up until now for instance two and a half years while I thought I would had a kid. And Jim and there are some some complications afterwards -- -- drastic but she did have some labs has various things done and and some procedures afterwards and of course you know -- like you say you have all these -- when you go in but the back end of that is that then free nude deductibles. You're getting. 56 different bills from different places. And nobody talks to each other so then try to sort all that out and figure out who had how your pain -- be so much easier for just could pay one bill. As such a great example another man he's still being more bills -- -- to get stuck with more out of pocket. I mean let's look at the population of the -- for example or. -- people you know what I'm wearing a -- to have surgery at an outpatient may be in a hospital outpatient. Sooner or surgery centers and -- catch. And then then sort of thing happens you go and you think you've. Collected at doctored that you and your network using Jim you've selected a hospital or endorsers and -- -- no -- Q -- you got it covered. You mean situations. You have to procedure done and then what he said -- targeting ability to get built and built from a lab -- Get bills hospital get built from the primary surgeon any bills and interest and certainly -- geologist with app are just. And some of them -- he may never even have Matt just aren't -- -- work then you have no way to know about. Happened that I didn't didn't get -- -- -- huge -- he never had any idea you get well we're talk a lot can happen that's just not gonna happen a little gotcha is. If it should happen or you have surgery it plays like catch. And those -- come true from us. Doctor Who does not in our network we're gonna take care of those in Morocco allowed Escude being you. Now we're psychiatrist -- -- we can -- up. Yeah exactly this sort of thing I'm talking about -- out -- these simple. It's got to be straightforward so people can make or actual issues so I feel secure -- recovered. Right so when you say that this is remember operated and a nonprofit certainly that's an end. And as usual. What do you think about insurance company. So let's get into into that how is that they you do listen to your members how do you members control what happens in the organization. Well presently and I had this all started the year ago looking focus groups could we don't have any members yet. Right well I guess you have to make -- good. Yeah we won't be enrolling until January 1. But next year at this time will be holding. And open elections -- board for the ball nice and. And insecure person on the board we'll have to be comprised from our membership so little. We're just right now. Building the structure the contracts she would bring about that sort of elections. When we begin having that actually do that some members now which we've gotten off exchange interpreting those are not cover -- -- this kind of struggling. Cheat sheet duty enrollment process but we've had membership come to a top -- exchanged so we're working here. Catcher and catcher but once it is in place then. You know we'll we'll have a safe your member and you've got to complain to someone to tell. Yes if you will and will continue military approach and then they have advisory committee it and for a confrontation around the state. So that every member and you know quite possibly even non members will be able to express what -- wants. And don't want as we move forward. Not just about it's not just about the benefits plan the courage. I'm under the Affordable Care Act. 3COM. Our our agreement with the government stipulates that our money can only be used for three things and process and we. Can only be used to treat change first just paid medical claims of course. Second is. To repay the debt we have we were under your loans from the federal government will go to pay goes back. And finally to build health programs. Our membership. We cannot get our money to invest in buying businesses -- building your startup businesses or. You know re branding a large portrait -- or anything like. Right you're just joining us I'm speaking with doctor Ralph crowds he is the CEO of ordinance health co -- And you can find out more information about organs health co op at the website which is no HC. OOP dot org so OH co -- dot org. -- -- go there and check it out and -- -- also how you can find out about the ruling with some. And all that which should enrollment for them begins in January 1 of this coming year and has done all this research do you you've done all these focus groups to find out how does this in your website that this is. Designed by org -- four or go any incidents approach to health care and -- know from speaking to other organizations over the the years that organs. Health care is. Is actually a little bit farther along -- a lot of the rest of the country that a lot of things that the Affordable Care Act are putting in place outside of the subsidies. -- we were already kind of heading there are so as far is -- goes is it true that we are a little bit more advanced -- houses to advance it further. Well I I think Morgan -- one of one of the leaders in the country in a number of certain number of dimensions. First docile meal back to what I was describing earlier and -- let me she -- good -- Clarence center. I mentioned came into the dot cheers and that is seen -- churches in the principles. And in that -- Can we heard more millions that we built in Q our plans. -- -- We continue to warm very organ specific things like natural patch. I'm an MD and I I I really didn't know that much about natural natural Patrick traditions -- the care. But in every single machine -- we tried him on this cannot. Well. You know they respect and defense. Austria has turned a nurse practitioners and traditions assistance and initial force they also spoke about these special relationship that they have the term natural has and how they rely on -- -- coach -- in ways to stay healthy rice moved more potential for actually. Coached them -- stay off of high cost prescription drugs mobile content -- -- -- And that's -- big help usually don't need surgeries and other teachers who -- on the console can't help. That cost us today then start exploring the whole idea of including natural Patrick primary care physician whose primary care physicians not. Complementary and alternative medical providers. Primary care physicians and. So we export this to a C -- -- -- now -- at Madison learned that they LS for your curriculum America looks quite a bit like a medical school curriculum. And that under the steady -- in fact become eligible to be licensed as primary care traditional. With all of the rights and privileges and responsibilities I have. Including providing preventive care immunizations well child care adult care. Writing prescriptions ordering lab capturing -- -- in the rest. And put -- -- -- -- that we made the decision because such as what we do we listen and we believe and act. We decided to credential natural Patrick positions as primary care physicians. In arms in our plan and so does he want knowledge we're the first health plan to be kept -- very unique and it Hugo other other places in the country. And it -- just how -- that. The color picture looks. As well as Oregon no we don't necessarily particularly people -- put it -- cutting edge -- Right well even mentioned you know might admire wife -- can a couple of years ago even there -- -- a large hospital very well known hospital but. Across the street from them they have they -- to a free. And the -- Winfrey operates independently. But they also you know have the option to be hand in hand with the hospital also. For the majority of everything we did. We use the midwest free and had to the natural childbirth we were planning. They had that been able to go through it didn't deserve our daughter was was breach of the last minutes of the had to do a C section. But there was where it was like OK we -- juicy section lets hander across the street and we went over there and they got to die and it was wonderful but then. Once that procedure was done to people from the mid Winfrey still came over to this kind of handled the rest of -- and it was a nice way of seen both of those world's -- hand to -- Think they can work and it can't you know I wanna be patient and have more sort of situation that. -- immigration and natural Patrick tradition to -- you wish traditional while Patrick finishing like me. You know at least Q. I medical practitioners. Have you -- normally worked sort of in silos and haven't communicated. Have a coordinated care. A large degree but that's open to change what we're gonna happen helped facilitate faster. I think around we're going to be edited and -- direction -- switched -- -- -- a lot of what happened. Previously which is osteopathic traditional and nurse practitioner as -- as those certain. Special teams have been recognized him. And facilitated when this sort of mainstream medical care very integrated way. Organ was let go around the country and a -- of other. Ways as well on the course. Most of the listeners have probably heard of and I coordinated care organizations or PPL -- coverage of hoppers and champion this. I DN organ is very unique in the creation of peace she she goes for Medicaid population. And he variant being -- How they can coordinate care better cut costs and improve quality for the Medicaid population. And could -- tackling saying that there were of course are in control or be commercially insured population. That's fantastic where we are human appear on the end of our time but I wanted to. Corps recruit quickly mention. How does that people can get involved with you guys -- The organs health co -- is the website which is OH CO OP dot org is that the best way to get -- he would ask questions that sort of thing. Okay so again OH TC OOP dot org says stands for organ health plan co -- And they check it out go there there's there's some very a brief information on the website give you the real general idea but that's. That's kind of the idea let's keep this simple let's take all of this complicated bureaucracy. And chopping down a bit I mean we're always gonna have little bit of that it's it's health insurance as he comes with the territory but. This certainly goes a long way to simplifying it and taken away -- so many of the headaches that seem to go hand in hand with with health care in this country. Well doctor thank you so much first space and time of the senate. You're very welcome thank you for asking not try to make more -- what's your comment. I would -- polluters would think so. Or -- co -- has not just an insurance plans. It's also a champion of a movement citrus really -- -- for people to get involved and make things better not to we're trying to do perhaps we can in the first. -- round of -- -- element and that was what our mission is sure what we'll continue to. -- in yet another step in and organs ongoing. Fight to be a leader in so many social causes it's extra fantastic. -- it makes me proud to be here. And how -- Dokic so much. All right that'll do it for this edition of match a scope and intercom communications public affairs program I've been your host Ed Douglas if given nonprofit or public affairs organization they would like to let others know about please email me at microscope @entercom.com. And -- -- than -- And please -- microscope in the subject line so it doesn't get snagged by my spam filter according go directly to the station's website click on the community -- -- your information here also -- like -- this program again you can visit our podcast page -- -- -- -- -- com where you'll find this and the last couple months with the episodes and please feel free -- your FaceBook -- MySpace -- blog Twitter your Google+ whatever you got. The -- get this information out to as many people as possible but thank you again doctors think you'll so much for listening this is thin mattress company. Today's news mean son Hugh moms same since now this. Yes. And I ask. Back. You Sam. And her. No. I mean good or bad it's okay. Hey. Yeah. They're. Okay. -- --