Updates from CareOregon |
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CareOregon selects a new pharmacy benefits managerJanuary 1 marks the advent of a new pharmacy benefits manager (PBM) for CareOregon. We'll transition from RxAmerica/CVS Caremark to Express Scripts Inc. The change will not affect pharmacy benefit policies or formularies, but there are changes to phone numbers and forms:
Two north coast counties are now part of CareOregon service areaStarting January 1, 2010, CareOregon will be providing Oregon Health Plan services in Tillamook and Lincoln counties. Managed care organizations (MCOs) have not been providing services for Oregon Health Plan members in these counties. As it has done in other areas of the state, the state is requiring that all Oregon Health Plan members in these two coastal communities switch from open cards to MCOs. CareOregon and Samaritan InterCommunity Health Network (IHN) will be providing these services. Presently about 6,200 people are eligible for the Oregon Health Plan in Lincoln and Tillamook counties, said Jim Carlough, senior manager for CareOregon’s Provider Services. Provider Services is the department tasked with building a network of providers in the new territory. “We’ve started relationships with the safety net clinics—the Federally Qualified Health Centers (FQHCs) and Rural Health Clinics,” Jim said. “We’ve also been working closely with the health systems and hospitals, including Tillamook County General Hospital, which is a member of the Adventist Health family of hospitals and clinics, and Samaritan Health System, including Samaritan Pacific Communities Hospital in Newport and Samaritan North Lincoln Hospital in Lincoln City.” Because of the proximity to Lincoln County residents, all of Samaritan’s facilities, including Corvallis, also are an addition to the CareOregon network. “We’re looking forward to building long-term relationships in these two communities to provide health care for CareOregon members and to help fulfill the mission of CareOregon,” Jim said. “And that mission is to see that high-quality health care services are available to all Oregonians.” One benefit that CareOregon can provide to patients in the two counties is to immediately provide access to the CareSupport care management program, he said. Help wanted: CareOregon providers sought for quality committees The Quality Management Committee is looking for providers who are willing to be a part of CareOregon’s quality monitoring and improvement process. Three of the six committees under the umbrella of Quality Management require external membership of providers who deliver patient care: doctors, nurses, nurse practitioners or physician assistants. (A fourth committee with external membership, the Pharmacy & Therapeutics Committee, is not seeking new members at this time.) Committees in need of members are:
If you are interested in serving on any of these committees, please contact Ann Blume, blumea@careoregon.org, 503-416-1723 Meet Jim Carlough, our Senior Manager for Provider Services
Jim Carlough, CareOregon Senior Manager of Provider Services, has seen just about every aspect of health care insurance in his 18-year career. “I’ve worked in all health care delivery systems: commercial, Medicare, Medicaid, and TriCare,” Jim says. “I also have a background in providing administrative services for self-funded employers and organized labor unions.” Most of that career was in Arizona. Born in New Jersey, Jim moved to the Grand Canyon state at age 2 with his family. He attended Northern Arizona University and lived in the Phoenix Area for many years. While Phoenix is where Jim got most of his experience working in managed care organizations, he has had responsibilities in more than 21 states, including Oregon and Washington. “I enjoy the challenge of network development and operations, the technical and legal aspects of contracting,” he says. “However, the rewarding work comes from ensuring the members have appropriate access to the services they need, when they need them. We accomplish this through developing a network of relationships and partnerships with community providers, because health care is local.” Jim moved to the Northwest in 2005 to continue his work in health care. He has been with CareOregon since May 2009. Off the job, Jim’s passions are family and golf. OHAC survey: Satisfaction with Oregon’s special-needs plans exceeds national average A recent customer satisfaction survey indicates that Oregonians with the greatest health care needs are more satisfied with their care than the average person. The Oregon Health Action Campaign (OHAC), a non-profit advocacy organizations, conducted the survey with help from Portland State University. They surveyed Oregonians who receive both Medicare and Medicaid services from one of two Special Needs Medicare Advantage plans: Trillium Community Health Plan and CareOregon Advantage. Special Needs Plan members tend to have one or more chronic illnesses, many are disables, about half need specialty care and 90 percent need prescription medicines. Both of the plans scored above national averages for commercial, Medicaid and Medicare survey ratings as reported by the national benchmarking database: Consumer Assessment of Healthcare Providers and Systems (CAHPS). Some 68 percent of CareOregon Advantage and 72 percent of Trillium CHP members rated their plans as 9 or 10 on a scale of 0–10. This compares to 36 percent for commercial plans, 59 for Adult Medicare and 50 percent for Adult Medicaid. For more information, see the CareOregon news release. |
CareOregon initiates Facebook page in support of Measures 66 and 67 To help keep interested Oregonians informed about the two measures on the January 26 ballot, CareOregon has launched its first Facebook page. This page will use this fast-growing social media to keep current information about the measures before the public. Connect with us at facebook.com/CareOregon For more information about Ballot Measures 66 and 67, see the related story.  This quarter in CareLinkThe winter 2009 issue of our member newsletter, CareLink, was delivered to members in mid December. Articles in this edition include:
Our web site includes the latest issue of CareLink and an archive of back issues, in English, Russian, Spanish and Vietnamese. Pharmacy updatesThe pharmacy department would like to remind you that the CareOregon Advantage formulary may change during the plan year. We post these changes on the web site in a table titled “CareOregon Advantage Formulary Update,” which you can reach from www.careoregon.org/ This table is updated monthly. |
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