From its inception, CareOregon has focused on primary care, and the importance of preventive and chronic care in improving health for the entire community. Dr. Andrew Suchocki, Medical Director of Clackamas County Health Department, has seen this first hand.
“CareOregon is unlike any other insurance company I’ve encountered,” says Dr. Suchocki, a longtime part of CareOregon’s extensive provider network. “Their knowledge of primary care and the community, and their ability to bring health providers together, has improved care for all. Without them, our region would not have the successful health system that now exists.”
In recent years, federal and state health agencies have called for a shift from fee-for-service to value-based payment models that reward providers for better health outcomes. CareOregon’s Network and Clinical Support Team began transitioning from fee-for-service to whole-health funding in 2015. Working with its provider network, CareOregon has become one of Oregon’s most innovative developers of value-based primary care reimbursement.
“This is a collaborative effort, and we are developing it with our partners as we go,” says Mindy Stadtlander, CareOregon’s Executive Director, Medicaid and Network Services. “Together, we’re designing a system that reimburses innovative clinical delivery models, such as primary care homes and behavioral health specialists. Our value-based payment model for primary care is based on what the clinics have identified as priorities.”
“One of the things CareOregon does best is listen,” says Dr. Suchocki. “They provide us the support we need, but they also provide us the freedom to decide what works best for our clinics. Then, together, we decide what payment models make most sense.”
In 2017, CareOregon’s alternative methods of provider payments increased to about 65 percent of payments across all types of services—primary care, hospital and specialty. In addition, 6.5 percent or $33.5 million in payments were based on improving processes and meeting goals for quality of care, access to care, care coordination and behavioral health integration specifically in primary care. These payment changes are partnered with practice facilitation and technical assistance aimed at helping primary care practices make a smooth transition.
“Our goal is to support the best possible health outcome for each member, and to financially recognize our providers’ commitment to improving that care so they can continue to invest in their care delivery,” says Mindy.
Financial incentives aren’t the only key to improving health outcomes.
“We hold regular learning collaboratives with our primary care network that allow clinics to share their barriers and successes,” says Mindy. In 2017, more than 80 practices participated in our learning collaboratives, and our practice facilitators delivered more than 1,375 hours of technical assistance to them. CareOregon also partnered with the University of California, San Francisco Center for Excellence in Primary Care to co-develop a national training for practice coaching for primary care.
Dr. Suchocki appreciates that CareOregon provides best-quality practice coaching for primary care transformation training, medical home training, and health coach training. ”When our organization was facing a variety of challenges, CareOregon helped catalyze change by providing a practice coach, and she was incredible,” he says. “They give us the support we need and then back away, but they are always there for you when you need them.”
“This emphasis on collaboration gives providers ownership in improving primary care for their own patients, while strengthening health care across the state.”
Oregon is known nationally for its primary care delivery innovations. From one end of the state to the other, medical practices have experimented with services that don’t adhere strictly to the traditional mode of acute care visits but that help patients get better faster, stay healthier longer and lower costs for care. But federal and state-defined payment systems still largely focus on code-based treatments, rather than practices’ innovations to improve whole health. CareOregon has made strides in changing that, with the goal of integrating innovative care and payment structures to ensure the best care for the members served by our partner Coordinated Care Organizations and our Medicare plans, says Mindy.
Strengthening primary care infrastructure
Integrating dental and behavioral health with primary care
Supporting the delivery of non-face-to-face visits
Investing in system-level care coordination
We recognize that the traditional fee-for-service payment structure is inadequate for important work we’re asking primary care to do, such as panel management, says Mindy. “We’ve had to think differently about our payment structure, because clinically it’s the right thing to do,” she says. “We aren’t stopping here. We will continue in our efforts to strengthen, support and help resource primary care to deliver healthy outcomes.” (See figures below.)
Dr. Suchocki of Clackamas County says he’s ready to keep the collaboration going: “Because, after all, it is really the patients who win.”
CareOregon has been exploring various ways to enhance care options for our medically fragile and seriously ill members. And in 2017, we brought the nationally known Housecall Providers into the family.
With home-based medical providers, Housecall Providers serves homebound and critically ill patients throughout their continuum of care—from primary and palliative care to hospice. In addition to offering outstanding care, Housecall Providers has proved itself to be one of the most cost-effective home-based medical organizations in the country. It has participated for five years in the Medicare Independence at Home national demonstration project, which includes 13 additional home-based medical practices that provide comprehensive primary care in the home. Results have been released for the first two years of the pilot. Housecall Providers had the highest cost savings per patient among the demonstration sites.
Housecall Providers’ Lead Care Coordinator Alicia Hanson says, “CareOregon patients have always had better access to community resources and support services than a lot of our other patients. Partnering with CareOregon, we are now able to access those services for the rest of our patients as well.”
Although Housecall Providers serves patients throughout the health care system, CareOregon is increasing its use of the program, particularly for members such as Gloria McClain, who has an advanced illness.
Gloria says the period before receiving support services from CareOregon was one of the darkest of her life. “For a long time, I didn’t think anyone was listening, and that is what scared me the most,” says Gloria. “No one knew my story, and I wanted others to know that you can get past hardships.”
In 2017, Gloria—who is 68 and has chronic obstructive pulmonary disease (COPD)—became Housecall Providers’ first palliative care patient not associated with its primary care program.
“Improving the quality of life for CareOregon members with advanced illness is without question one of the benefits of this new partnership,” says Housecall Providers Clinical Operations Director Kristi Youngs.
Gloria fully understands the impact of the right care at the right time. Forthe last five years, she’s relied heavily on the support of Heather Stoecklin, one of CareOregon’s respiratory therapists. Another “angel” of her care team is Housecall Providers Registered Nurse Monica Ontiveros, who’s been visiting Gloria at her apartment in North Portland since last December.
Receiving medical care in her home has meant that the energy she’d normally spend getting to her appointments she can now use to engage with her community. “I am able to go to my meetings, which is so wonderful because it gets me up and out and allows me to communicate with people of all walks,” says Gloria.
Palliative medicine focuses on providing relief from the symptoms and stress of a serious illness. “The job of a palliative care chaplain is to stay within the patient’s spiritual frame of reference and to support whatever that might be,” says Housecall Providers Palliative Care Spiritual Counselor Dean Yamamoto. In Gloria’s case, this included her asking Dean to baptize her.
There was a time that Gloria thought she had used up all her chances. But the support of her family, community and her care team showed her how important it is that she carry on.
"I feel blessed every morning I take my first breath,” says Gloria. “I no longer ask, ‘Why me, why me?’ "
Stable housing is the foundation of both individual and community health and wellness. That’s why CareOregon actively works with the community to help end homelessness in our service areas.
In 2017, CareOregon sponsored Central City Concern’s “Housing is Health” project by donating $4 million. CareOregon has also deployed housing case managers in buildings where our members struggle to navigate housing issues. We help members reverse their current crisis and provide training on how to avoid eviction. We are now focusing on integrating housing support with clinical and disease-specific needs.
Our member Derek Romero, a 50-year-old of Apache descent, demonstrated how his living situation and health were tied together.
A year ago, Derek owned Ohana Bike Rental, a few feet from one of the most beautiful beaches in the world. “I spent 10 years in Maui,” Derek says. “Right there by the Kaanapali grocery store. I had a rental business for about eight years: mopeds and bikes. Did real well until this liver thing.”
“This liver thing” was cirrhosis, diagnosed about eight years ago. It had been 10 years since Derek had stopped drinking; alcohol is often associated with the disease. By early 2017, the doctor said Derek could no longer work.
His business was lost, along with his income and home. Derek sold the business and came back to Portland, his hometown, where he still had a small network of family and friends who might help.
His overriding goal was to find a warm place to live before cold weather hit. Otherwise, “I’d have to leave Oregon because I couldn’t handle that in the streets,” Derek says. That would have put me behind on my liver specialist and on a transplant.”
At OHSU Family Medicine at Richmond, Derek met Molly Dressler, a CareOregon Health Resilience Specialist. Molly’s job is to look at the non-medical factors in a person’s life that make healing difficult. Homelessness is a big one. Seeing that Derek was homeless, Molly contacted Naudia West, a CareOregon Housing Case Manager.
“Once I connected with Derek, we worked with Home Forward,” Naudia says. “Due to his terminal illness, he was eligible to get on a priority wait list.”
Now Derek lives in a small apartment managed by Home Forward, formerly the Housing Authority of Portland. Derek and his mother found some furnishings from the Community Warehouse, and with the addition of a few items that honor his Native American heritage, Derek was able to make this new apartment feel like home. His companion is Rah-Rah, a terrier who has his own collection of outfits, including aloha shirts from his days as the “spokesmodel” for Derek’s business in Maui.
Finding housing was a major step, but Naudia’s work with Derek did not end there. Derek also benefited from a partnership to help formerly unhoused people successfully keep their new home. The partnership includes CareOregon, Portland/Multnomah County’s Joint Office of Homeless Services and JOIN, a Portland nonprofit that helps homeless individuals and families transition out of homelessness into permanent housing.
CareOregon and the Joint Office teamed up to fund a contract to expand JOIN’s housing placement and stabilization work to some of CareOregon’s members, says Pam Hester, CareOregon’s Health and Housing Manage. JOIN provides housing retention services to more than 45 CareOregon members each year.
Angie Hernandez is Derek’s JOIN retention worker. She says JOIN helps with the barriers that sometimes force newly housed people back out onto the streets.
“We just try to get people involved with the community, and to feel happy again and be able to go forward, not only with housing, but with their lives.”
Retention workers take a holistic approach, In Derek’s case, that meant finding him an attorney when his Social Security application was rejected despite the terminal illness that made him eligible. For others, it might mean making sure that medications are taken as directed. Sometimes it’s coming over to keep them company.
“We just try to get people involved with the community, and to feel happy again and be able to go forward, not only with housing, but with their lives,” Angie says.
Without housing, Derek could not be on a waiting list for a possible transplant. As Derek says, “That’d be the death notice for me.”
Ohana, the name of Derek’s business, is Hawaiian for “family.” It could be said that Derek has found a new family with his housing support team.
“They are life-changing,” Derek says. “They keep you up to where you’re inspired to move forward. “Once I found out I was dying, then I really started living, so life’s a whole different scene for me than it was before .”
Making health care work means meshing all the components of care into a smooth, easy-to-use, compassion-based process that works for members and providers alike.
Last Thanksgiving, one member’s story dramatically reinforced the importance of creating our new Regional Care Team based on high-touch, full-system coordination. A 56-year-old man who had lived on the street since age 9 found his way to a Providence hospital emergency room. Diagnosed with end-stage cancer, he was enrolled in the Oregon Health Plan.
Many care teams, including ours, swung into action. Providence assigned a case manager, Oregon Health & Science University (OHSU) assigned a social worker, and CareOregon provided transitional care and housing assistance. Housecall Providers, which joined the CareOregon family in 2017, supplied hospice services.
Complex, end-of-life treatment can lose its patient focus. But all caregivers collaborated to create a peaceful, caring, end-of-life experience for a man who hated living “inside.”
“He wasn’t eligible to go anywhere,” said Jane Duck, CareOregon’s High-Risk Populations Programs Manager for Population Health Partnerships. Because he had a wound, he couldn’t go to the shelter. “He didn’t qualify for a skilled or nursing facility, and he wouldn’t have gone. He didn’t want to be enclosed away from his support system on the street.”
CareOregon arranged his stay in a close-in hotel so he could get to the shelter at meal time to see friends while he could still walk. Staff from CareOregon, Housecall Providers, Providence and OHSU coordinated daily visits to make him comfortable and arrange meals.
“We are collaborating on the best way to wrap members in a warm blanket of care.”
“It was phenomenal because we all worked so well together,” says Jane. “Everybody was very sensitive to his needs, wishes and goals. It was a huge use of human resources, especially over the Thanksgiving holiday, but not financial resources.”
“We came together to make it possible for (this member) to stay warm, fed and have his wishes honored,” reflects Housecall Providers Social Worker Youske Eto.
The broad array of CareOregon resources brought to bear in this case—transitional care, hospice, housing, exceptional needs care coordination—all come under CareOregon’s newly organized Regional Care Team.
“We provide so many services, from one-on-one health resilience to medication therapy coordination to chronic care support,” says Jonathan Weedman, Director of Population Health. “We’ve recognized the need for internal integration. We are collaborating on the best way to wrap members in a warm blanket of care.”
Staff from many departments have daily check-ins to get a 360-degree view of the ways CareOregon touches members, from health resilience to housing. The goal is for departments to share a dashboard that allows this information to be seen at a glance.
“By integrating our own work, we can increase member and provider support without creating an overwhelming number of calls or questions,” Jonathan says. “We can also reduce duplication of work and improve member outcomes. We have learned a lot in terms of working together, and we are very excited to move formally to the Regional Care Team structure.”
The pilot was developed in 2017, officially kicked off January 2018 and will be fully implemented by the end of 2018.
Compassion, effectiveness, efficiency, collaboration—these are the foundation of our new Regional Care Team.
While cost and administrative efficiency are key goals, the true payoff is in quality member service.
Coordinated Care Organizations (CCOs) were designed to integrate all aspects of health.
In 2017, Jackson Care Connect, our CCO in Southern Oregon, provided financial and technical support to help primary care clinics integrate behavioral health into their practices. Some 70 percent of primary health care visits have a psychosocial driver. In integrated clinics, 9 percent of Jackson Care Connect members (1,800) were seen by a behavioral health consultant.
Jackson Care Connect member Jean Fitch uses such a clinic, the La Clinica Wellness Center. Jean has a history of complex health issues—trauma, chronic depression and seizures—as well as a history of injuries. The Medford-based clinic she visits includes primary care, mental health counseling and wellness services, including movement and nutrition classes.
Once she was enrolled in OHP, Jean connected with Dr. Justin Adams as her primary care provider. Dr. Adams is also the Chief Medical Officer for La Clinica. Being able to call the Wellness Center her medical home has been “massively life changing” for her, Jean says: “I can literally say this place has kept me alive.”
In addition to regular visits with Dr. Adams, Jean also sees a licensed clinical social worker and a wellness coach who “work really hard at helping me stay out of the hospital.”
“It’s my life. It’s my health, I should have a stake in it.”
La Clinica used its integrated approach to address Jean’s seizures, something she’s lived with for much of her adult life. Jackson Care Connect covered seizure studies, and the team at La Clinica discovered a psychogenic component to them. The tools she learned, as well as the quality of care she is receiving, helped her decrease the number of seizures from 40–50 a day to about five a week.
“It’s kind of a collaboration that gets me involved,” Jean said. “It’s my life. It’s my health, I should have a stake in it.”
She has taken advantage of La Clinica’s classes in yoga, mindfulness, nutrition and stress release. Through the nutrition classes, Jean discovered ways to eat better and reduce inflammation, and she is now able to walk without pain for the first time in years. She’s lost 50 pounds, and her blood sugar, blood pressure and cholesterol numbers have all improved.
Through the wellness classes, Jean has discovered mindfulness as a means of coping with pain, depression and anxiety.
“So, the goal for everybody is overall general health,” she says, and “to get to the point where you can manage whatever chronic issues you have.”
Another important revelation for Jean was a diagnosis of post-traumatic stress disorder, which gave her a new perspective on her health.
“It feels less like I’m the crazy person. It’s more like your life experiences are what has opened you up to this,” she says.
Through the improvements Jean has made with the help of her team, she has learned that she is a survivor.
“I had lost hope,” Jean says. “I had lost energy. I had lost everything. And now I have the energy to work on it. I have tools to work on it.
“I am grateful that OHP exists. I am grateful that Jackson Care Connect and CareOregon put it together in the way that they do.”
Strengthening communities sometimes means looking beyond our own neighborhoods to national issues like the opioid epidemic. Unfortunately, Oregon has more than its share of the problem.
In declaring addiction and substance abuse a public health crisis, Gov. Kate Brown noted “a 400 percent increase in opioid use disorder over a 10-year period ending in 2015. Roughly one in 10 of our young adults, aged 18 to 25, have abused opioids. Every other day, on average, we lose one more Oregonian due to an opioid overdose.”
CareOregon and its family of Coordinated Care Organizations (CCOs) are working diligently to address this issue throughout the state.
One outstanding example is the work being undertaken by Columbia Pacific Coordinated Care Organization. The CCO staff, board of directors and multidisciplinary clinical advisory panel have partnered with physical and behavioral health care providers and the community to develop innovative programs to reduce and treat opioid use. They have also helped mobilize the community around this issue.
Overdose deaths from opioids in Clatsop, Columbia and Tillamook counties exceed the state average, says Dr. Safina Koreishi, Medical Director for Columbia Pacific CCO. “Over the last couple of years, we have made great progress on a variety of initiatives, including annual community-wide summits on opioid and substance use disorder, training on safe prescribing and difficult conversations for primary care providers, completing regional prescribing guidelines and increasing the use of Naloxone by emergency responders.” And, she says, they’ve worked with the community to place drug take-back boxes in pharmacies to cut the number of unneeded opioid pills in circulation.
All this has been overseen by the Columbia Pacific CCO Clinical Advisory Panel and the Northwest Regional Substance Use Steering Committee. Columbia Pacific CCO also partnered with local primary care and behavioral health clinics to support developing increased medication-assisted treatment services for opioid addiction within the community. The hope is to build on this progress, says Dr. Koreishi, by using a trauma-informed lens to inspire collaboration and de-stigmatize addiction in their communities.
Columbia Pacific CCO worked with providers in Tillamook, Clatsop and Columbia counties to establish a behavioral health-based wellness center in each county. These centers work with patients in smallgroups over a 10-week period. Participants learn to manage pain through movement, yoga, meditation and education. The wellness centers are free to CCO members.
The CCO has also launched a community education campaign to help people in pain “get their life back” by helping direct them to these wellness centers.
In Columbia County, the CCO partnered with Columbia Community Mental Health to expand Pathways Substance Use Disorder Rehabilitation Center to include Bridge to Pathways, a medication-assisted inpatient detoxification program. Managed by a medical care provider, it is the only program of its kind in the region. Before Bridge to Pathways, patients had to search all over the state to find an available detox bed. CCO members are given priority status.
The North Coast Crisis Respite Center is a partnership in Clatsop County that includes Greater Oregon Behavioral Health, Clatsop Behavioral Health, Columbia Memorial Hospital, Providence Seaside Hospital, Columbia Pacific CCO and the Clatsop County Public Health Department. The crisis respite center is a sanctuary for community members experiencing a behavioral health crisis, including substance use disorder.
All the CCOs within our CareOregon family are addressing substance use disorders through a wide variety of clinical and educational efforts to shift this community crisis into a community collaboration for better health.
In 2017, CareOregon elevated oral health integration to one of our top priorities, establishing an Oral Health Integration Steering Committee. Physical, behavioral and dental integration is made easier by the fact that Executive Dental Director Alyssa Franzen and her team manage oral care throughout the CareOregon family of plans.
This team helps the dental plans that contract with Columbia Pacific CCO and Jackson Care Connect develop oral health strategies and clinical integration. It also leads CareOregon Dental, our Dental Care Organization serving the metro area. By working with CareOregon’s medical and behavioral health teams, the leadership of each CCO and the Dental Care Organizations in various parts of the state, the Dental Department has made oral health an integral part of whole health.
“Our goal is to demonstrate that oral health, behavioral health and physical health are equally important as they relate to an individual’s total well-being,” says Dr. Franzen.
Address oral health for CareOregon’s youngest members, ages 0–5
Increase oral health awareness by pregnant women
Improve navigation to oral health services
To give our youngest members a good start, the Dental Department and affiliated CCOs adopted First Tooth—a statewide program to integrate oral health into physical health practices for children in their earliest years.
“Most children see their pediatric doctors seven to 11 times in the first three years of life, and well-child visits are a great opportunity for oral health screens and interventions,” says Alexa Jett, CareOregon Dental Innovations Specialist.
First Tooth trains and certifies physical health practitioners to evaluate the oral health of their young patients. They recommend interventions such as fluoride varnish, counsel parents on oral health and refer them to a dental home. When providers are certified, they can be compensated for oral health screenings for their Oregon Health Plan patients.
The Dental Department took First Tooth further than the state, expanding it from children 0-3 up through age 5. They include both primary care and dental innovations specialists in their training team to emphasize the importance of oral health to the child’s physical health. Innovations specialists show primary care providers how to fit oral health into busy patient visits and make it easy to connect patients with their dental plans.
“It’s a way that we’ve integrated health information as well, so we can cross the great divide of medical to dental,” says Cathleen Olesitse, Oral Health Program Manager.
“We’ll take it from there and ensure that the child’s dental plan knows that this child exists, knows that this child got a fluoride or an oral health service in primary care,” Alexa says. “Then the dental plan will do an outreach to get them to establish a dental home. It’s an awesome opportunity to move toward that health home model, where it’s not just medical, but you really look at the whole health of the person.”
In 2017, a cross-disciplinary team led by the Dental Department did the groundwork for increasing the number of women who receive oral health care during pregnancy. This addresses oral and physical health for both mother and baby.
Having access to member physical health data makes it possible for CareOregon Dental to help obstetrics providers connect members with their dental plans. And that makes it more likely that the member will follow through and get oral health services during pregnancy.
“In 2018, we want to see a 5 percent increase in the number of pregnant women receiving a dental visit during the nine months before delivery,” says Cathleen. “Usually the mother is the primary caregiver. If she has a high bacterial load in her mouth, she will transfer that to the child. So, let’s start by getting the mom healthy.”
The team worked with women’s health providers to develop specific steps to help clinics move forward. These efforts ranged from creating a member brochure to training obstetrics providers in how to explain to their patients the importance of oral health care.
Dental Care Organizations can reach out on their own to pregnant OHP members. But the patient is much more likely to respond positively if the obstetrics provider has already shared the importance and safety of oral health during pregnancy, Cathleen says.
Additionally, CareOregon Dental accepted grant requests from Federally Qualified Health Center medical clinics that want to expand oral health services for mothers, infants and toddlers. These ranged from embedding a dental hygienist in a maternity clinic to providing mobile dental equipment for outreach at scattered health clinics and Native American cultural events.
Adding an oral health referral form to the provider portal and improving website communication were important parts of the initiative to improve oral health navigation and communication in 2017. Perhaps an even greater component is an intentional, well-designed shift in thinking.
“The intent of that navigation and communications initiative was to ensure that every single communication, whether in writing or verbal, has an oral and behavioral health component in it,” Cathleen says. “If there is any way during a member touch that we can include oral health information, navigational services or care coordination, that opportunity is to be taken.”
“It is definitely a culture shift,” Dr. Franzen says.
It’s similar to the process used a few years ago by CareOregon, the CCOs and the state to consider behavioral health and physical health as co-equal.
In addition, we want to include all the elements of health—physical, mental and oral—when addressing social determinants of health.
“When one of our staff is working with a member on social determinants of health—food insecurity, housing instability and all those things—they need to take the opportunity to make sure their behavioral health and their oral health are considered,” Cathleen says.
Because CareOregon is responsible for our own Dental Care Organization (DCO), CareOregon Dental, and for working with the DCOs serving Jackson Care Connect and Columbia Pacific CCO, we have an opportunity to collaborate with dental organizations across Oregon.
The Dental Department worked with a cross-disciplinary work group accountable to the oral health steering committee. Together, we developed and led clinical integration initiatives between medical and dental care, starting with pregnant women and 0- to 5-year-olds.
CareOregon Dental also has maintained the highest sealant performance among all of Health Share of Oregon’s dental plans since the Oregon Health Authority established this goal two years ago.
CareOregon was honored when the Nine Federally Recognized Tribes of Oregon recommended that the Oregon Health Authority (OHA) contract with us to provide care coordination services to American Indian and Alaska Native (AI/AN) Tribal members on Oregon Health Plan (OHP) open card.
Over the past few years, the Tribes have wanted more of a relationship with CareOregon, according to Sharon Stanphill, Health Operations Officer, who oversees the health system for the Cow Creek Band of Umpqua Tribe of Indians.
“It is more than obvious to the Tribes that CareOregon is kindred to us,” says Sharon. “CareOregon is just the partner we’ve been waiting for.”
Together, CareOregon, Tribal Leaders, the Native American Rehabilitation Association of the Northwest (NARA) and OHA worked to develop a culturally appropriate, statewide telephonic program for over 16,500 Tribal members on OHP open card. The CareOregon Tribal Care Coordination program launched Aug. 1, 2017; in February 2018, an additional 1,600 Tribal members, formerly with FamilyCare, became eligible for this program and joined the other Tribal members with CareOregon.
“I’m really impressed that CareOregon staff came to our homelands searching to get to know us and understand our Tribal members’ needs.”
Tribal Care Coordination supports members as they navigate chronic health conditions, establish primary health care homes, find specialty providers, access transportation for appointments or access durable medical equipment. Tribal Care Coordination services can also help Tribal members maneuver through the health system in general by identifying what is working well for the member or advocating alongside the member to remove barriers. The care coordination provided by our Tribal-specific clinical team is available at no cost for Tribal OHP open-card members.
“I’m really impressed that CareOregon staff came to our homelands searching to get to know us and understand our Tribal members’ needs,” said Sharon. “We sat down, shared a meal, talked about how we do things and how CareOregon could deliver services to our members. They really got to know us as individual Tribes, and by coming to our homeland and meeting our staff, we knew we were going to get the attention and benefits our Tribal members would need.”
Sharon shared an experience of a Cow Creek Band of Umpqua Tribe of Indians’ family, and how Tribal care coordinators helped the family work through a challenge. This family drove two hours with their very sick grandchild to have a scheduled diagnostic appointment. In preparation for the appointment, the child had no food or liquid--adding to the pain he was already experiencing.
When the family arrived, they discovered that a required prior authorization hadn’t been obtained, and thus the procedure would have to be canceled. “In the past,” Sharon says, “the family would have turned around and driven two more hours home without having the crucial service.”
Instead, the family was advised to contact CareOregon’s Tribal Care Coordination program. The Tribal care coordinators worked together, advocated alongside the family, and obtained the appropriate approvals for the child’s procedure to move forward that day.
By the end of 2017, the Tribal Care Coordination team began receiving more repeat referrals from patients who had been assisted in the past, and many are calling back for support with more complex health care needs. By engaging with patients long-term, this team is demonstrating to Tribal members that they are an accessible and trustworthy resource that truly coordinates their health care needs.
The Tribal Care Coordination team has found opportunities to serve the health care of Tribal OHP members in a deeper and more meaningful way. CareOregon staff members were thankful to have cultural competency training organized by NARA and the Yellowhawk Tribal Health Center. They learned from Tribal community members about the history of indigenous peoples, and the difficulties they have faced historically and continue to face. During this training, CareOregon staff also learned about historical trauma, intergenerational trauma and how resilient Tribal people have been and continue to be.
While visiting CareOregon for a celebration of Native American Heritage Month, NARA Chief Operating Officer Michael Watkins, a citizen of the Confederate Tribes of The Grand Ronde Community, told staff, “Everything you learned in school about Indians — throw it out the windows, because it wasn’t true.”
NARA’s Cultural Director and Hunkpapa Lakota Elder Philip Archambault Sr. talked about the differences in spiritual backgrounds between Native Americans and non-Tribal members, and emphasized that spirituality is a key part of health for indigenous people.
“Our sweat lodge is our church, where we go to pray,” he said, and to “develop your mind and the positive aspects of your life.”
He shared that up until legislative changes in 1978, American Indians were denied their religious beliefs by law, which had a significant impact on the physical and mental health of the Tribal members. The forced boarding schools, where cruelty was common, was another factor for many Elders. Understanding the historical and intergenerational effects is key to health care.
Health and well-being for Tribal members requires that they live in harmony with Mother Earth, says Philip. “Our goal is to respect Tribal medicine and traditional beliefs, as we integrate them with available health systems.”
“I feel good being here with you because you want to help our people,” said Philip to CareOregon staff. “You have to live by good values—mental, physical and spiritual—and then you can be proud.”
CareOregon’s staff is indeed proud and honored to walk alongside the Nine Tribes of Oregon, NARA, and all the Tribal OHP members. We are committed to serving, identifying and removing barriers, as well as advocating alongside all Tribal members with a goal of providing the best possible service to Tribal Care Coordination users.
It was our great privilege to have met and learned from Philip Archambault Sr., who passed away in July 2018. We will honor his memory by putting his wisdom into practice with each member we work with through the Tribal Care Coordination program.