The potential for a second coordinated care organization in Clatsop County could diminish the ability of some nonprofits to serve the needs of the community, Helping Hands Re-entry and Outreach Centers Executive Director Alan Evans said.

Along with the Columbia Pacific Coordinated Care Organization, Greater Oregon Behavioral Health Inc. and the insurer Moda Inc. have partnered and are seeking a contract.

Coordinated care organizations, through a contract with the Oregon Health Authority, determine eligibility for the Oregon Health Plan to provide quality physical, oral and behavioral health care to low-income and disabled patients.

“We’ve had this relationship for a long time,” Evans said of the partnership between Helping Hands and Columbia Pacific CCO. “A change in that with another person or agency coming in could mean the difference between us surviving in the role we’re taking now. It’s a scary thought that we would have to start from scratch with anyone else.”

Jonathan Nicholas, a spokesman for Moda, declined to comment. “We are not able to make any public comments at this time,” he wrote in an email.

How county’s CCO works

At the introduction of the coordinated care organization model in 2012, there was “a recognition that the health care system was broken,” Columbia Pacific CCO’s chief executive officer Mimi Haley said in a phone interview. “We convene the local conversations, local leaders, for us to have a unified discussion: What people need, and how we come together so we can bring those funds to the people who need them.”

The goal, she said, is to recognize the needs of the “whole person.”

“To improve health, you need more than health care providers, you need to wrap services around people like Alan provides to help them get their basic needs met,” Haley said. “If you don’t have housing, food, a job, how can you be healthy? That was really the intent: to be locally governed to address local needs, for local issues, with local leadership.”

Helping Hands and other local providers receive funds through the CCO for a crisis worker, who can provide an evaluation without requiring admittance into the emergency room.

Crisis workers enable Helping Hands to sign people for the Oregon Health Plan right at the door.

The triage can save taxpayers and providers millions by determining need before heading to the hospital’s emergency room.

An email is automatically generated to an assistor who “meets them at the door the next day at 8 a.m. to provide them with that service,” Evans said. “We educate them on our partnership with the CCO and all the services that come with that health coverage.”

The crisis worker conducts an evaluation that can flag mental health issues, post-traumatic stress disorder and addiction, he said.

In the first six months of 2014, there were 64 calls to the Seaside Police Department for crisis situations, Evans said.

The average cost — two officers, one mental health worker and an emergency room visit — was estimated at $1,832 per call.

After hiring a crisis/behavioral health manager in mid-June, in the last six months of 2014 there were a total of eight crisis calls — an 87% reduction in calls with an estimated savings to the hospitals and taxpayers of over $100,000k.

“While we can’t assume that our crisis manager thwarted exactly 56 crisis calls, it is evidence that there was a significant impact and our clients received immediate triage services that prevented crisis escalation,” Evans said.

New contracts

Earlier this year, insurers notified the state of their intent to apply for contracts as a coordinated care organization. People served by CCOs receive Oregon Health Plan coverage, a taxpayer-funded program for Medicaid.

This year, the state began accepting applications for a new five-year contract. Haley is “quite confident” Columbia Pacific CCO will receive another contract with the state.

Two CCOs in the county could have “half of the impact” and add unnecessary complexity to an already complicated process, Evans added.

“We have a system in place that works very, very well, that we’ve worked hard to get to,” he said. “When we have to shift our energy internally to change things the way we’ve done them before, that impact has a ripple effect through our organization. We do it on a shoestring budget now. To have any of those funding streams potentially cut in half or even worse — that’s scary for us.”

For Evans, his biggest concern is the lack of a voice in the process.

“From an agency’s point of view, it’s somebody else having a say-so thinking that they know what’s best for us. That’s a hard place to be.”

“Because we’re an organization that every agency in the community sends people to if they are unsheltered, we have the ability to find out who is in need and who is not,” Helping Hands Re-entry Outreach Centers Executive Director Alan Evans said. “The partnership with the CCO allows us to have that communication so we can bring them the best services we basically can.”

The goal, he said, is to help individuals avoid the cycle of debt and medical bills that can mount from poverty.

Evans himself knows of what he speaks — formerly homeless himself, he said he is “just getting out of the hole” after hundreds of thousands of dollars in medical bills. “I’m 17 years off the streets, and just last year paid of the last of my medical bills,” Evans said. “I bought a home. I couldn’t have done that with that money chasing me around. All of the costs were medical bills.”