CareOregon responsibilities greatly expand under CCO 2.0

The new decade brought a new day for coordinated care organizations (CCOs). “CCO 2.0” – the next iteration of Oregon’s health care reform – launched January 1, following a year of preparations. It meant revised contracts between the Oregon Health Authority (OHA) and the 16 CCOs across the state.

The CCO 2.0 contracts spelled out one- or five-year agreements, and we were pleased that OHA awarded five years to CareOregon’s two CCOs (Columbia Pacific CCO and Jackson Care Connect) and Health Share of Oregon, our partner CCO in the Portland tri-county area.

Under these contracts, we accepted expanded responsibilities. They represented the progression of our decision, back in 1993-94, to help create an innovative managed care plan dedicated to Oregon Health Plan (OHP) clients. As the state’s health reform evolved to coordinated care organizations in 2012, the intent was to deliver comprehensive care. CCO 2.0 was another big step in offering a holistic approach that combined physical, dental and mental health care.

For the CareOregon family, CCO 2.0 brought changes in behavioral health, non-emergent medical transportation (NEMT) and oral health. At the same time, Jackson Care Connect saw a sharp, overnight rise in membership due to a decision by a major provider network.

Охрана психического здоровья

We began serving all Health Share members’ needs for mental health care and substance use treatment, which better allowed for integrated care delivery and administrative efficiencies, says Jill Archer, Vice President, Behavioral Health.

At the start of 2020, before the pandemic changed all expectations, the behavioral health team expected to be refining our contracts and processes for interacting with the nearly 200 behavioral health providers we’d engaged to serve more than 300,000 Health Share members.

NEMT

Providing free transportation to covered health care visits is a complicated undertaking.

In CCO 2.0, CareOregon took responsibility for this important benefit. In January we continued the immense amount of preparation and soft launches of different aspects of handling NEMT for all Health Share members, with eyes on a full handover from Health Share in March 2020.

Working with transportation experts that make up Ride to Care, a transportation program serving Clackamas, Multnomah and Washington counties, we assembled an initial network of 65 subcontracted NEMT transportation providers, says Jen Martinek, Strategic Business Partnership Manager. With the help of new NEMT-scheduling software and live GPS data tracking, we began planning and testing a sustainable process capable of offering nearly a million transit passes, trip reimbursements and vehicle-provided rides to eligible members in the year ahead.

Oral health

For the first time ever, CareOregon Dental moved beyond the Portland tri-county area with its services. With CCO 2.0 dawned a partnership with Tillamook County Community Health Centers. In January, CareOregon Dental became a second dental plan serving Columbia Pacific CCO members, along with Willamette Dental. We onboarded more than 4,750 child and adult dental members who live in Tillamook County.

We entered the region with a great deal of ideas and plans, says Alyssa Franzen, DMD, Vice President, Dental, and excitement about the opportunity to collaborate with physical health practitioners and patients.

In the Portland area, Dental was part of a significant shift of CareOregon members to health homes that are able to provide both primary care and dental services. Aligning physical and oral health services, particularly at federally qualified health centers (FQHCs), offers members the chance for more cohesive, streamlined care.

Jackson Care Connect membership

With the flip of the calendar to January 1, our CCO in Jackson County took on more than 10,500 new members. This large jump - from 33,260 members to 43,849, an increase of nearly one-third - was the outgrowth of an earlier decision by the board of PrimeCare.

PrimeCare, a provider network representing more than 500 doctors in the Medford area, had decided it could best serve OHP members by contracting mainly with a single CCO. We’re grateful the network chose Jackson Care Connect. In welcoming and serving this flood of new members, we focused on continuity of care for them, and close communication with our provider network and the OHA. See details in Jackson Care Connects’s Report to the Community.

Other 2020 commitments

Across the CareOregon family, we greeted the '20s ready to expand our language interpretation and translation services. We also carried forward our commitment to focus on housing and trauma-informed care, and provide equitable, accessible and culturally competent health care. By investing in individuals and communities, we are determined to keep progressing in reducing health disparities as we make health care work for everyone.

“Our goal is to get parents back to self-sufficiency and out of state services,” said Shawn Bower, Executive Director of Iron Tribe Network. “But it’s the parents that do the hard work to get their kids back by getting into substance use treatment and finding jobs, support networks and stable, affordable housing. We provide a platform for that to happen.”

Housing and healthy communities

Why did Columbia Pacific help fund supportive housing? CareOregon’s family of CCOs has long known that factors outside the traditional health care setting affect the well-being of our members and the broader communities we serve. Drawing on extensive community input, Columbia Pacific has made addressing housing insecurity a key part of its plan for improving member and community health in its three-county region.

Like other parts of the state, the Columbia Pacific region is grappling with issues ranging from a dearth of affordable housing to elevated levels of homelessness. Relative to other states, Oregon has a disproportionately large number of people experiencing homelessness, an estimated 35 out of every 10,000 residents as of January 2020, according to federal data. Experts say the pandemic has only exacerbated the state’s homelessness crisis and pushed many Oregonians to the brink of eviction.

In the Portland metro area, CareOregon responded to greater levels of housing insecurity in 2020 by providing nearly $1.1 million in pandemic-related relief to community-based organizations working on multiple fronts. With our support, local organizations helped vulnerable Oregonians stay in their homes or find shelter, get safe delivery of food, access telehealth, and provided COVID-safe medical care to people living on our streets, among other critical services.

JOIN, for instance, used CareOregon relief funds to ramp up its efforts to keep people housed during the initial phase of the pandemic when job losses, health care challenges and the closure of schools and child care programs hit many families hard. With a $25,000 grant from CareOregon, the Portland-based nonprofit was able to pay for move-in costs and provide rental assistance to more than dozen households served by the Oregon Health Plan (OHP). It also provided safe delivery of food boxes and purchased mobile phones and laptops for OHP member households, helping them to access care digitally, combat social isolation and stay connected to JOIN’s Outreach and Retention workers. Our support also helped JOIN meet the skyrocketing demand for food and other basic services at its day center for individuals experiencing homelessness.

Jackson Care Connect responds to multiple crises

In Oregon, housing insecurity isn’t just a big city issue. In fact, only 25% of Oregonians experiencing homelessness are concentrated in the Portland metro area, according to state data. Most families experiencing homelessness (more than 3,000 people) live in coastal communities or southern Oregon.

Southern Oregon's housing crisis was laid bare in 2020 by the pandemic and the destructive Almeda wildfire. Even before the blaze destroyed more than 2,300 residential structures - most of them affordable housing - the rental market had a slim, 1.5% vacancy rate. The loss of affordable housing has forced many people out of the region and, a year after the fire, hundreds are still living in hotels.

Jackson Care Connect invested some $2 million in 2020 to address the region’s housing challenges, including $500,000 in fire relief and affordable housing support. A portion of that, $50,000, helped fund a new position at the Housing Authority of Jackson County focused on the development of mobile and manufactured homes, a critical piece of the affordable housing puzzle.

Columbia Pacific puts its housing impact fund to work

For Columbia Pacific, 2020 was a pivotal year when it came to addressing the housing needs of Northwest Oregon, where developable land is in short supply and the proliferation of short-term vacation rentals has reduced the limited stock of affordable rental homes for lower-income residents.

In 2020, Columbia Pacific seeded its newly created Regional Housing Impact Fund with nearly $2 million. It also made its first grants from the fund, totaling more than $870,000. One of the largest grants, $400,000, was awarded to the Northwest Oregon Housing Authority for the development of a 42-unit affordable apartment community in Clatsop County. Once complete, Trillium House at Chelsea Gardens will offer multiple layers of assistance to tenants earning less than 60% of area median income.

Shaped by extensive community input, Columbia Pacific’s housing fund seeks to amplify its impact by making grants that allow recipients to attract additional financial support and/or buy property that might otherwise be sold to commercial interests.

Its grant to Iron Tribe Network helped the organization buy Arnold House with a limited amount of bank financing, and thus hold down its operating costs. With the purchase of the property, Iron Tribe Network can now serve a larger number of families in Columbia County.

“After several years of gathering feedback from key stakeholders on the housing needs in our region and refining our approach to housing, we began to deploy capital in 2020 that’s making a real difference in the lives of some of the most-vulnerable Oregonians,” said Nancy Knopf, Community Health Partnership Director.

Housecall Providers’ COVID-19 task force meets for the first time

The Housecall Providers leadership team met with a big task in front of them. With the first U.S. COVID case confirmed, the novel coronavirus was no longer a distant threat. The team knew the virus had the potential to hit their patients, caregivers and staff hard, and they had to make sure they were ready.

The task force's first priority was to secure personal protective equipment (PPE) like gowns, N95 respirator masks and gloves used by medical professionals to minimize the spread of infection. PPE was in short supply nationwide, and for weeks Housecall Providers was only able to obtain small supplies. Eventually, the National Partnership for Hospice Innovation enabled 100 hospice providers across the country to band together and purchase larger quantities.

Creative approaches to address limited supply

In the meantime, Housecall Providers became a community resource for Portland-area adult care homes (ACHs). Volunteer sewing circles provided an abundance of cloth masks, and they were able to share those supplies with ACH owner/operators as well as patients and caregivers in private homes.

In mid-March, in order to prioritize the limited supply of PPE they did have for hospice visits, Housecall Providers made the difficult decision to suspend primary care intakes and house calls for several weeks. Their Advanced Illness Care program, which provides community-based palliative care for the safety net population, also paused new intakes and relied on telephone check-ins and outside visits with patients when weather permitted. Hospice visits continued throughout the pandemic, so they could provide urgent end-of-life care for patients and families.

"Pausing primary care for the first six weeks of the pandemic definitely took its toll. It was heartbreaking to not be able to admit new patients to our primary care service temporarily, and this also affected our bottom line," says Housecall Providers CEO Rebecca Ramsay. "Our focus had to be on those patients who were at the end of life and making sure the available PPE went to our hospice team members, so they could provide care safely."

Managing the precious supply of PPE added a layer of duties for staff, including learning how to properly fit-test N95 masks to each person, and implementing systems to carefully track the supply. Housecall Providers also purchased two ultraviolet ovens, which they used to decontaminate and reuse PPE, stretching its use. This was a process that was temporarily approved by the Centers for Disease Control and Prevention during the low-supply period.

Pivoting to telehealth

Nurse Practitioner Barb Sutton, who provides primary care for Housecall Providers' patients, says she's been doing house calls for most of her career, and notes it's challenging for people to get care even in the best of circumstances. Under the adverse conditions created by the pandemic, it was even harder.

“Lessening that care is devastating, because the need is so great,” she says.

The organization had already planned to implement a telehealth platform by the end of 2020, but once COVID hit, they urgently needed to bump up the timeline. Housecall Providers launched the platform Doxy.me for their primary care practice in an expedited process that took just a few weeks.

Sutton says the success of telehealth visits often depended on in-home caregivers and staff at care facilities. "We have to put a lot of trust in them," she says. She also acknowledges it's been a frustrating and fatiguing time to be a care provider, as no one was fully prepared for the enormity of the pandemic. However, she's also found great reward in being able to help people through these challenges.

Throughout the spring, Housecall Providers primary care visits continued virtually, but by June, once a reliable source of PPE was available, all three programs were able to start doing more in-person visits. Until vaccines were approved, however, concerns remained. "We had to protect staff and patients. We're a vector. We're going into congregate settings, and if our staff gets COVID, they can spread it," Ramsay says.

As the number of COVID cases increased, Housecall Providers began regular COVID testing for all their clinical teams at the end of July. The team set up an on-site testing area in the Housecall Providers parking lot, with the frequency of testing dictated by the level of positivity rates in each county.

Balancing in-person visits and telehealth

With metro-area clinics relying on telehealth to give care, many patients no longer needed to leave their home to see their primary care provider. Thus, referrals to Housecall Providers primary care service dropped in 2020.

When in-person visits resumed, many providers and clinicians were thrilled to see patients in person again, even with the barriers of masks and protective shields and the discomfort of suiting up in full PPE.

With so many patients who are homebound and isolated, the socialization of a house call can be as important to a patient as the physical health care. Sutton even remembers one client reaching up to kiss her face shield because she was so happy to see her.

While they are happy to be making house calls again, care teams are also glad to access the advantages of telehealth. In some cases, it allows them to treat patients more quickly, using a quick video or phone check in, rather than squeezing a rush hour trip into a day that's already filled with patients.

Sutton says she's been able to treat infections she's seen via video and has even diagnosed shingles. She says "having telehealth as an additional access point is so important. It allows us to reach more people."

CareOregon begins expanding telehealth options

In the early days of the pandemic, people everywhere were learning how to juggle work, school and life from the confines of their home, making do with whatever equipment or furniture they already had. CareOregon staff members were also adapting, and when work-from-home measures were put in place, people quickly improvised temporary work settings from home.

Health care providers had a huge challenge of their own: learning how to see and treat patients via telehealth. It was critical to help providers, so they could continue to get members the care they needed in the midst of the pandemic. CareOregon staff quickly navigated the challenges of virtual collaboration to tackle this important project.

New guidance

Prior to COVID-19, the uses of telehealth approved by the Oregon Health Authority (OHA) were minimal, and many clinics were not set up for video conferencing. In early March, however, clinics began asking CareOregon for guidance on how they could use video or phone calls to get members the care they needed, and how to get reimbursement for those services.

Getting telehealth capabilities up and running involved researching what was working for other health care providers, exploring best practices and learning about system capabilities.

Beth Sommers, Director of Network Relations & Innovation at CareOregon, recalls the Centers for Medicare and Medicaid Services (CMS) released an initial round of guidance around telehealth in early March, and CareOregon pulled together a team including representatives from Network and Clinical Systems (NCS), CareOregon lines of business leaders, Information Systems, Operations, and Brand Marketing and Engagement, among others. The team worked quickly to figure out the operational components of implementing this guidance, along with the communication preferences from network partners.

Josue Aguirre, NCS Operations Manager, says the group prioritized finding consistent responses to provider questions. The team brought questions forward so they could be triaged, and evaluated questions based on urgency. All of this informed the guidance CareOregon would send to providers. CareOregon Innovation Specialists, who serve clinics in each region, put together a technical assistance guide, including information on various communications platform offerings, and how providers could integrate telehealth into their workflows.

Stepping up to support providers

Telehealth changes didn’t happen all at once, and the discrepancy between state and federal standards created some temporary inequities in state/federal policy.

Sommers notes that even in this confusing landscape, CareOregon's priorities were clear. She says, "What I continued to hear from leadership was 'we need to do what's right' for network partners for members, for patients. They decided, 'Yes, we're going to take it on.'

“Our operating baseline was that members could get seen and providers could get paid,” she says.

Changes came from OHA nearly every week, as the state responded to provider needs. For example, initially, a virtual visit could only take place from a clinic. That guidance was changed so providers can give a virtual visit from any location.

Opening up new pathways

Prior to the pandemic, there was a small group of billing codes-around 30-that CMS allowed providers to deliver via video or phone. Now they can use nearly any code that makes sense, which has expanded the types of services that can be delivered via telehealth.

The huge amount of work that it took to support telehealth, and the continual refining that is still happening as clinics find the right processes and approach to serve members, has helped open up critical new avenues of care. In the Columbia Pacific CCO service region, members who live in rural or remote regions now can more easily access specialists that previously would have required a trip to the Portland area. Mimi Haley, CEO of Columbia Pacific, says "telehealth has been really amazing in the behavioral health world. Being able to offer specialty services in a new light has really rounded out the services we can offer our members."

Primary care clinics among sites affected by governor’s postponement order

Surgical and non-surgical masks, disposable gloves, goggles, face shields, gowns and N-95s: When Gov. Kate Brown issued Executive Order 20-10, “PPE” went from obscure jargon to everyday language.

The PPE-conserving order called for postponing elective and non-urgent procedures. It touched hospitals, surgicenters, veterinary clinics, and, importantly for the CareOregon family, outpatient clinics - including student health centers, dental clinics and community health clinics.

Immediately, our Clinical Integration team in the Portland area asked themselves, “How can we help the provider network successfully and comfortably shift to telehealth?”

In the Columbia Pacific region, telehealth was top of mind, too, along with a host of practicalities. For a short moment, Tillamook County Community Health Centers felt overwhelmed by the immense amount to learn and address. Then they quickly shifted to planning mode, reaching out to us for support with virus testing and helping patients who could not quarantine at home.

Our stance with our provider network was simple, says Maranda Varsik, Columbia Pacific Project Manager, "Whatever you need, let us know." In these unsettled times, we would do whatever we could to be there for them and for our members.

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Gov. Brown allows dentists and other clinics to provide non-urgent care, with limitations

Dental care is hands on. Doing dentistry over the phone? "It was foreign to not have the patient in a chair in front of you," says Alyssa Franzen, DMD, CareOregon's Chief Dental Officer. "We had never done any kind of phone visits."

That changed in a blink. And by the time clinics with adequate personal protective equipment (PPE) were allowed to re-open May 1 for general care, they’d had about seven weeks’ experience in practicing remotely. (The visits were typically by phone because online presented barriers for many patients.) Dentists were making critical clinical triage decisions as they collected patients’ history, signs and symptoms.

Mostly sight unseen, dentists used that information to decide whether patients needed to come to the office for urgent or emergency care, if patients could handle the problem at home, or if the situation could wait until non-urgent visits resumed.

Then there were practice guidelines to set up for this new frontier. In the summer, CareOregon Dental transitioned to offering certain preventive services through teledentistry. Staff quickly collaborated with federally qualified health centers (FQHCs) on practical questions, says Alexa Jett, CareOregon's Oral Health Integration Manager. They hammered out the types of care that were appropriate to offer remotely, what clinical decision-making could be done, and billing procedures.

Surprising benefits with virtual visits

Selynn Edwards, DMD, the Dental Director at Clackamas County Health Centers, remembers thinking back in March 2020, “Gosh, what can we do by telephone?”

A surprising amount, as it turned out. Moreover, these telephonic visits offered unexpected advantages. Edwards was among those dentists and dental hygienists who overcame early doubts and found that phone visits:

• Helped establish rapport with members who feared dentists, and paved the way for a less-stressful experience when the patient came to the clinic in person.
• Helped staff deal with dental emergencies more efficiently. When an emergency patient walked in the door, "instrument trays were ready," says Franzen. "The person could be onsite for a much shorter time."
• Allowed effective outreach to special groups in the spring, including parents of young children, or patients with diabetes. While those calls weren't billable, clinics could check in with members, offer a caring break from isolation, and let them know the clinic was available for dental emergencies and questions.
• Reduced the number of patients who needed in-person follow-up visits after an urgent procedure. Staff could assess post-op symptoms by phone, and "many times could answer their questions," says Franzen, "or assure them they were on a normal path."
• Improved no-show rates when a phone visit preceded an in-person visit. “There sure is a lot of preventive care and trauma-informed care happening when you do the telemedicine visits,” notes Edwards of Clackamas County.

The phone visits helped Edwards recognize the number of patients who were nervous about dental care. During a telehealth call, they could break through those barriers. Patients became at ease as they talked through their issues. And she would conclude by saying, "We've 'met!' I look forward to seeing you in person."

Teledentistry remains useful throughout the year

In May, when clinics could reopen for regular care, they were juggling new protocols, including reduced clinic capacity, continued social distancing and increased room-cleaning procedures.

Teledentistry remained an important tool while office capacity and staffing were reduced, both as an alternative for patients and an aid to clinic procedures under COVID. For example, if adults or parents of young children were not comfortable coming into a clinic, staff could use the phone or online tools to assess and advise them.

Dentists alternated between procedures and phone appointments. This gave exam rooms a break from back-to-back use and reduced staffing needs. Clinics staggered their support staff’s schedules to limit the number of exposures if any COVID-19 cases were to occur. In addition, the Portland tri-county area experienced the same staffing challenges that other dental practices faced nationwide after dental assistants and hygienists left the profession because of varied pandemic-related factors.

Through all the changes, Franzen, the CareOregon Chief Dental Officer, appreciated the flexibility of the dentists and dental hygienists who championed teledentistry, determining what could or could not work remotely, as well as the specialty dental network who stepped up to help CareOregon when FQHCs capacity was limited.

With creativity and a dedication to patients, a hands-on profession found ways to safely continue care for members. Teledentistry challenged the dental community to practice in a new style, and brought unexpected benefits along the way.

High-risk member outreach begins

CareOregon Advantage wants members to know that while they’re staying at home, we’re still here

As the pandemic and social distancing wore on, CareOregon Advantage wanted to help our members feel connected to their health care and health-affirming activities, even during the governor's "stay home" order. The "Healthy at Home" mailing was our way of letting our Medicare members know they could count on us to support their health in multiple ways.

Members could get a 90-day, mailed supply of many prescription drugs, take part in online Silver&Fit fitness classes, or use their OTC debit card to get over-the-counter wellness and first aid products shipped to their home at no extra charge. And if they needed a friendly, knowledgeable voice to help them through a health care situation, they could connect by phone with our Customer Service staff, health care coordinators or 24/7 Nurse Advice Line.

CareOregon swiftly releases last of nearly $1.1 million in COVID-related grants; continues community giving across our service areas

After the pandemic hit Oregon, it took only a few weeks for the new coronavirus to upend virtually every facet of life here. At CareOregon, we knew we needed to move just as fast to offer members, communities and community-based organizations our support in the face of the wholesale disruption.

In mid-March, after CareOregon shifted to remote work, Shawn DeCarlo, Shared Learning and Grant Evaluation Program Manager, immediately went into high gear. He allocated monies to COVID-related grants, created a trackable, equitable distribution process, and posted an emergency grant application on the CareOregon website.

By April 17, a first round of COVID-19 related grants was out the door. By June 10, CareOregon had awarded our full allocation of $1.07 million, to 68 organizations in the Portland tri-county area.

Meanwhile, our regional coordinated care organizations were also busy. In southern Oregon, Jackson Care Connect awarded $378,000 in emergency COVID-related grants. On the north coast and along the Columbia River, Columbia Pacific CCO awarded $586,886 in COVID-related relief.

"CareOregon had an incredible ability to rapidly respond to the needs of the community," says Chief of Staff Jeremiah Rigsby, "even when anxiety was at its highest." Responding to a company priority, 45% - $450,000 - of the Portland-area grants went to culturally specific organizations, which span race and ethnicity, LGBTQ+ and abilities status.

The emergency grants were part of more than $5 million in overall community giving across the CareOregon family in 2020, including charitable grants and sponsorships.

Responding rapidly to community needs

COVID was an isolating time. But for nearly 900 families with young children in the Portland area, CareOregon helped break up those lonely months with the "Family Care Boxes" project. Our largest COVID grant, $40,000, was to United Way of the Columbia-Willamette, to support Help Me Grow care boxes. CareOregon's donation personalized each Help Me Grow base box with games, books and toys that matched each family's culture.

The boxes were given to families that project partners had identified as those with children ages birth to 5 years, who were economically disadvantaged, experiencing high social isolation due to COVID, and who identified as Black, Indigenous or a Person of Color.

In this joint effort, Health Share bought the base boxes. Clackamas and Washington counties, the city of Portland and Health Share helped assemble and deliver the boxes to nearly 1,600 children. Our culturally specific activities were added to the base boxes of age-appropriate, enriching books and activities (plus toothpaste and toothbrushes!). Depending on the family, the additions might be bedtime songs and stories in Chuukese, a Loteria (Mexican bingo) pictographic game, a piñata-making kit or books celebrating diversity. "Families are encouraged to explore the materials with their children … This provides a special opportunity to connect more deeply," said Help Me Grow's report to CareOregon.

Supporting families - especially families of color during the pandemic - with education and social-emotional development is a CareOregon priority. We know the importance to individual and community health and the disparities these families often face as a result of systemic racism and oppression The COVID pandemic exacerbated these disparities.

Meeting three types of needs in the Portland area

In the tri-county area, our COVID-19 grants were targeted to:

• Basic essentials. CareOregon believes housing is health, and that nutrition is fundamental to good health. We gave $447,000 to organizations that support secure housing, food and emergency assistance. Examples: Bradley Angle ($25,000), Oregon Energy Fund ($20,000), and Self Enhancement Inc. ($20,000).
• The viability of partner nonprofits. We gave $482,000 to nonprofits to maintain critical operations, such as program services, outreach materials and employee assistance. Examples: Cascade AIDS Project ($10,000), Ecumenical Ministries of Oregon ($5,000), Northwest Housing Alternatives ($25,000), and Portland Opportunities Industrialization Center + Rosemary Anderson High School ($20,000).
• Innovative responses to the pandemic. We gave $149,750 to help organizations reduce isolation (Such as the Family Care Boxes), provide on-street medical care to reduce COVID risks, and strengthen families. Examples: Oregon Family Support Network ($20,000),The Arc of Multnomah Clackamas ($14,750), and Portland Street Medicine ($25,000).

Community giving across CareOregon

While we shifted a great deal of our focus to the immensity of COVID, we also stayed engaged in the other community needs that we support. In the Portland area, CareOregon gave $1.45 million in 2020 for housing, education, social determinants of health, and culturally and linguistically specific organizations.

In Clatsop, Columbia and Tillamook counties, Columbia Pacific CCO gave $1.835 million to support housing, chronic disease prevention, suicide prevention, trauma-informed care, and access to behavioral health, primary care, oral health and the social safety net. In Jackson County, Jackson Care Connect dedicated $500,000 to support affordable housing and organizations providing direct fire relief and recovery services to those affected by the fall 2020 fires.

Our commitment to community has earned us recognition by Portland Business Journal as a top Oregon Corporate Philanthropist for the past five years, with peers including Nike, Cambia Health Solutions, Intel and Bank of America.

The recognition feels good. But simply serving Oregonians feels even better; that's why CareOregon exists. In 1994, we were founded to meet the health care needs of low-income Oregonians. Since then, we've increasingly recognized how the health of a community is intertwined with the health of its residents. After the tough times of 2020, we remain fiercely committed to creating quality and equity in individual and community health for all Oregonians.

Tribal care coordination renews for the fourth year

In July, CareOregon's Tribal Care Coordination role was renewed for the fourth year. Our formal relationship with Oregon's Tribal communities began in 2016, when the nine federally recognized Tribes of Oregon and the Native American Rehabilitation Association (NARA) approached CareOregon with a request that we provide care coordination for the state's American Indian/Alaska Native Medicaid population who were on open card (fee-for-service). Thus began CareOregon's Tribal Care Coordination team.

The work has evolved as we continue to strengthen our partnerships with Tribal communities statewide. Pirani oversees the Tribal Care Coordination team, and she credits the trust established in those ongoing relationships.

"We remain humbled and privileged to have the trust of the nine Tribes, NARA and the Oregon Health Authority (OHA) in offering culturally specific care coordination services to Tribal fee-for-service members," she says. "I'm proud of the partnerships staff have developed with individual Tribes' staff. I expect the curiosity and learnings to continue as the Tribal team continues to grow."

Throughout 2020, that strong foundation was especially helpful as the team helped members navigate the year's challenges. The team worked hard to make sure they were prepared to handle member questions on telehealth, COVID testing and accessing care.

Rising requests for behavioral health care

The multiple challenges confronting society over the past year likely affected Tribal people in Oregon as it did many others. The compound challenges of the pandemic, isolation, fires and more led to many Tribal Care members seeking behavioral health services - some for the first time. Tribal Care Team Supervisor Troy Monserrat-Gonzales says, "A lot of old trauma wounds were coming up in the midst of the pressure cooker we were all under. Some of that was post-traumatic stress disorder, some was manifesting as anxiety or depression, and some meant the need for more substance use treatment."

Behavioral Health Care Coordinator Toby Brooks began his role at CareOregon just two weeks before most CareOregon staff were sent home to work remotely. His extensive background in mental health crisis work and in Native health care allowed him to quickly jump into new projects to help streamline care. The number of providers who will accept fee-for-service OHP is limited, and the challenges of the pandemic further taxed those limited resources. To maximize resources for members, Brooks researched all of the options they could refer members to. In the process, he opened lines of communication with those providers, which helped him to have the most current information so he could better match members with providers.

"I've built a level of trust with these providers so that they want to work with us and with our members, and they know the reasons why it's important," he says. Brooks looks to providers who are culturally competent, and who understand that members may be coping with residual effects of colonization or generational trauma, along with day-to-day problems.

In the early stages of the pandemic, the care team also noticed a rise in interpersonal violence, which is consistent with trends that have been reported nationwide. Brooks built a list of 64 resources from across the state, to help connect people to the resources they need.

"This is not an easy system to navigate. If they are calling us, they want help. Once they call us it's like opening the door to getting the help they need," he says.

Navigating care in a pandemic

In addition to behavioral health care, the pandemic created a deferred demand in dental services. With dental clinics closed to most services in the spring, a lot of oral health care was delayed. That led to increased demand in the late summer and fall, when many dental clinics were able to see patients again.

Adjusting to telehealth also took some time. Monserrat-Gonzales recalls that at first, many members were hesitant to use telehealth services to access health care. For members who may be hesitant to seek care in the first place, overcoming the telehealth barrier can be extra challenging. The care team helped members work through their hesitations.

“That’s helping members making that bridge to get to care,” she says.

For mental health care, Brooks said many members enjoyed using telehealth. They were comfortable accessing care from their homes, and he's happy to reassure members now that telehealth is still available. It also broadened the pool of resources he could draw from, in case a local provider was not available.

Trauma-informed care

Monserrat-Gonzales says her team is inherently trauma informed. The team is adept at recognizing where someone is emotionally and culturally, and they can quickly de-escalate situations and help members feel hopeful. In addition to connecting them to health care, the care coordinators also help members find community resources such as culturally responsive resources or peer support groups.

Brooks says, "When members come to us, the matters they are talking with us about are complex." He's honored to be trusted with that information. "What I love is building those relationships with our members and with our providers, and to be able to finely tune those relationships," he says.

All of this intentional work to build relationships with both members and providers is paying off in terms of quality care. Monserrat-Gonzales says they frequently have members whose care coordination needs have been met, but who later call with new needs. Additionally, members also often refer friends and family to care coordination services. She says, "This is an excellent marker of our success providing trauma-informed, client-centered and culturally responsive care for our members."

CareOregon Dental’s support helps Clackamas County hold outdoor children’s clinic

In a big grassy area next to Gladstone Health Center, squealing children ran through a bubble machine – then headed to tables where nurses and dental staff gave needed immunizations, topical fluoride treatments, toothbrushing lessons, and healthy goodie bags. 

In the throes of the pandemic’s first year, Clackamas Health Centers notched a happy first: Gladstone’s first joint (“integrated”) primary care-oral health event. When Selynn Edwards, DMD, Dental Director of Clackamas Health Centers, caught wind that the primary care side was planning an outdoor children’s clinic, she immediately asked if the dental side could join in. 

As the dental and primary care staff worked side by side at the midsummer event, they got to know each other. This new familiarity paved the way for dental and primary care staff to ask each other questions back at the clinic. 

“It is one thing having all lines of services in the same building,” Edwards says, “but if you don’t know who each other is, it doesn’t feel like integration.”  

CareOregon Dental had reached out as a stabilizing force when clinics were closed to all but emergency and urgent care, and as clinics reopened under new safety protocols. “CareOregon Dental filled a huge gap by providing funding for the dental clinic at the integrated Gladstone health center,” says Edwards, the dental director. That funding, and our presence as an active partner, she adds, gave the federally qualified health center the latitude to think creatively about ways to serve the community under COVID restrictions.  

Cue the bubble machine – and toothbrushing lessons that just might outlast the pandemic. 

CareOregon announces that we’ll continue in maximum work-from-home status through at least the end of 2020

After Oregon counties allowed businesses to re-open, summertime found COVID-19 cases on the rise. The concerning trendline, combined with a predicted October surge, changed CareOregon's plans. We'd intended to begin returning on-site, in waves, in the fall. That became imprudent. Recognizing that near-term certainty would help employees plan for their families' needs, we announced that CareOregon would remain in maximum work-from-home (WFH) status through at least December 31, 2020.

As the pandemic gained force, it brought new challenges, uncertainties, anxieties and changes. To help employees feel informed, supported and safe while working remotely, CareOregon took a number of steps. Some highlights:

• When employees are far-flung, timely and accurate communication can be more difficult. Leadership teams prioritized internal communications through a range of channels, connecting staff to accurate, up-to-date information. This included the weekly e-newsletter "Briefly" (which frequently featured updates from Eric C. Hunter, President and CEO), a living "COVID-10 Work from Home Guide" on the intranet, virtual All Staff meetings (offering information, insights and a chance to ask questions), and a Q&A inbox.
• Recognizing that COVID-19 also presented parents and other family caregivers with immense challenges, CareOregon firmly committed to offering employees the flexibility that would allow them to better handle the multiple responsibilities they faced in working from home while schools, child care facilities and other care options were closed.
  
  Hunter made this clear in his August 6 CEO Update. "We encourage you to work with your manager or supervisor to figure out the best way to get your work done," he wrote, "while balancing all of the issues and needs that accompany working from home."
• WFH saved commute time but posed the possibility of added out-of-pocket expenses. To help with costs such as faster internet service, home office furniture, higher utilities and office supplies, CareOregon instituted a monthly $60 WFH stipend that began August 31.
• HR encouraged employees to take care of their physical and emotional health during the pandemic, just as we encourage our members to do. We expanded the range of health-promoting activities that are eligible for a $35 monthly wellness benefit, and reminded staff about their employee assistance benefit.
• CareOregon had a special in-person culture. In employee engagement surveys, employees remarked on our warm, collaborative work environment and its value in creating a sense of purpose and teamwork. While there's no replacement for dancing along with our float at the Starlight Parade, the wicked-clever Halloween costume contest, or the decadent Cupcake Wars benefiting United Way, we made an effort to stay cohesive while apart.
  
  The SPIRITED committee organized competitions around artistic face masks, a team trivia scavenger hunt and talent videos. They brightened staff mailboxes with a care package that included a card, "encourage-mints" and a CareOregon face covering. And when the Rose Festival Grand Floral Parade shifted to a Porch Parade and a virtual shoebox #ParadinginPlace event, our own parade committee kicked off an employee contest for Best Porch and Best Petite Float. Employees took advantage of opportunities to enjoy each other even while apart.

The CareOregon Board of Directors and leadership team appreciate the hard work, good humor and adaptability of our staff across the CareOregon family. Because of them, we were able to continue serving our members, at a high level, during unsettled and trying times. Each day, we had new opportunities to live up to our SPIRITED values of Service, Passion, Initiative, Results, Innovation, Teamwork, Equity and Diversity.

Community Engagement Team begins a series of virtual support events for members

Normally, the Community Engagement Team is busy helping members at events throughout the community. With new safety restrictions made necessary by COVID-19, however, most of those events were canceled. To make sure we could still help members enroll in the Oregon Health Plan (OHP), navigate their benefits and get their questions answered, the team met members virtually at events throughout the fall and winter, starting with this one at the Portland Rescue Mission.

Wildfires roll across Oregon, destroying thousands of homes

While Oregonians have increasingly come to expect dry summers with high temperatures and smoky skies, 2020 included fires that were more dangerous than anyone expected. On September 8, a lethal combination of high winds and newly sparked fires devastated large areas across the state, as rapidly moving fires destroyed 4,000 homes and killed nine people. The fires and hazardous smoke levels they created affected all of CareOregon's service areas and left many wondering if these devastating conditions would be part of our new "normal."

In Tillamook County, members were evacuated due to fire danger, and Columbia Pacific CCO helped arrange for temporary hotel stays for those with respiratory problems due to heavy smoke levels. In Clackamas County, CareOregon provided relief supplies like clothing, bedding and food to organizations supporting fire evacuees. They also offered virtual OHP enrollment and navigation support to evacuees in temporary shelters.

Tribal Care Coordination helped members across the state get refills on medications they left behind when they were evacuated. This involved working with out-of-area pharmacies that could support members while they were displaced.

Almeda fire causes heartbreaking destruction

Our members in Jackson County were the hardest hit, as the devastating Almeda fire ripped through the towns of Talent and Phoenix, destroying more than 2,400 homes in one day. Another 33 homes were lost in the Obenchain fire near Butte Falls.

About three-quarters of the homes lost were affordable housing units including mobile homes, manufactured homes and apartments. Three groups were disproportionately affected: the Latinx community, senior citizens and low-income individuals.

The entire community felt those losses, including Jackson Care Connect staff, as we saw the unimaginable destruction our family members, neighbors and communities endured. We knew many members would be among those who lost homes, and we immediately reached out to partners and members to offer help. That included working at The Connection Station at the Jackson County Expo Park, which was quickly established as a one-stop shop for fire survivors and evacuees. Staff helped members get refills on medicine, replacement medical equipment and connections to community resources. The Community Engagement Team also helped organize a Latinx workgroup, helping ensure services were linguistically and culturally responsive.

In addition, Jackson Care Connect and CareOregon staff helped house and transport members. We lifted limitations on the transportation benefit, helping members evacuate fire zones. We also found temporary shelter in hotels for 116 members (300 people total, including family members).

Providers also were affected by the fires, as staff lost homes and buildings were affected. La Clinica helped support staff members who lost homes, while they served hundreds of patients who also had lost homes.

To serve fire survivors who needed extra help, Jackson Care Connect partnered with Mercy Flights on the Fire Response Program. Their team of community paramedics served fire survivors with complex needs, including home-bound members. They provided a health risk screening, addressed gaps in care and connected members to support with food, housing or other social needs. By the end of 2020, the program served 328 members, including 188 dual Medicare/Medicaid members.

Committed to rebuilding

The longer road to fire recovery and home rebuilding will take years. Jackson County already had a slim 1.5% housing vacancy rate before the fires, and the destruction of so many properties created an even more urgent need. Knowing the important role stable housing has on a person's health, and the role affordable housing plays in helping our community recover, Jackson Care Connect committed $500,000 in fire relief and affordable housing support. CareOregon and coordinated care organizations Jackson Care Connect and Columbia Pacific CCO will keep working to support members' needs, like safe housing, that affect their health. We will keep finding ways to help ensure our members and communities have the resources they need to keep themselves and their families safe.

CareOregon Advantage mails members a handy care package

In fall 2020, who could use a good face mask, pocket-sized hand sanitizer and nice surprise? Basically, everybody! Last October, as the U.S. was preparing for a fall surge of COVID-19 cases, CareOregon Advantage packaged up two hand sanitizers along with a pair of cheerful orange, adjustable face coverings. We mailed them to our 14,000 Medicare members, with a message reminding them that we are here for them if they need anything.

CareOregon Advantage initiates smartphone pilot to enable annual wellness visits by telehealth

In an ordinary year, an annual in-home wellness visit from a Signify Health provider is a favorite benefit of our Medicare Advantage members. This free visit is 45-60 minutes long, allowing Signify Health's providers to take a full medical history, check vital signs and answer questions in a less-rushed way than a typical clinic visit allows.

Of course, 2020 was not ordinary. And when the pandemic hit, Signify switched to virtual visits. As their staff called CareOregon Advantage members to set telehealth appointments, they heard a continuing theme: "I'm interested. But I don't have the right equipment for telehealth."

The interest in virtual visits was a big shift in preferences for CareOregon Advantage members. In early March 2020, before the pandemic's stay-home orders, we had conducted focus groups and interviews for Medicare members. Back then, members expressed low interest in accessing health care through digital tools such as smartphones, preferring in-person visits.

The about-face was in line with national trends that showed a sharp rise in telehealth services, forced by COVID-19. As CareOregon's Melodie Farmer got the reports from Signify indicating that some members were interested in virtual visits but lacked a smartphone and internet connection, she saw a chance to address the digital gap. Farmer, who's Population Health Quality Manager, asked the Medicare team, "Is there anything we can do to help them get the equipment?" She saw a possibility in flexible Medicare dollars that the Centers for Medicare & Medicaid (CMS) was allowing through the end of the 2020.

After some quick, cross-departmental planning, Medicare Advantage launched a temporary benefit using Health Related Services Funds. In early December, we created a smartphones pilot project. The project reached out to about 225 high-risk members who had told Signify they lacked the equipment to try a video visit.

A pair of Customer Services reps, Nicole Ready and Trisha Diaz, called these members to verify their interest in telehealth and their capability to activate a smartphone. In the end, CareOregon sent a phone and limited data card to about 45% of those members.

In their conversations with the members, Ready and Diaz picked up ideas for ways CareOregon Advantage could offer members additional practical help with using digital technology if circumstances again required remote visits.

"I was really excited to do this outreach," says Farmer, who noted that CareOregon doesn't directly capture data about members' access to a smartphone. In this first time, small-scale effort, we connected dozens of high-risk members for a wellness visit, supporting their health during a time of great isolation and need.