Document text
200 Jackson County workers to lose their jobs Jackson County is losing 200 workers because of CCO pullouts. Mail Tribune / Jamie Lusch Wednesday Jan 25, 2017 at 6:35 PM Jan 26, 2017 at 3:17 PM Vickie Aldous Mail Tribune @VickieAldous Jackson County plans to lay off about 200 workers after it could not reach an agreement with AllCare Health to continue providing mental health services to the organization's Oregon Health Plan members. This is the second and final coordinated care organization to sever ties with Jackson County Mental Health. The other local CCO, Jackson Care Connect, began transitioning out of county services this month. The county had been providing services to AllCare for $13 million per year but was offered $8 million, county officials said. The county provided the services at-cost and could not have absorbed the $5 million cut without subsidizing the shortfall, said County Administrator Danny Jordan. "We would have to subsidize it with general fund dollars. We said, 'No, we can't do this,' " Jordan said. The county is not mandated by the state to provide mental health services to CCO patients, he said. AllCare gets $13 million from the state to cover mental health care for its OHP patients, said Jackson County Health and Human Services Director Mark Orndoff. AllCare Chief Medical Officer Dr. Mark Bradshaw said the offer was fair and Jackson County would have received 8 percent more than is being paid for mental health care in neighboring Josephine County. AllCare is headquartered in Grants Pass and has buildings in both counties. Jackson County will cut about 180 mental health workers, plus 20 more in other areas of health and human services. It currently has 335 full-time equivalent health and human services employees, with 230 in mental health. The county will be left with about 50 mental health employees once the wave of layoffs is finished July 1, Orndoff said. Orndoff broke the news to employees in staff meetings Wednesday. "They're feeling shock, anger and they're saddened — particularly for clients," Orndoff said. "That's what our people really care about. They're worried about our clients and, of course, they're worrying about their futures, too." Jackson County had greatly expanded its mental health care staffing and services after contracting with AllCare and Jackson Care Connect to provide mental health care for Oregon Health Plan members. OHP membership skyrocketed after the 2010 Affordable Care Act greatly expanded mental and physical health care coverage. About 60,000 Jackson County residents — nearly one-third of the population — are now on OHP, and about 6,000 to 7,000 of those sought mental health care through the county, Orndoff said. Jackson Care Connect, which had been paying the county about $15 million for mental health services, has begun an 18-month transition plan to move its patients to ColumbiaCare, Kairos and other mental health care providers. The pullout of AllCare and Jackson Care Connect has dealt a severe blow to Jackson County, which has been recruiting mental health workers from across the country. The county had hoped to expand even further into drug and alcohol treatment and begin accepting patients with private insurance for mental health care. Orndoff said he expects other mental health providers used by Jackson Care Connect and AllCare will begin recruiting county workers — even before the layoffs are complete. "There is a workforce they likely will be able to pick off. We've groomed and trained them and brought a lot of (mental health) people to Jackson County," he said. The county will scale back its operations to crisis support, indigent care and other services traditionally provided by county health and human services departments before the Affordable Care Act expansions. It also will continue programs like Early Assessment for youth and Assertive Community Treatment for high-risk patients, Orndoff said. County officials said they are concerned about AllCare being able to transition vulnerable mental health clients to new providers by spring — especially when there is already a shortage of providers locally and nationwide. "We're very concerned about the transition of care for communities that are the most vulnerable," Orndoff said. "We hope they are successful in the transition and clients don't fall through the cracks. They could end up in jail, in hospitals and in other parts of the system." AllCare issued a press release earlier this week saying Jackson County would be providing only crisis mental health support for AllCare patients starting April 1. The current contract between AllCare and Jackson County expires March 31. AllCare said it has asked the county to extend the current contract by three months and expedite the transfer of medical records. It has also asked the county to allow Options for Southern Oregon, with which AllCare contracts administrative services, to work out of county buildings to help coordinate care plans and answer the questions of patients and their family members. "Our primary concern is that our members are not thrown into distress and that the transition is as smooth as possible," said AllCare Behavioral Health Director Athena Goldberg. Bradshaw said AllCare wanted to keep using Jackson County as its primary mental health provider in the county. "This is not the way we wanted it to go. We wanted to keep using Jackson County. It comes down to rates," he said. Bradshaw said AllCare has 23,000 members in Jackson County, and about 3 percent are seen by Jackson County Mental Health. When Jackson Care Connect announced in December it would transition away from Jackson County mental health services, AllCare officials said they wanted county workers to continue seeing AllCare clients for direct care, but Grants Pass-based Options for Southern Oregon would take over administrative duties. Options, which also is a mental health provider, acted as the negotiator between the county and AllCare. Executive Director Karla McCafferty said Options made a fair offer to Jackson County for continued services. "We tried to give them a fair rate. We do similar services, so we know what it should cost," McCafferty said. Asked whether Jackson County's mental health services are too expensive, she said, "I don't know how they allocate their funding. We looked at the cost to provide good quality care. If they had been underfunded, we would have paid more." McCafferty declined to confirm county officials' statement that Options had offered $8 million in payments, a $5 million cut from the past payments of $13 million. She said the difference between the new offer and past payments would have been used to fund expanded mental health care in the community, including psychiatric hospitalizations, residential programs for children and adults and respite care. "Up to $13 million would still have been invested in mental health in Jackson County," McCafferty said. Options is a nonprofit organization, while AllCare is a physician-led, for-profit organization that started more than 20 years ago as the Mid-Rogue Independent Physician Association. AllCare had member service expenses of $142 million in 2016 and profits of $11.3 million. It paid out $3 million in dividends and distributions, according to financial data reported to the state. The dividends and distributions all went to one shareholder - AllCare Health itself - for infrastructure improvements, said Josh Balloch, vice president of government affairs and health policy. (added online) AllCare recently built a new 45,000-square-foot headquarters in Grants Pass. Jackson Care Connect, a nonprofit, reported $92.4 million in member service expenses in 2016, a net loss of $338,080 and no dividends or distributions. In 2014, Jackson County and many members of the community celebrated the opening of a new Health and Human Services building on Holly Street in downtown Medford. The $36 million building offered integrated, one-stop shopping for people seeking mental health care and a variety of other social services. McCafferty said Options has a different philosophy on how to provide convenient mental health care for patients. "We're envisioning and working toward having health care in places where people already naturally go, like doctors' offices, pediatricians' offices and schools. It's about having mental health care where people are going and where they are already comfortable going," she said. As for hiring laid-off Jackson County mental health workers, McCafferty said Options will continue its normal processes and advertise open positions. She said she is not familiar with Jackson County's salary and benefit structure, and can't answer whether former county employees would earn less with other providers. Orndoff said he also doesn't know whether laid-off county workers will earn less. "We've heard recently there have been some nice incentives like signing bonuses offered to incentivize people to leave us," he said. "Now that everyone knows we're losing staff, they may be less ready to dangle incentives." Private mental health provider Roxanne Rae said she has worked with both Jackson County and coordinated care organizations as a community partner to provide care. She said the county had many added requirements for community providers, including submitting annual audits and writing reports to justify provider actions. "It was cumbersome for the provider, but Jackson County Mental Health had the best quality assurance. The county clearly communicated with us on what we should do," she said. From both a clinical and taxpayer perspective, Rae said, the county's focus on quality services was good. She also is worried about the fast timeline for transitioning AllCare clients from Jackson County Mental Health to other providers. "I'm concerned about how AllCare expects to do it in less than three months and not have it negatively impact people," Rae said. — Reach staff reporter Vickie Aldous at 541-776-4486 or [email protected]. Follow her at www.twitter.com/VickieAldous.