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Tuesday, May 24, 2016

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PacificSource Health Plans Receives $211,298 Grant from Oregon Health Authority to Study Alternative Payment Methods for Integrative Care

Grant will help PacificSource explore alternatives to traditional fee-for service model of Behavioral and Physical Health Integration

SPRINGFIELD, Ore.)— PacificSource Health Plans has been awarded a $211,298 grant by the Oregon Health Authority that will help fund PacificSource’s efforts to advance alternative payment methods in support of Behavioral and Physical Health Integration (BPHI).

With the OHA grant, PacificSource will identify and develop payment methods that differ from the conventional fee-for-service model, and better foster a team-based approach to providing health care. PacificSource is uniquely positioned for this study among Oregon’s insurers because it services all three lines of health businesses: Medicare, Medicaid, and commercial

PacificSource, which will contract with BPHI alternative payment methods expert Dr. Lynnea Lindsey-Pengelly, PhD, MSCP for the study, has three objectives with the grant:

  • Assess the level of integration in each participating clinic and explore ways to raise that level.
  • Develop a true cost basis for each clinic to provide that level of integrated care.
  • Use that information to develop a sustainable alternative payment model that would both meet the needs of PacificSource’s members and over the costs to providers to support an integrative model.

The goal is to implement BHPI alternative payment methods across PacificSource’s provider networks starting in at least two practices in 2017. Until then, PacificSource will work with Dr. Lindsey-Pengelly to assess and verify current levels of clinical integration among select provider partners, and to develop a cost data set that reflects a close approximation of the true costs
along the entire spectrum of activities associated with levels of fidelity BPHI practice.

“PacificSource wants to learn how to sustainably reimburse a team-based approach that requires coordination and consultation among and across multiple providers,” said Dr. Mike Franz, MD, who will oversee the program as PacificSource’s Medical Director of Behavioral Health. “Alternative payment methods in integrative care have received a lot of experimentation in the
world of Medicaid, but that research really hasn’t extended to commercial health care. This is an opportunity to try to develop and pay for Integrative Behavioral and Physical Health models in primary care across lines of business so that our whole population can be better and more cost-effectively served.”

The providers that will act as core participants in the effort include Bend Memorial Clinic in Central Oregon, Central Oregon Pediatric Associates, Mid-Columbia Outpatient Center in Hood River and Wasco counties, PeaceHealth in Eugene, and St. Charles Health System in Central and Eastern Oregon. Children’s Health Alliance in the Portland/Vancouver and Salem areas, Legacy Health in the Portland area, and Mosaic Medical in Central Oregon will participate in an advisory role.

“The participating providers were carefully selected by PacificSource because they represent members from across Oregon, cover multiple lines of businesses, and have all implemented various levels of integration with a commitment to expand on and improve this type of integrative clinical model,” Franz said.

About PacificSource Health Plans

PacificSource Health Plans is an independent, not-for-profit community health plan serving the Northwest. Founded in 1933, PacificSource is based in Eugene with local offices throughout Oregon, and in Idaho and Montana. The PacificSource family of companies employs 700 people, serves more than 275,000 individuals, and has 3,900 employer clients throughout the Northwest. PacificSource Community Health Plans is a subsidiary of PacificSource Health Plans and markets Medicare Advantage products under the name PacificSource Medicare. PacificSource Community Solutions is a subsidiary of PacificSource Health Plans and provides Medicaid coverage in Oregon through the Oregon Health Plan. For more information visit pacificsource.com.

InTouch for Members

Last updated 5/25/2016