RE: RE: [ACA-Members] Adequate Network - Defined? Need Some Help Here in Oregon!

[Guest guest]

Hi Vern,It seems to me we're leaving an opening for all or most of the "non-MD/DO providers" to be PTs or nurse practitioners or other ancillary allopathic providers. I feel we need to very specifically include DCs in every CCO.They'll like this - One DC per MD or nurse practitioner.....i.e., one MD and 2 FNPs = 3 DCsWe could add in that every CCO must additionally include at least one ND and one LAcA question about the CCOs: If a patient "joins" a CCO but the chiropractor whom they have previously been seeing and have a good relationship with, is NOT part of that particular CCO or maybe not part of any CCO, can that patient continue care, and have it paid for, with the "outside DC" of their choice? I would hope that will be the case. Perhaps we may wish to add wording to that effect?Vern, Thank-you for all of your great work!

Janet L Rueger, DCCertified in CraniopathyCertified BodyTalk Practitioner149 Clear Creek Dr., # 105Ashland, OR, 97520541-690-6799bodytalk@...

On Mar 6, 2012, at 4:30 PM, vsaboe wrote:

I like it thanks Dr. Sheely! Vern From: Sheely [mailto:drrobsheely@...] Sent: Tuesday, March 06, 2012 12:50 PMvsaboe@...Cc: ACA-Members@...; Oregon ChiropractorsSubject: Re: [ACA-Members] "Adequate Network - Defined? Need Some Help Here in Oregon!" To assure freedom of choice of healthcare provider, and to encourage healthy competition in over-all cost effectiveness between healthcare providers that treat patients with the same diagnosis or condition, an adequate network of all healthcare provider types means within a coordinated care organization’s service area(s) the percentage of credentialed non-MD/DO healthcare providers allowed on a CCO’s network must be equal to or greater than the percentage of credentialed medical and osteopathic physicians allowed on the network.” ______________________________________________________ACA-Members Mailing ListTo post to the list: ACA-members@...List policyNOTE: The ACA does not accept requests/inquiries through the listserv. The listserv is for peer-to-peer collaboration only. If you have an insurance-related question/concern you wish to bring to the attention of the ACA, please email insinfo@.... If you have a dues/benefits question or issue, please email memberinfo@.... Technical questions or to request to be removed from the list, please contact dmillard@...

[Guest guest]

I agree with this concept. The time to include all the other providers is over

let us just advocate for us to be included in a certain ratio.

s.fuchs dc

>

> >

> > I like it thanks Dr. Sheely! Vern

> >

> >

> >

> > From: Sheely [mailto:drrobsheely@...]

> > Sent: Tuesday, March 06, 2012 12:50 PM

> > vsaboe@...

> > Cc: ACA-Members@...; Oregon Chiropractors

> > Subject: Re: [ACA-Members] " Adequate Network - Defined? Need Some Help Here

in Oregon! "

> >

> >

> >

> > To assure freedom of choice of healthcare provider, and to encourage healthy

competition in over-all cost effectiveness between healthcare providers that

treat patients with the same diagnosis or condition, an adequate network of all

healthcare provider types means within a coordinated care organization's service

area(s) the percentage of credentialed non-MD/DO healthcare providers allowed on

a CCO's network must be equal to or greater than the percentage of credentialed

medical and osteopathic physicians allowed on the network. "

> >

> >

> >

> >

> >

> >

> >

> > ______________________________________________________

> > ACA-Members Mailing List

> >

> > To post to the list: ACA-members@...

> > List policy

> >

> > NOTE: The ACA does not accept requests/inquiries through the listserv. The

listserv is for peer-to-peer collaboration only. If you have an

insurance-related question/concern you wish to bring to the attention of the

ACA, please email insinfo@... If you have a dues/benefits question or issue,

please email memberinfo@...

> >

> > Technical questions or to request to be removed from the list, please

contact dmillard@...

> >

> >

> >

>

[Guest guest]

I am curious who this CCO plan will cover. Will it be the Oregon Health Plan patients we have not been seeing because we couldn't get paid no matter which song and dance we did? Will it be a new group that are managed by the CCO and are covered by the private health plans that have traditionally paid us? Will it be MCO's already in place? Will it be a new hybrid from the "health insurance exchange"?And if we are involved as point of entry providers whose duty it is to determine where patients are to be sent for appropriate care, is there reimbursement for being the triage manager or are providers paid only if they determine they are the appropriate providers and send the patients to themselves? Or is there going to be some sort of capitation system where incentives yield less patient care for more remuneration, which will inevitably eliminate a lot of "unnecessary treatment" as determined by the CCO managers? Will the CCO patient care determination system work as well as the IME system? (heh, heh, heh - just had to throw that one in there)What will be the determining factors for doctor inclusion into the CCO system - first come, first served? Those already enrolled in MCO's? Best equipped to be point of entry physicians? Lottery? Status? Political affiliation? Good looks? Good karma? Ow, my head hurts.....Rod , DCTillamook Natural Health Center Re: [ACA-Members] "Adequate Network - Defined? Need Some Help Here in Oregon!"

> >

> >

> >

> > To assure freedom of choice of healthcare provider, and to encourage healthy competition in over-all cost effectiveness between healthcare providers that treat patients with the same diagnosis or condition, an adequate network of all healthcare provider types means within a coordinated care organization's service area(s) the percentage of credentialed non-MD/DO healthcare providers allowed on a CCO's network must be equal to or greater than the percentage of credentialed medical and osteopathic physicians allowed on the network."

> >

> >

> >

> >

> >

> >

> >

> > ______________________________________________________

> > ACA-Members Mailing List

> >

> > To post to the list: ACA-members@...

> > List policy

> >

> > NOTE: The ACA does not accept requests/inquiries through the listserv. The listserv is for peer-to-peer collaboration only. If you have an insurance-related question/concern you wish to bring to the attention of the ACA, please email insinfo@... If you have a dues/benefits question or issue, please email memberinfo@...

> >

> > Technical questions or to request to be removed from the list, please contact dmillard@...

> >

> >

> >

>

Rodney G. , DC

Tillamook Natural Health Center

309 Laurel Ave.

Tillamook, OR 97141

503-842-6532

[Guest guest]

These are the questions that many of us have, Rod, but haven't wanted to broach. Thanks for your post. My guess is that, as MCOs, a certain amount of "insider" trading will determine those who are chosen for the primary CCO roles (among all provider types): who you know, who knows you, a reflection of the social network of those making the decisions, biz as usual IOW. But, there may also be an opportunity for healing protocols that work, not as primary triage, but as contracted ancillary offerings. I imagine success in capturing some of that work will depend on how well the protocol works, and how well the protocol story is able to be sold to the CCO managers doing the contracting. We'll find out who these CCO managers will be in the near future; and I guess, start beating on their doors then.This is all just my imagination, but perhaps a point of starting to consult on how to proceed. Sears, DC, IAYT1218 NW 21st AvePortland, Oregon 97209v: 503-225-0255f: 503-525-6902www.docbones.comOn Mar 8, 2012, at 7:47 AM, Rod DC wrote: I am curious who this CCO plan will cover. Will it be the Oregon Health Plan patients we have not been seeing because we couldn't get paid no matter which song and dance we did? Will it be a new group that are managed by the CCO and are covered by the private health plans that have traditionally paid us? Will it be MCO's already in place? Will it be a new hybrid from the "health insurance exchange"?And if we are involved as point of entry providers whose duty it is to determine where patients are to be sent for appropriate care, is there reimbursement for being the triage manager or are providers paid only if they determine they are the appropriate providers and send the patients to themselves? Or is there going to be some sort of capitation system where incentives yield less patient care for more remuneration, which will inevitably eliminate a lot of "unnecessary treatment" as determined by the CCO managers? Will the CCO patient care determination system work as well as the IME system? (heh, heh, heh - just had to throw that one in there)What will be the determining factors for doctor inclusion into the CCO system - first come, first served? Those already enrolled in MCO's? Best equipped to be point of entry physicians? Lottery? Status? Political affiliation? Good looks? Good karma? Ow, my head hurts.....Rod , DCTillamook Natural Health Center Re: [ACA-Members] "Adequate Network - Defined? Need Some Help Here in Oregon!" > > > > > > > > To assure freedom of choice of healthcare provider, and to encourage healthy competition in over-all cost effectiveness between healthcare providers that treat patients with the same diagnosis or condition, an adequate network of all healthcare provider types means within a coordinated care organization's service area(s) the percentage of credentialed non-MD/DO healthcare providers allowed on a CCO's network must be equal to or greater than the percentage of credentialed medical and osteopathic physicians allowed on the network." > > > > > > > > > > > > > > > > ______________________________________________________ > > ACA-Members Mailing List > > > > To post to the list: ACA-members@... > > List policy > > > > NOTE: The ACA does not accept requests/inquiries through the listserv. The listserv is for peer-to-peer collaboration only. If you have an insurance-related question/concern you wish to bring to the attention of the ACA, please email insinfo@... If you have a dues/benefits question or issue, please email memberinfo@... > > > > Technical questions or to request to be removed from the list, please contact dmillard@... > > > > > > >

Rodney G. , DC

Tillamook Natural Health Center

309 Laurel Ave.

Tillamook, OR 97141

503-842-6532

[Guest guest]

I know Vern can answer all of those

questions for everyone. My limited understanding is that this new Oregon plan is

either laying the groundwork for National Healthcare reform or is formulated from

NHR. Which providers that are included and to what extent they are included is

determined from models that work. Even if you don’t or won’t treat

Medicaid people under this new Oregon

system you may be forced into practicing under this same model of care under

NHR. This is why it is so vitally important to be a player in this game. You

will have to use evidence based guidelines, you will have to prove the value of

your care in health outcomes and cost savings.

Here is my modified definition of ‘adequate’ network. I

would not use the words certified or credentialed but only State Licensed Provider:

To assure freedom of choice of healthcare provider, and to encourage

healthy competition in over-all cost effectiveness between healthcare providers

that treat patients with the same or similar diagnosis or condition, an

adequate network of healthcare provider types means : Within a coordinated care

organization's service area(s) the percentage of state licensed non-MD/DO healthcare

providers allowed on a CCO's network must be equal to the percentage of state licensed medical and

osteopathic physicians allowed on the network. "

s.fuchs dc

From: Sears

[mailto:dm.bones@...]

Sent: Thursday, March 08, 2012

9:23 AM

Rod DC

Cc: Sharron Fuchs;

Subject: Re: RE:

[ACA-Members] " Adequate Network - Defined? Need Some Help Here in Oregon! "

These are the questions that many of us have, Rod, but haven't wanted

to broach. Thanks for your post. My guess is that, as MCOs, a

certain amount of " insider " trading will determine those who are

chosen for the primary CCO roles (among all provider types): who you know, who

knows you, a reflection of the social network of those making the decisions,

biz as usual IOW. But, there may also be an opportunity for healing

protocols that work, not as primary triage, but as contracted ancillary

offerings. I imagine success in capturing some of that work will depend

on how well the protocol works, and how well the protocol story is able to be

sold to the CCO managers doing the contracting. We'll find out who these

CCO managers will be in the near future; and I guess, start beating on their

doors then.

This is all just my imagination, but perhaps a point of starting to

consult on how to proceed.

Sears, DC, IAYT

1218 NW 21st Ave

Portland,

Oregon 97209

v: 503-225-0255

f: 503-525-6902

www.docbones.com

On Mar 8, 2012, at 7:47 AM, Rod DC wrote:

I am curious who this CCO plan will

cover. Will it be the Oregon Health Plan patients we have not been seeing

because we couldn't get paid no matter which song and dance we did? Will it be

a new group that are managed by the CCO and are covered by the private health

plans that have traditionally paid us? Will it be MCO's already in place? Will

it be a new hybrid from the " health insurance exchange " ?

And if we are involved as point of entry

providers whose duty it is to determine where patients are to be sent for

appropriate care, is there reimbursement for being the triage manager or are

providers paid only if they determine they are the appropriate providers and

send the patients to themselves? Or is there going to be some sort of

capitation system where incentives yield less patient care for more

remuneration, which will inevitably eliminate a lot of " unnecessary

treatment " as determined by the CCO managers? Will the CCO patient care

determination system work as well as the IME system? (heh, heh, heh - just had

to throw that one in there)

What will be the determining factors for

doctor inclusion into the CCO system - first come, first served? Those already

enrolled in MCO's? Best equipped to be point of entry physicians? Lottery?

Status? Political affiliation? Good looks? Good karma?

Ow, my head hurts.....

Rod ,

DC

Tillamook Natural Health

Center

-----Original

Message-----

From: sharron

Sent: Mar 7, 2012 5:34 PM

Subject: Re: RE: [ACA-Members] " Adequate Network -

Defined? Need Some Help Here in Oregon! "

I agree with this concept. The time to include all the

other providers is over let us just advocate for us to be included in a certain

ratio.

s.fuchs dc

>

> >

> > I like it thanks Dr. Sheely! Vern

> >

> >

> >

> > From: Sheely [mailto:drrobsheely@...]

> > Sent: Tuesday, March 06, 2012 12:50 PM

> > vsaboe@...

> > Cc: ACA-Members@...; Oregon Chiropractors

> > Subject: Re: [ACA-Members] " Adequate Network - Defined? Need

Some Help Here in Oregon! "

> >

> >

> >

> > To assure freedom of choice of healthcare provider, and to encourage

healthy competition in over-all cost effectiveness between healthcare providers

that treat patients with the same diagnosis or condition, an adequate network

of all healthcare provider types means within a coordinated care organization's

service area(s) the percentage of credentialed non-MD/DO healthcare providers

allowed on a CCO's network must be equal to or greater than the percentage of

credentialed medical and osteopathic physicians allowed on the network. "

> >

> >

> >

> >

> >

> >

> >

> > ______________________________________________________

> > ACA-Members Mailing List

> >

> > To post to the list: ACA-members@...

> > List policy

> >

> > NOTE: The ACA does not accept requests/inquiries through the

listserv. The listserv is for peer-to-peer collaboration only. If you have an

insurance-related question/concern you wish to bring to the attention of the

ACA, please email insinfo@... If you have a dues/benefits question or issue,

please email memberinfo@...

> >

> > Technical questions or to request to be removed from the list, please

contact dmillard@...

> >

> >

> >

>

Rodney G. , DCTillamook Natural Health Center309 Laurel Ave.Tillamook, OR 97141503-842-6532