026 – Community Governed Healthcare That Works | Jim Rickards MD, MBA

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026 – Community Governed Healthcare That Works | Jim Rickards MD, MBA

Our Health Plan
December 7, 2017

026 – Community Governed Healthcare That Works | Jim Rickards MD, MBA

People like to say things like “If you’ve seen one healthcare system, then you’ve seen one healthcare system” or “every community is different”. That may be true on some level, but these are really just  excuses to keep doing things the same old way.  In fact, most communities are exactly the same when it comes to the most important issues facing the U.S. healthcare system.

If you pick any random community across the country and examine their healthcare delivery system, you’ll find that:

  1. Traditional healthcare delivery accounts for only 10-20% of health outcomes. Social Determinants of Health (SDOH) drive the rest.
  2. Healthcare costs are growing in an unsustainable manner
  3. There’s heavy competition between the players in the community and limited collaboration
  4. Governments, companies and individuals are struggling to pay for it all

On this episode, Jim Rickards MD, MBA tells us the story of how Yamhill County, Oregon is addressing these issues through their Community Care Organization (CCO). Made possible by Oregon’s 1115 Medicaid Waiver, the CCO is a community governed health plan that brings competing hospitals, providers, dentists, community leaders, patients and their families to the table. The CCO, as Jim puts it, “gave the community permission to work together”. And they have. Whether it be allowing patients to choose Naturopaths  as PCPs, tapping latent community resources to launch a paramedicine program, or the creative approach to engaging highschoolers through “Teen Swag Night”, Yamhill County has shown that there are ways to move the needle on some of our most pressing healthcare issues. It just takes a change in perspective.

This all comes from Jim’s new book, Our Health Plan: Community Governed Healthcare That Works. It’s very well written and accessible even if you’re not an expert in healthcare delivery or the business of healthcare in general. I highly recommend it to anyone trying to drive collaboration in their community, or just generally looking for a new approach to addressing the Social Determinants of Health (SDOH).

“The CCO gave the community permission to work together” -Jim Rickards MD, MBA

Here’s a breakdown of the topics we discuss:

  • What is a Community Care Organization? (1:00)
  • What was the catalyst for Medicaid reform in Oregon?
  • What are the 3 ways to reduce healthcare spending? (12:15)
  • What was your strategy for getting competitors to collaborate? (16:30)
  • How is the health plan funded? (27:30)
  • Can you give some examples of community collaboration that drove meaningful changes? (32:30)
  • Quality Measurement: How do you (and CMS) ensure that you’re doing a good job for the community and the patients? (37:30)
  • How did you pick your clinical quality measures? (42:40)
  • Are the providers on board with the quality measures? (44:00)
  • Tell us how the CCO helps the doctors meet their quality measures, as opposed to just measuring them. (46:25)
  • What is “Teen Swag Night” and how does it help you close gaps in care? (47:00)
  • Do you think the program has been successful? (51:00)
  • Do the providers and others stakeholders in your community think the program has been successful? (52:15)
  • What things might a critic point to as still needing work? (53:00)
  • This was a 5 year program and has been extended by CMS. When did things click for you? When did you start to feel like you were making an impact? (55:00)
  • Tell us about the Teledermatology program. (57:30)

Give it a listen and then give yourselves permission to work together.

~ Don Lee


About Jim Rickards MD, MBA

Jim Rickards MD, MBA is the senior medical director at Moda Health in Portland, Oregon and author of Our Health Plan. He was a pioneer in developing the Coordinated Care Model for the state of Oregon as a new way to deliver healthcare services to its nearly 1.1 million Medicaid members.

Previously, Dr. Rickards was the Chief Medical Officer of the Oregon Health Authority, where he provided clinical and policy leadership in managing Oregon’s Medicaid population.

He received his B.S. from Indiana University Bloomington, MBA from Oregon Health and Science University, M.D. from Indiana University School of Medicine, and completed residency and fellowship training in radiology in Chicago at Cook County Hospital and Rush University Hospital, respectively.

Dr. Rickards currently resides in Mcminnville, Oregon.

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