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Backdrop
In 1993, only 58% of Oregonians under the poverty level,
had access to
Medicaid (health insurance for low income
people). Many of these residents, and those with higher
incomes but without medical insurance, received services
from CHD and many struggled with accessing health care
in our community.
The Oregon Health Plan (OHP) was
conceived and many more people in Oregon now have health
insurance-a major milestone for healthcare!
However, with the new OHP, came the concept of managed
care. Most of us were very unfamiliar with managed care
at the time; but, through state meetings, ed-net
presentations, trainings and other forums, we learned a
great deal-or so we thought.
The county commissioners, at the time, were also
concerned about managed care. They definitely were not
comfortable with any notion of "at-risk contracting"
because they did not want the county's general fund to
be liable (put at risk). The state, which was still
waiting for federal approval of a Medicaid waiver, in
order to implement the OHP, was fairly sure that they
would "carve-out" certain mandates, and that these
mandates would not be part of any managed care contract.
So, the question became, would CHD (a department of
county government), be downsized to only providing
publicly-mandated services (e.g.: immunizations, vital
records, etc.)? If this occurred, a decade and a half of
integration of physical health, mental health,
addictions treatment, veterans services--and the
continuum of care--would be lost.
(CHD Story) Not to mention,
all of the non-mandated services that were developed by
CHD that the community had grown accustom (e.g.: senior
mental health, vocational services to mentally ill,
children's case management, prevention services, etc.).
There had to be another way....
Twenty months later, CHD was privatized from county
government, maintaining a contract with the county to
serve as its mental health and public health authority
and veterans services department.
(County Health Authorities)
Privatization Process
The county, with Commissioner Steve McClure in the lead,
initiated intensive research and embarked on a full
public input process. It began with identifying five
values and six different models of governance to be
studied in relation to the values. A research team: CHD
administrators, Marlene Perkins, the county
administrator, and Steve McClure, also began working on
legal matters, such as state delegated authorities,
contracts, liabilities and assets.
Later in the process, other staff members were recruited
for various tasks, including union negotiations. The
various Advisory Committees that CHD had at the time
(Mental Health, Alcohol & Drug, Public Health), and all
staff, became involved in analyzing the research and
formulating a recommendation to the commissioners.
The commissioners, at a public meeting decided that they
liked the recommendation but wanted to take it to the
public. Two different series' of public meetings and
media coverage, eventually led to the decision, in
October '94, to privatize CHD into a non-profit
corporation. A myriad of logistics needed to be worked
out within the intent of the decision, which took until
July 1, 1995.
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