LIPA succeeds despite constraints.

Byline: GUEST VIEWPOINT By Leo Cytrynbaum For The Register-Guard

Before moving to Lane County with my family, I participated in Medicaid health plans for poor and disabled patients in California and New York. It was a shocking and frustrating experience. I learned that around the country, and even in other parts of this state, that many Medicaid patients have their care thwarted by the limited resources available to them.

I am proud to practice medicine in Lane County where, under the auspices of the Lane Individual Practice Association, patients who have Oregon Health Plan insurance (Oregon's version of Medicaid) go to the same doctors and hospitals as everyone else. They are treated as people. And that is because of LIPA's success at running the Oregon Health Plan in our community.

Of course, no health plan is perfect. The idea behind the Oregon Health Plan was to provide health insurance for as many poor and disabled Oregonians as possible. This is an honorable goal, but the only way for Oregon to achieve this was to create rules for the health plan that limit the benefits for any individual patient. LIPA must follow these rules.

For instance, according to state rules, certain medical problems (from sprains to certain cancer treatments) are simply not covered. Also, if a patient has a medical problem that can reasonably be solved in several ways, Oregon Health Plan patients must be provided with only the least expensive alternative.

These rules can be at times frustrating. But they are the law, and LIPA must follow them. And they allow the state to save money and give health insurance to proportionally more people than other states do.

Although LIPA must make hard decisions about patient care, sometimes denying or changing requests for care, it never profits from these decisions. The state allocates a specific amount of money to LIPA to spend on taking care of patients: doctor visits, hospital stays, medications, medical equipment and therapies. All of that money goes toward patient care. Every penny.

If LIPA denies a patient's request for medical care or a piece of equipment, all of those funds are still spent on patient care - either on treating that patient in a different way, or on treating other patients on the Oregon Health Plan.

The state does designate a certain amount of money that LIPA may use to take care of the administrative costs of running the Oregon Health Plan in Lane County. Any extra money in that pool is the profit for LIPA. None of LIPA's profits come from money designated for patient care.

As a matter of fact, last year LIPA took $1 million of money that it was allowed to keep for administrative costs and gave it instead to patient care. This money was spent on primary, emergency and prenatal care for Oregon Health Plan patients. This year, LIPA is again on track to take approximately $1 million from its administrative budget and give it to the care of Lane County's Oregon Health Plan patients.

The Oregon Health Plan is run with less money and more government regulations than any other health plan in our community. Nonetheless, our patients deserve the best - the best quality, the best access to doctors and the highest level of customer service.

For the past couple of years, improving customer service has been a major priority at LIPA. We have paid for independent quality reviews, cooperated with a state investigation and focused significant resources on improving our level of customer service. Our efforts are paying off. We are seeing dramatic improvements in the level of service we provide to our patients. There is more work to be done. And it is being done.

Years ago, the Oregon Health Plan system in Lane County was on the verge of deteriorating. Commercial insurance companies running the program decided to pull out because they were losing too much money. The physician-run board of directors of LIPA directed the association to take on the responsibility of coordinating the Oregon Health Plan. Ensuring that care for plan patients would continue and be intelligently coordinated was important to all of us.

Physicians continue to govern LIPA. There are always challenges in running a Medicaid health care plan for the poor and disabled, but it is our honor to serve these patients and meet their needs as best as we can.

It will always be our goal to provide all Oregon Health Plan members with the best possible access to quality health care and customer service. There is always room for improvement, and we will continue to strive meet the challenge.

Leo Cytrynbaum has been a physician with Oregon Medical Group since 1996. He is a board member of the Lane Individual Practice Association.