LIPA works as provider and police.

Byline: GUEST VIEWPOINT By Terry Coplin For The Register-Guard

`Patricia" came into the clinic nearly every month. The doctors and nurses who administered and reviewed her diabetes tests looked forward to her smile and positive spirit. But last year, when the Legislature cut funding for the Oregon Health Plan, Patricia could no longer afford home testing and required more frequent trips to the clinic.

Later, in order to remain on the Oregon Health Plan, she was required to pay a monthly premium and co-pays for each visit to the doctor's office.

Today, Patricia cannot afford coverage. She receives care only when her blood sugar levels become life-threatening and she is forced into an emergency room. Her once-normal life is now in permanent crisis.

Ironically, this is exactly the scenario the Oregon Health Plan was created to prevent. In the 1980s, then-Senate President John Kitzhaber designed the plan so that low-income families had access to basic health care. The alternative was to watch these families show up in emergency rooms at a far greater cost to society than a rational health care system.

As CEO of the Lane Individual Practice Association, I still share that vision, despite the severe cuts to Oregon's once-vaunted health care plan.

We administer the health plan for Lane County's 28,000 enrollees. With this arrangement, we agree to cover the cost of care and manage the benefits for the families who qualify for the health plan. In return, the state pays us to provide these services.

Recently, it has become clear to us that in the area of patient communications, we dropped the ball. The state Office of Medical Assistance has said that some of our employees were rude to patients. The state also believes that we may have caused delays in the provision of some medical equipment.

Our health plan members should never experience discourteous behavior from us. Every patient, regardless of income or status, deserves respect.

We are taking actions to be more sensitive to our patients' concerns and to ensure a courteous and helpful interaction with our staff. First, all managers, current employees and all new employees are now required to be certified in a customer service program focusing on courtesy and patients' rights. Second, a sophisticated computer-based complaint tracking system has been implemented. Third, a comprehensive, internal corrective action program is being developed to ensure long-term cultural changes.

And while there is no excuse for providing poor customer service, an explanation may help to clarify the role of organizations working to keep the Oregon Health Plan afloat. With limited resources, we have to maximize medical services to as many people as possible. In addition, the state, in its effort to save money, has severely reduced covered benefits, toughened enrollment criteria and asked people with severely limited income to help pay for their own care.

That means community-based health care plans, such as LIPA, must enforce these tougher standards. In other words, we have to police the system and provide health care.

Oregon voters have made it clear they will not increase taxes to fully fund a health plan. With so many people like Patricia, the money must be used prudently. LIPA works hard to find cost savings and to approve the most clinically efficient options that fit within the allowable benefits.

And sometimes that's the rub; patients may want a brand name prescription instead of the generic. A medication may be denied because a patient's diagnosis, under the state rules, does not qualify for coverage. The best and latest technology simply may not be available under the OHP.

When the Standard Oregon Health Plan was cut last year, many health care companies simply pulled the plug and shut their doors to the remaining OHP enrollees. LIPA did not abandon these individuals, even though the new limitations caused hardships for patients and physicians. During the past 18 months we have voluntarily set aside money for a program designed to increase access to care. Our unique prenatal program has reduced pre-term births by 20 percent.

We are gratified that the results of independent surveys and other data used in the state's review, have actually painted a very positive picture of LIPA's management. We are proud that the medical care for the patients in our plan is excellent and delivered at the highest standards available.

We will strive to maintain that excellence and improve our service. We are dedicated to making the Oregon Health Plan work. And this series of events - while painful at times - will ultimately make it work better.

Terry Coplin is CEO of the Lane Individual Practice Association.