A big step forward this week for Oregon health care reform

By JONATHAN J. COOPER, Associated Press Published: Jul 29, 2012 at 1:57 PM PDT Last Updated: Jul 30, 2012 at 8:38 AM PDT
A big step forward this week for Oregon health care reform
In this Monday, June 18, 2012 file photo, shows Dr. Ora Botwinick performing a pre-natal exam on Maria de Lourdes at the Multnomah County's North Portland Health Center in Portland, Ore. (AP Photo/Rick Bowmer, File)

PORTLAND, Ore. (AP) — Gov. John Kitzhaber and his health care chiefs have spent the past two years trying to convince anyone who will listen that they can fix some of the health care system's most vexing problems: out-of-control costs and less-than-stellar results.

Starting this week, it's time to prove it.

Oregon created new "coordinated care organizations" charged with taking a more active role in the care of low-income patients on the Oregon Health Plan. The first of those organizations go live on Wednesday with 260,000 patients, and more will launch in the months that follow. Eventually, they'll cover most of the 600,000 people on the Health Plan statewide.

For the patients affected, Wednesday won't be dramatically different from the day before, said officials with several of the seven coordinated care organizations launching that day. They'll keep the same doctor and their benefits will be the same.

But over time, officials said, patients with complex conditions can expect their doctors, nurses and therapists to coordinate their work and to be better prepared to help them handle their treatment between visits to a clinic.

The exact model is different for each coordinated care organization. In general, executives said they've prepared for the transition by hiring staff to handle calls from patients and to coordinate their care and investing in new computer systems to share patient records.

"If you're just discharged from the hospital after having a heart attack, those first 30 days are critical for you," said Terry Coplin, chief executive of Trillium Community Health Plan, which will be a coordinated care organization in Lane County. "If you don't understand how to load your medicine containers, you need someone to help you with that. If you have health literacy problems and you don't understand what you need to do as follow up after you get out of the hospital, then you're going to need help with that."

Many of the first coordinated care organizations, including Trillium, are existing companies created years ago to manage medical care for Oregon Health Plan patients. As a CCO, they'll begin integrating mental health and addiction treatment into their existing medical programs.

In some areas, entirely new companies were created with investments various elements of the health care system, including hospitals, clinics, insurance companies and county governments.

If all goes according to plan, the coordinated care organizations will save billions by reducing unnecessary procedures, treating patients in primary-care clinics instead of expensive emergency rooms and managing chronic conditions so that hospitalizations aren't necessary.

Critics question whether it's realistic to expect such significant savings from those reforms.

The Oregon Health Plan is this state's version of Medicaid, a program jointly funded by state and federal governments to provide health care to people with low incomes or disabilities. The federal government has approved a request from Oregon to change the Medicaid payment model, so the coordinated care organizations will get a fixed budget with broad leeway to spend the money how they want.

Instead of linking their costs to a specific procedure and patient, the organizations can pay for other services that help patients, like caseworkers to help navigate the complex medical system or training to prepare a diabetes-friendly diet.

The federal government has promised Oregon nearly $2 billion over the next five years to ensure the coordinated care organizations have enough cash to invest in those programs upfront. In exchange, the state promises to significantly lower the long-term costs.

"We have an ability now to spend money where it makes more sense," said Freddy Sennhauser, communications director for the AllCare Health Plan, a coordinated care organization in southern Oregon.

AllCare has started working to identify and intervene with frequent emergency room visitors, Sennhauser said. An existing Medicaid provider formerly known as Mid Rogue Oregon Health Plan, AllCare has hired a psychiatrist to handle mental health cases and staff to handle calls from clients.

FamilyCare, which will operate in the Portland area, is developing a new program to improve prenatal care for pregnant clients, including addiction treatment for mothers who need it, said Jeff Heatherington, the chief executive. The program will be active for the child's first year, he said, ensuring babies are born healthy and mothers have support.

WVP Health Authority in Salem has had significant success with a similar program, and officials there have been eager to expand it with the new flexibility they'll have as a coordinated care organization. The program was previously funded largely through charity, significantly limiting the participation and the length of time that mothers could participate.

Copyright 2012 The Associated Press.