With federal money, Oregon kicks health care reform into high gear

With federal money, Oregon kicks health care reform into high gear

PORTLAND, Ore. (AP) - Now that federal officials have all but committed to giving Oregon nearly $2 billion to redesign its Medicaid system, the state's health care industry faces the challenge of getting it done. Officials said Friday they're pressing ahead.

Gov. John Kitzhaber has convinced the Obama administration that he can deliver better health care at a lower cost by investing in preventive care that reduces avoidable hospitalizations — a model that's shown some success in pilot projects. But nobody's ever tried to do it for 600,000 patients on Medicaid.

The state announced Thursday that the federal government had tentatively agreed to spend $1.9 billion over five years in exchange for a state commitment that it will ultimately save $11 billion over a decade.

"The federal investment is a very smart investment, and Oregon's health care community stands ready to make sure it's an investment that will pay off in better care, better health and lower costs in the years to come," George Brown, president and chief executive of Legacy Health, a hospital group, said at a news conference Friday.

Brown chairs a committee of health companies that want to implement the plan in a three-county region that comprises the Portland metro area. It's one of 14 groups applying to be among the first "coordinated care organizations," which will be responsible for managing the health care of patients in their region within a fixed budget. Many of the potential care organizations include hospitals, insurance companies, physician groups, mental health providers and county governments agreeing to work together.

The first $620 million is scheduled to arrive July 1, but the federal Centers for Medicare and Medicaid Services first must formally approve Oregon's application for a waiver from standard Medicaid requirements.

The money will significantly reduce severe cuts in payments to health care providers that are slated to begin this summer, allowing providers to invest in new infrastructure and staff.

Kitzhaber said each coordinated care organization will make its own decisions about what it needs to buy.

They're likely to invest in technology to share information between providers, health officials have said, and in community health workers like Becky Wilkinson, who works with patients making frequent emergency room visits.

Wilkinson calls herself a "patient advocate" who works hard to connect with her clients on their level and be a "bridge" between the patient and the doctor. For some clients, she helps them navigate the health care system so they know where to get the services they need and how to manage their illness. Sometimes she calls them daily to make sure they're taking medication, or goes with them to doctor's appointments. For others, she might check in just once a week.

"Thinking outside the box, spending just a little bit of money at a time is something that can really help the system and the patients overall," Wilkinson said Friday.

Her work has reduced the number of trips her clients make to the emergency room, but traditional Medicaid has no mechanism to pay for it, officials have said.

Kitzhaber and his health care advisers have worked closely over the past year with President Barack Obama's administration to design the program and negotiate the funding. Details were hashed out in a meeting at the White House with some of Obama's senior health and budget advisers Tuesday afternoon, Kitzhaber said.

The governor said he isn't concerned that his initiative would be derailed if Obama loses his re-election bid or Republicans take control of both chambers of Congress.

"It's never been a partisan issue here in Oregon," he said. "I'd be very, very surprised if it was a partisan issue in Washington."
___
Follow AP writer Jonathan J. Cooper at http://twitter.com/jjcooper

Copyright 2012 The Associated Press.