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Since the federal healthcare bill passed, Oregon leaders have stated their intentions to ready the state for the upcoming transitions that would follow.
Like the state, healthcare leaders in Crook, Deschutes, and Jefferson counties desire to stay ahead of the curve and upgrade healthcare services region-wide.
Central Oregon healthcare reform efforts intend to attain what they call the Triple Aim, which promotes “better health, better care, and lower costs. So far, their work has already met two of those goals, saving region hospitals more than $500,000, which in turn could eventually result in lower hospital costs for the patients.
State legislators passed healthcare reform legislation (Senate Bill 204) in 2011 that enables the Central Oregon region to create new public and private partnerships to improve healthcare. Meanwhile, legislators will consider another bill (House Bill 3650) in the upcoming session that will continue moving healthcare reform forward statewide utilizing the same types of partnerships.
SB 204 essentially calls for a Central Oregon Health Council comprised of a host of public and private agency leaders. According to Crook County Health Department Director Muriel DeLaVergne-Brown, the group includes a county commissioner from each county, the St. Charles Hospital CEO, the board president of the Central Oregon Independent Practice Association, the senior vice-president of government programs for health insurance provider Pacific Source, as well as a representative for the region’s senior citizen population and another for healthcare consumers.
“This bill allows Central Oregon . . . as a pilot to go forward and find a way to create savings,” said Crook County Commissioner Ken Fahlgren, who represents the Crook County Court on the Health Council.
Under the Health Council, the bill requires an advisory committee comprised of multiple healthcare leaders in the region. The group includes public and mental health department heads, members of Mosaic Medical and hospitals throughout the region, and area physicians.
While DeLaVergne Brown acknowledged that region-wide efforts for healthcare reform originated several years ago, those efforts didn’t always bring all the players together the way SB 204 does.
“It’s really nice to see all the community partners at the table,” she said. “And we’re really working together as a group . . . to look at how we improve health in the region.”
These partnerships would eventually segue into the reforms set forth in HB 3650. According to Fahlgren, legislators created the bill to fulfill the requirements established by the federal healthcare bill. To that end, the legislation proposes the creation of Coordinated Care Organizations (CCO).
The bill’s executive summary explains that CCOs are “the next step forward for Oregon healthcare reforms that began in 1989 with the creation of the Oregon Health Plan.” The summary goes on to point out that the managed care, mental health, and dental care organizations have succeeded in keeping costs down. However, each entity is paid separately by the state to manage its cliental, which limits the maximized efficiency and value of health care the state could achieve by coordinating those entities to provide person-centered care.
DeLaVergne-Brown explained that the bill would funnel all the Medicaid and Oregon Health Plan dollars through one organization, and they would pay the individual providers.
In addition, the Coordinated Care Organizations would establish primary care homes, which consolidates multiple specialists into one community.
“The goal is that we will be able to keep the patient from having multiple trips to Bend or Redmond,” Fahlgren said of Prineville residents. “Other physicians would come to them.”
Work has already begun on creating primary care homes, coupled with an attempt to cut healthcare costs in the region by cutting down on unnecessary emergency room visits.
“What has happened through the first part of this program is that two private industries (on the Health Council) went out and said the highest utilizers (of the emergency room) were the ones that were spending 90 percent of the money,” Fahlgren said. “They identified the top 60 users, or those who had expended the most money and helped them and followed them, and worked to guide them from going to their emergency room.”
He went on to explain that they connected these patients with primary care providers and other specialists to care for non-emergency needs.
“They have to be willing,” Fahlgren said, “but it’s so helpful and so positive for those people that they have a medical home, specifically have a doctor — they have someone lining them out to where they are welcomed and they’re being shown that the there are better ways to take care of their health.”
Curtailing excessive emergency department visits is one of many reforms that HB 3560 calls for that yield measurable outcomes. For example, the limited visits saved hospitals and patients money. Other potential performance measures include rate of tobacco use, quantity of cancer, depression, or fall risk screenings, and obesity rates.
“I think one of the big differences with what’s happening now is that there’s a big focus on prevention,” DeLaVergne-Brown observed.
Going forward, the Central Oregon Health Council has applied for a $22.5 million grant that will help the region continue the CCO work outlined in HB 3560. Meanwhile, the Health Council is working on a health improvement plan for the region.
“The last year, we have been working on a community assessment,” DeLaVergne-Brown explained. She went on say that they will determine the top 10 health issues and create a plan and initiatives associated with those issues.
Ultimately, by getting out in front of the upcoming changes, the region intends to help shape healthcare reform.
“We would rather make up the rules than be handed the rules and not have any say,” Fahlgren said.
And DeLaVergne-Brown believes the Central Oregon community can capably do just that.
“We are considered one of the leaders in the state for this work,” she said. “We have worked really hard. We have great partnerships, and we really believe in making a difference for people in this region.”
