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Posts published in “Day: August 9, 2012”

Inside a ‘transformation’

At the Coordinated Care workshop in Portland/Randy Stapilus


The word that has been bandied around is "tranformation" - as in, transformation of Oregon's health care system. And what the new coordinated care organizations (CCos) are trying to do is major, and - if they work more or less as planned - they could lead to a big shift in the way health care is delivered, and how much it costs. Less, hopefully.

What some of this translates to as a more practical matter came a little clearer at the August 8 CCO workshop in Portland, led by the FamilyCare Health Plans, a local nonprofit which in its self-descriptions says it is "dedicated to creating healthy individuals through innovative systems. We offer affordable, high quality, patient-centered health plans to Oregonians receiving benefits through Medicare or the Oregon Health Plan."

That's what's involved at this stage: Not all Oregonians but rather those using Medicare and the Oregon Health Plan. But a lot of them will be getting their health services this way, an estimated 81% of Medicare patients by September 1. The idea is that, instead of each medical provider being paid for whatever goods or services they bill for, a large lump sum will be spent on the system, apportioned out, with the idea of using it efficiently to do whatever's needed to keep people healthier and out of emergency rooms.

Speaker after speaker, including legislators, state officials and care organization leaders: "There will be no turning back."

Speakers referred several times to the walls between various types of providers, different organizations and types of organizations, different medical specialties, physical and mental health, and more. The CCOs are intended to serve as a central communications hub, bringing together the various groups in work for specific patients.

It's a concept easier to grasp through example than description. One example raised was of an eight-year-old boy who had asthma, who experienced attacks that every other week, for months, sent him to an emergency room. Finally, a team of physicians and other social and health workers got together and worked out a set of changes that allowed him to better manage his problem; he stayed out of emergency rooms thereafter. The estimate has been been that 20% or so of patients - like this boy - account for 80% of health care costs (and some guesstimate, informally, about a 5%/50% ratio); catching those chronic cases in the early stages is a big part of what the new CCOs are supposed to do. (more…)