Oregon Public Broadcasting

The state of Oregon is trying to come up with a new, and cheaper way of keeping people healthy.

Currently, health care providers are paid for a patient’s office visits, tests and procedures -- the more there are, the higher the cost of care.

But the Oregon Health Authority wants to develop a healthier population, at a lower cost. 

Just how they're going to do that is the subject of a whole series of meetings.

But, as Kristian Foden-Vencil reports, a plan for what’s called “coordinated care” is to be laid out in front of the legislature next year.

Governor John Kitzhaber says the increasing cost of providing health care far exceeds the rate of inflation. So something had to change.

He says the economic downturn presented an opportunity, "If we didn't have this fiscal crisis, people wouldn't be willing to change."

What Kitzhaber and the legislature did this year was pass House Bill 3650. It started the planning for a statewide system of Coordinated Care Organizations, or CCOs. The hope is those organizations will both lower health care costs and improve outcomes by emphasizing prevention.

The idea is that 20 percent of patients use 80 percent of health care money. So the state wants to focus on making that 20 percent better.

A couple of years ago, Rebecca Clark was among that 20 percent. She was suffering chronic back pain, headaches and fatigue, all brought on by a concussion and severe stress. To tackle all those problems she had a doctor, a chiropractor and a neurologist.

Sitting in a coffee shop, Clark says it would have been a dizzying schedule of appointments and medications for a healthy person, let alone someone who was sick.

"It's so disruptive, especially if you're having to travel. Let's say your commute is a half an hour both ways, you're losing an hour of your time. Plus, you know wait time, say they're running late with their appointments so you've got 15 minutes to a half an hour for that, plus your hour appointment. That takes a lot of time out of your day. And if you're seeing multiple doctors in a day, you might as well forget about doing anything else," Clark says.

Health experts at the state say chronically ill people like Clark end up missing appointments, forgetting to take their medications or not remembering what each doctor told them to do.

And that, says Bruce Goldberg the chief of the Oregon Health Authority, costs the state a lot.

"If you have diabetes but aren't regularly checking your blood sugar and reviewing those results with somebody. You're likely to end up with diabetes out of control and much sicker in a hospital spending a lot more money. That can be prevented."

The state wants to take such chronically ill people and have all their nurses, doctors, chiropractors, dentists, psychologists and whoever else, work together to develop one clear plan.

Goldberg says the aim is to keep patients focused on getting well.

"For some of them it may be a phone call two or three times a week from a nurse. For somebody else it might be a community health worker who can go into a home and be certain that people are taking their medicine or blood sugar. For others it might be setting them up with a variety of devices that can monitor your blood pressure and weight at home and electronically send that information into a nurse or the doctors office. It's going to be in a variety of different ways."

It's a new way of delivering health care. And the state wants to set up a series of Coordinated Care Organizations to do it.

And to further encourage doctors not to order duplicative tests or unneccessary procedures, those organizations will operate on one overall budget -- instead of getting paid for every procedure they perform.

Goldberg says providers will then be able to share in any savings.

"We hope that organizations will look at creating budgets for hospital care, which will create an incentive to keep people out of the hospital.  Right now, hospitals make their money by admitting more and more people.  There's not a lot of incentive for a hospital to make investments to keep people out."

It's a bold plan. But not everyone is sure it's going to work.

Mitch Anderson is the director of the Benton County Health Department. His agency has already taken steps to create a Coordinated Care Organization or CCO.

"I do believe there is a lot of money that's waisted in the current system. Can you create a CCO system and in a matter of a year's time, flip a switch and realize all these savings, I don't think so," Anderson says.

In the longer run, he says, it's hard to tell.

The state's health budget is based on the premise that this new system will produce substantial savings. If it doesn't, Oregon's neediest individuals will be looking at service cuts of more than 30 percent over two years.

Meanwhile, back at the coffee shop in Portland, Rebecca Clark thinks having a team of health experts would have helped her.

"I think that first of all, if you're giving a lot of attention to someone whose community has really broken down for them, because chronically ill people have a tendency to be sort of marginalized by society. You give them a chance of feeling like they're being supported by something. That's going to give them a tremendous amount of hope."

The plan for setting up Coordinated Care Organizations will be presented to the legislature in February.

Find more health news at http://news.opb.org/health/