Sunday, August 7, 2011

Oregon's Team Approach

Diabetes afflicts an estimated 262,000 Oregonians and contributes to 56,000 hospitalizations a year, at a cost exceeding $1.1 billion but health professionals in Oregon realize that it is possible for timely and well-coordinated care to hold diabetes in check.

A coordinated care team at the Multnomah County Health Clinic located in North Portland started using the patient-centered approach to track patients with diabetes about two years ago. The clinic uses computers to tally blood sugar levels, hemoglobin, blood pressure and cholesterol to make sure the readings remain in the safe zone. Regular report cards are sent to doctors to let them know how many of their patients are meeting targeted measures.

This team approach enables doctors, nurses, social workers, and medical aides to work together using EHRs to quickly track patients and their test results, allergies, or medications without pouring through a foot high paper stack. In some cases, patients can go to a health home to receive treatment instead of making unnecessary trips to the hospital emergency room.

This year, the state has been actively involved in promoting coordinated care on the legislative front. On July 1, 2011, the Governor of Oregon signed (HB 3650) the “Health System Transformation” bill to establish Coordinated Care Organizations (CCO) for recipients of the Oregon Health Plan that includes Medicaid and other state-based public insurance programs covering 600,000 Oregonians.

The legislation will enable patients to have all their health needs coordinated to include mental, physical, and dental plus preventive services are emphasized. Each CCO will be given a global budget and will be held accountable to the health outcomes of the people it serves, rather than being paid on a fee-for-service basis.

The legislation will cover medical assistance recipients and individuals who are dually eligible for both Medicare and Medicaid, and will use collected information to measure health outcomes, healthcare quality, costs, and efficiency metrics. Communities and regions will be accountable for improving the health of their communities and regions thereby reducing avoidable health gaps among different cultural groups.

The Oregon Health Policy Board upon the passage of (HB 3650) set up four new short term work groups to discuss how Medicaid and Medicare will integrate care and services. The groups will discuss certification criteria, outcomes, quality, efficiency metrics and global budget methodology. The work groups will build on ideas obtained from communities and stakeholders and incorporate this information into a work plan to present to the legislature February 2012. At that time, the legislation will be reviewed and plans are to launch the first CCO July 2012.

In another legislative move, the House passed (SB99) the “Oregon Health Insurance Exchange” bill. So far, Oregon is the only state that has passed health insurance exchange legislation with significant bipartisan support in both houses. A business plan for the exchange will be presented to the lawmakers for review on February 1, 2012. After approval, the exchange will begin providing coverage in January 2014. Rocky King, who was part of the exchange design team for the Oregon Health Authority, has been appointed Interim Director for the Exchange Corporation by Governor Kitzhaber.

To make coordinated care possible using health IT, the state released an RFP on July 19th seeking proposals for Health Information Exchange core services with proposals due August 18, 2011. For more information, go to the Oregon Health Policy Board web site or go to