The idea is to make sure every patient gets the care he or she needs to either stay healthy or minimize the complications of acute illnesses and chronic diseases. The services to be offered will be as varied as finding rides for a young woman who needs pre-natal care, translating medical instructions for a patient who speaks another language, and providing mental health counseling for an elder who suffers from depression. It also means developing protocols to ensure that patients who are discharged from hospitals receive follow-up treatment and consultation to avoid unnecessary readmissions.
Licensed and monitored by the state, the new groups will be governed in each community by a board representing health care providers, consumers and local government. It’s envisioned that counties, localities and many of the state’s existing managed care companies will apply for state certification.
It sounds expensive, but Kitzhaber and his allies are convinced it will actually save the state a considerable amount of money. For one thing, the governor believes it will keep people healthier and reduce the amount of medical treatment they need. For another, he says, it will be more efficient.
When Kitzhaber talks about how coordinated care organizations will change the way health care is delivered, he uses the hypothetical example of an elderly woman who lives alone in southern Oregon, where the summers are hot. She suffers from congestive heart failure and has repeatedly been admitted to the local hospital for treatment.
"One summer there is a heat wave and the temperature in her apartment goes up to 105 degrees for a day or two — putting enough additional strain on her cardiovascular system to tip her over into full blown congestive heart failure," he said during his Washington speech this month.
"Under the current system," he continued, "Medicaid and Medicare will pay for the ambulance and the $50,000 to stabilize her heart failure, what it will not pay for is the $200 window air-conditioner, which is all she needs to stay in her apartment and out of the acute care medical system."
"Under a more rational system with a connection to the community," Kitzhaber said, "someone — maybe a community health worker — would be checking on her on a regular basis to make sure...that (not) just her medical needs are being taken care of, but also her non-medical needs that can lead to medical needs."
Over the next two months, Oregon officials will be detailing the requirements and specifications for the coordinated care groups through a statewide public hearing process. In February 2012, lawmakers are expected to give their final stamp of approval. This year’s vote on the concept for the new organizations was nearly unanimous.
Beyond Medicaid
At first, the new health groups will be sole providers for the state’s 600,000 Medicaid beneficiaries. Soon, however, Kitzhaber wants them to serve Oregon’s 300,000 state employees and teachers. Later, universities and possibly small businesses may become clients.
Eventually, the plan’s backers hope that coordinated care organizations would be available to anyone who wants to sign up. Before that happens, though, “they will have to demonstrate their value,” says Kitzhaber’s health policy adviser, Mike Benetto. That means improving health outcomes, saving money and getting a thumbs-up from consumers.
The concept for these new health groups was tested in central Oregon on a group of so-called “frequent flyers” who had a record of checking into local hospitals as many as 25 times a year. The result was a big drop in hospital admissions and significant Medicaid savings.
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