After months of activity, the Oregon Health Policy Board has rolled out its idea for changing the way the state delivers health care to low-income Oregonians. But there's still a lot of confusion.
Alan Bates is a doctor in Medford.
He recently saw an elderly woman who'd broken her ankle in a fall.
It was an easy fix. The problem was, trying to find her somewhere to go so she could heal.
Bates worries that if she goes home -- with crutches and on pain medications -- she'll fall again and end up in an intensive care unit, where one night can cost as much as $10,000.
If he could have his way, and bypass the red tape, he'd get Medicare to put her up in a home for a month for much less.
But Medicare has red tape and she's not eligible for that kind of care, because she was in hospital one night, not three.
So now says Bates, she could go broke paying for both a care home and her apartment.
"She will deplete her savings. She won't be able to afford an apartment anymore. She'll end up in an assisted living facility paid for by the state and taxpayers. Her quality of life will be diminished. The overall cost to the system will be much higher for poorer outcome for this lady," Bates says.
Now, Bates is not just any doctor. He's also the Democratic State Senator for Medford. And with Governor John Kitzhaber and many other's he's trying to develop a new way for the state to deliver health care.
They're setting up a system of so called coordinated care organizations or CCO's. What it will mean is that instead of working on their own, doctors can coordinate with nursing homes, mental health experts, dentists and even the county.
So in the case of the elderly woman, Bates could make one phone call to a CCO and it would find her somewhere to stay while she heals.
"We just want to say that we want to do this in a more efficient manner, so a woman like this can go back to her own home, live where she wants to live. And have some independence in that living of her years left. She's 81," he says.
Bates believes CCOs will also save the state money -- because hospital care is much more costly that other care options.
But not everyone's convinced. And that's been because the plan hasn't been very solid.
Now, however, the Oregon Health Policy Board has released its blueprint.
And at the recent House Health Care Committee, Representative Mitch Greenlick didn't seem that impressed.
Specifically, he wanted the director of the Oregon Health Authority Bruce Goldberg, to tell him why the blueprint doesn't contain a definition of what a CCO should be.
"I notice on your implementation plan you punt on that one and suggest that will happen some where along the time line. Is that not something that you would plan on presenting to the legislature to deal with? And if not, have you begun to work on that absolutely critical question as to what's a CCO," Greenlick asked.
"I think if you look at the proposal, it doesn't say here's the definition, but we begin to outline what the criteria are," Goldberg replied.
Goldberg says CCOs are going to vary greatly.
The state will simply issue the criteria, and if a health organization meets them, then it'll be considered a CCO.
It's all a bit vague.
But Tina Edlund, the chief of policy with the Oregon Health Authority, says the blueprint does lay out what kind of organizations will qualify to be a CCO; how their budgets might work; and how they'll be held accountable.
"I think that in some areas you'll have a hospital coming together with local clinics and perhaps the county to talk about how they could take responsibility for the health of their community. I think that in some areas it will be the existing managed care organization that partners with a mental health organization. There could even be cases where the initial discussion is led by a single physician. But a single physician isn't going to probably form a coordinated care organization on his own," Edlund says.
So what do health care organizations around the state think about such a loose-knit definition?
Jeff Heatherington runs FamilyCare. It provides Medicaid services for about 50,000 people. He says FamilyCare already treats physical and mental health problems, so bringing in dental care and the county shouldn't be too much of a stretch. But, he says, he's heard talk of having to deal with the housing needs of patients too.
"You can take the health of an individual and stretch the needs clear out through housing and education. And the question that hasn't been answered yet is how far the CCO is going to have to reach into what I would call the social areas of these people's needs, in addition to just the health care issues," Heatherington says.
Heatherington regards the CCOs as basically the Oregon Health Plan on steroids.
Still, he thinks they probably will save the state money -- but $20 or $30 million -- not the $240 million the legislature has written into the 2012-13 budget.
Meanwhile, if the legislature gives the idea its blessing, the first CCOs are expected to start operating by July.