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Think Out Loud

How To Coordinate Care

When he’s asked to explain how coordinated care organizations (CCOs) work, Oregon Governor John Kitzhaber has a favorite hypothetical example he likes to bring up. The example goes like this: There’s a 92-year-old woman with well-managed congestive heart failure who lives in an un-air-conditioned apartment. A heat wave would be enough of a strain on her system to send her to the emergency room, which would cost a lot of money. Under the new CCO system, Kitzhaber argues, a community health worker would be checking in on this hypothetical nonagenarian and would prevent the expensive emergency room visit by providing her with an air-conditioner.

Kitzhaber mentioned this example just last month when we interviewed him at the City Club of Portland and a few weeks later when he spoke to the New York Times. He also used it in a 2011 speech on health care reform and when he was on the campaign trail in 2010.

This story left us wondering: Who exactly pays for the air-conditioner? Who decides it’s medically necessary? And what about the doctors at the emergency room who never see this patient — how do they get paid under this new system focused on preventative care?

We’ll talk to one of the 15 CCOs that is up and running about how exactly this model might work.

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OPB | April 24, 2013