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Health | local | Vital Signs

Oregon's Idea For Fixing Medicaid Hits The National Stage

The federal government has taken the unprecedented step of giving Oregon almost $2 billion, for what amounts to a health care experiment.

Oregon’s governor has convinced the Center for Medicare and Medicaid Services that he has a way to make Medicaid treatment better and cheaper.

As part of OPB’s on-going health series Vital Signs, Kristian Foden-Vencil spoke to people on the front lines of some of the state’s health care experiments, and files this report.


When an Oregon idea makes it to the national stage, there’s a lot of excitement.

“Governor, I know that you’re not prone to being overly demonstrative. But would you indulge me with a high five? Ha ha ha,”  Malia Wasson, president of U.S. Bank in Oregon laughed.

Care Oregon outreach worker Amy Vance checks James Prasad’s blood pressure.

Kristian Foden-Vencil / OPB

Governor John Kitzhaber used to be an emergency room doctor. This year, the governor and the legislature, including both Republicans and Democrats, passed a budget in the blind faith that the feds would come up with this money.

So, what is the big idea?

Well, it’s nothing short of a complete change in the way Oregon’s sickest people get health care.

So-called Coordinated Care Organizations are being set up in just about every town. So Portland will have one, Salem with have one, Eugene will have one.

And most of the big health care players in those towns: the hospitals; the doctors offices; mental health providers and dentists; will come under the umbrella of their Coordinated Care Organization.

Kitzhaber’s hope is that the silo mentality between those competing businesses will break down and allow patients to travel between them getting the care they need.

“I think this is really a defining moment for health care in the State of Oregon and I think that if we’re successful probably for health care beyond our borders. It gives us the opportunity to change our delivery model from one that focuses on after-the-fact acute care to prevention and wellness and the community-based management of chronic conditions,” Kitzhaber says.

One of the experiments creates a new group of health care workers — kind of like health coaches.

They’ll work with Medicaid’s sickest 20 percent — the people the state says are responsible for using 75 percent of Medicaid money.

These are people suffering from chronic illnesses.  They need a lot of attention - for diseases like diabetes and heart failure. They’re people like 69-year-old James Prasad.

Prasad is  having his blood pressure checked at his doctor’s. He used to help travelers at Portland International Airport — pushing wheelchairs and answering questions. But health problems forced his retirement.

“I got a by-pass surgery. Stomach surgery, a big surgery … I have to go to the doctor.”

He’s had to go to the doctor a lot, and to the hospital a lot, and the emergency room. That’s why he came to the attention of Amy Vance. Her official title is outreach worker for Care Oregon — Prasad’s health plan. But think of her as his health coach.

Amy Vance: “So, I’ll call doctors with you.”

James Prasad: “Yes.”

Amy Vance: “What else have we done? We’ve talked to pharmacy before together.”

James Prasad: “You’ve arranged medical transportation for me.”

Amy Vance: “We’ll double check on med’s together so I’ll come to an appointment. And then at home, we’ll make sure that the medications are actually out of his med-pack.”

It might seem expensive to have a personal health guide.

But while Vance’s time may cost several hundred dollars a month, she can also save thousands — even tens of thousands —  if she keeps  him out of the hospital or the ER during that time. Vance says that when people are faced with so many different medical problems, they can get depressed, give up and fall into a cycle of getting sick, going to the ER to get stabilized, then going home to restart the cycle.

But says Vance, with her help, patients can take control of their illnesses, and start to get healthy.

For example she asked Prasad to record his weight every day. He took it to heart and started writing down all kinds of things. 

James Prasad: “This is have my recordings. How much is my what you call it, my weight, my diabetic, my blood pressure. How much medicine I put in.”

Kristian: “So here we have a book here with everything written down from the time and the day and all the different medications and blood pressure and things like that you’re watching out for?”

James Prasad: “Yes.”

Prasad’s doctor Judy Becher says she can now look at his book and adjust medications accordingly.

Judy Becher: “When you felt poorly you can point to what time it started based on the entry.”

James Prasad: “Yeah.”

Vance, the health coach, deals with about three patients a day. She carries a caseload of about 30 people and her cell phone is always on — for those in crisis.

State leaders — from both sides of the political aisle — are backing Kitzhaber’s plan.

But there are skeptics, like Republican State Representative Jim Weidner, who says, “It doesn’t really drive down the cost of health care. It’s just shifting costs into different spots.”

Weidner says it’s an experiment that’s going to end up costing the state a great deal of money.

But Kitzhaber has an answer for that.

He plans to pay the new Coordinated Care Organizations with a lump sum.

The idea is to create an incentive to heal patients quickly.

The thinking goes that now, hospitals and doctors don’t have the financial incentive to make people better.

Quite the opposite, in fact.  If a patient keeps coming back, the health care entity keeps getting paid.
But under the new Coordinated Care Organization system, healthcare organizations save money if somebody gets well.

In fact, Governor Kitzhaber believes Oregon will be able to save the feds every penny of the $2 billion the state’s been given over the next five years.

“We estimated that if every state Medicaid program in the country were to adopt this model, the net savings would be about $1.5 trillion dollars over 10 years. To put that into perspective, the super committee is planning to find $1.2 trillion dollars over the same period of time by decimating non-security domestic discretionary spending,” Kitzhaber says.

Sounds great. But the feds have said that if the state doesn’t cut Medicaid spending by 2 percent next year, all the new federal funds could dry up.


This story is part of a reporting partnership between OPB, NPR and Kaiser Health News.

Kaiser Health News is a nonprofit news service covering health policy and politics. It is an editorially-independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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