Special Section: Health Care Reform

Health care reform: a window of opportunity

If health care reform excites you, now is a great time to be playing a part of it.

That was the message that Gov. Ted Kulongoski’s senior health policy advisor gave May 8 in Portland. Ree Sailors spoke at the “Transforming Health Care in Oregon: Celebrating IHI 5 Million Lives Campaign” conference. The conference featured the efforts of hospitals across the state to adopt improvement efforts under the Institute of Healthcare Improvement program.

“Little windows of opportunity open up about once a decade,” Sailors said. “We’re in one of those windows now.”

“I am impressed and I am hopeful.”

—Ree Sailors, senior health policy advisor to Oregon Governor Ted Kulongoski   Photos by Jeanie Lunsford

Sailors, the keynote speaker, addressed the health care situation in the nation and the state, and spoke of the current efforts of the Oregon Health Fund Board.

The board was established by the Oregon Legislature and charged with a fundamental transformation of health care in the state. By November, the board is to report to the governor and Legislature with a comprehensive plan that:

• Covers the uninsured
• Reforms delivery system
• Ensures timely access to care
• Finances coverage of essential health services
• Encourages participation
• Encourages public-private partnerships
• Controls costs
• Improves end-of-life care
• Sets fair provider payments
• Establishes a high-quality, transparent delivery system
• Provides equitable and affordable funding
• Limits cost growth to no more than general inflation, as measured by the Consumer Price Index (CPI).

How we stack up

It is a considerable task, just as is the national health care challenge, Sailors said.

“The amount that the U.S. pays for health care per capita is almost double that of other countries,” she said.

Health care is now consuming 16 percent of our economy (gross domestic product) and the percentage is climbing.

“It will literally take over the United States budget if we can’t get costs under control,” Sailors said.

Annual medical inflation is now two to three times greater than CPI.

“We are now really getting to where our noses are pressed up against the window,” she said. “There’s no way that we can keep pace.”

At the same time, “we don’t get the outcomes in terms of mortality, morbidity and birth rates that the other countries have,” Sailors said. “We see statistic after statistic that says we really have a problem.”

Emerging ideas: reasons for hope

Sailors described herself as a veteran cynic. But in observing health care in Oregon and efforts to make changes, “I am impressed and I am hopeful,” she said.

The current reform effort by the state of Oregon is centered in the Oregon Health Fund Board, its six committees and hundreds of volunteers.

• The Benefits Committee is making recommendations for an essential benefit package for Oregonians.
• The Delivery System Committee is discussing system transformation, including integrated health homes, quality, cost and transparency.
• The Eligibility Committee is addressing affordability, outreach and enrollment.
• The Federal Laws Committee is charged with looking at federal policies that have an impact on state reforms. The committee will report its findings to the state’s congressional delegation this July.
• The Finance Committee is exploring financing options as well as an insurance exchange that could create a group insurance market model for individuals and small businesses.
• The Health Equities Committee made recommendations to improve access to culturally appropriate care for all Oregonians.

The committees have conducted hundreds of meetings, and the full Board hosted a series of public meetings across the state to gather the concerns, thoughts and ideas from Oregonians.

Among the suggestions being considered is a rethinking of the approach to cost containment, Sailors said.

Most recent efforts to control costs have focused on denying care, she said. The new approach is to get the right care to people at the right time to produce the right outcomes.

That’s why promising new ideas have emerged, such as the primary care medical home, multi-disciplinary teams and making sure providers have access to evidence-based protocols at the point of health care service.

The ambitious goal of getting the right care to all the people, including those who are now uninsured—16 percent of Oregon residents at the most recent reckoning—will cost money.

With federal matching funds, every dollar the state contributes toward health care for the most financially needy citizens results in $1.60 for the programs. But the federal government doesn’t match contributions for adults with incomes above a minimum, even though people with this income level have no discretionary funds to pay for insurance and only 60 percent of employers provide insurance.

Providing health care, even finding the funds to generate the federal match, requires a new source of revenue, Sailors said.

Some of the ideas proposed include taxes on provider or health transaction, a general payroll tax, a “pay or play” payroll tax combined with a credit for employers that provide employee health insurance, recapturing the savings of cost shifting from secondary to primary care or some combination.

And the system of heath care delivery and payment needs to be designed to that there are incentives to producing better outcomes.

The Health Fund Board will complete its draft plan this summer, and plans to take public comments in August and September. (The public comment process has not been developed yet, but will be announced on the Health Fund Board web site.)

The final plan will be presented to the governor and legislature in October for legislative action in 2009.

“As we go into session in 2009, your voices are important,” Sailors said.

Fixing health care

“If we had the same tolerance for errors in the rest of business in the United States as we do in health care," says Ree Sailors, Gov. Ted Kulongoski’s senior health policy advisor, "here are some of the things we’d see:”

22,000 checks would be deducted from the wrong bank accounts every day.

16,000 pieces of mail would be lost by the Postal Service every hour.

2,000 unsafe airplane landings would be made every day.

2 major airplane accidents would happen each week.

2,000,000 documents would be lost by the IRS each year.

Here is what we have in health care:

Almost one third of health care expenditures goes to care that is duplicative, fails to improve patient health, or may even make it worse.

Preventable medical errors occur in nearly one quarter of primary care visits. They result in 8 million Adverse Drug Events (ADE) per year in ambulatory care, a half million of which are life threatening.

About 98,000 Americans die each year from preventable medical errors in hospitals.

Americans receive recommended care about only 55 percent of the time.

500 incorrect surgeries are completed every week.

Outcomes do not meet the standards of the rest of the world.

Better outcomes, higher satisfaction with providers and less cost in the delivery of health care services are critical and possible. Every day, the physicians, nurses and others who provide health care services for CareOregon members prove that these goals are attainable.

More on health care reform and the IHI 5 Million Lives Campaign

Energizing health care improvement
Hospitals transforming health care in Oregon
Take part: give your input to the Oregon Health Fund Board

Video: John Kitzhaber's keynote address to Institute for Healthcare Improvement national conference