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Oregonians to play a big role in health care reform

Former Gov. John Kitzhaber keynotes Institute for Healthcare Improvement national reform conference; CareOregon and network of clinics present conference participants a visionary approach to primary care; Sen. Ron Wyden addresses IHI teleconference participants in Portland.

Oregonians played a prominent role the week of Dec. 8-12 in the nation’s premiere conference on health care reform: the Institute for Healthcare Improvement’s National Forum on Quality Improvement in Healthcare in Nashville, Tenn.

With real, transformational health care reform seen as crucial to pulling the United States out of its current economic straits, the Institute for Healthcare Improvement is sure to play a major role in reform. And reform models pioneered or expanded in Oregon will likely be prominent.

Former Oregon Gov. John Kitzhaber, MD, was a keynote speaker.

Gov. John Kitzhaber, MD 
Gov. John Kitzhaber, MD

President-elect Barack Obama’s top two priorities—repairing the economy and moving toward energy independence—cannot be accomplished without the third priority on his list: health care reform, Kitzhaber said. With health care costs climbing at a faster rate than overall cost of living, and with the first baby boomers qualifying for Medicare before Obama’s first term ends, there simply won’t be enough financial resources to address energy and the economy unless health care is fixed.

Simply providing access to care won’t fix the problem, he said. The system rewards treatment of episodic, acute incidents, such as heart attacks or accidents, at the expense of preventive care. Yet 70 percent of health care costs are to care for people with one or more chronic conditions that could be helped by preventive care.

Gov. Kitzhaber’s address is posted on the IHI web site.

Representatives of CareOregon and collaborating clinics presented results of efforts to improve delivery of primary and preventive care and to address complex and chronic care.

CareOregon was one of 15 organizations participating in the initial IHI Learning Institute initiative to test putting the Triple Aim—improving the health of populations, the experience of care and per-capita cost—into practice. Positive results from its CareSupport program, a health plan-based multi-disciplinary program for improving outcomes for high-risk members, led CareOregon to move improving population health to a broader scale through the Primary Care Renewal medical home initiative.

In early 2007, CareOregon and five of its partner primary-care clinics began collaborating on the medical home model of care, integrating teams, including a case manager, medical assistant and a provider (doctor, nurse practitioner or physician assistant), to proactively address all the health needs of their panel of patients, emphasizing preventive care. At the end of 2008, all five organizations—Multnomah County Health Department's Mid County Health Center and HIV Health Services Center, Central City Concern Old Town Clinic, Legacy Clinic Emanuel, Virginia Garcia Memorial Health Center Cornelius Campus, and Oregon Health & Science University Richmond Clinic—have expanded beyond the original pilots and now 27 teams are working together and seeing positive results in access and outcomes.

A case study of the CareOregon programs presented at the forum is downloadable.

Portland Monthly magazine's January 2009 issue also presents a detailed account of the Primary CAre Renewal clinics.

Sen. Wyden proposes transformational change

Sen. Ron Wyden, D-Oregon, addressing IHI teleconference participants at CareOregon’s Portland headquarters, spoke with optimism about the chances of success for his Healthy Americans Act. The act is cosponsored by Sen. Robert Bennett, R-Utah, and has been introduced in Congress with eight Democrats and eight Republicans signed on as cosponsors (Senator-elect Jeff Merkley, D-Oregon, will join the list of co-sponsors when he is sworn in January 2009).

Gov. John Kitzhaber, MD 
Sen. Ron Wyden

Wyden said the legislation has two components that earlier, failed health care reform efforts lacked: It is bipartisan, and it accepts the basic arguments of the two parties. For Democrats, that is the belief that there cannot be good quality, affordable health care unless it’s provided to all. For Republicans, it is the belief that health care can’t be fixed simply by handing it over to the federal government.

The act would provide a basic plan for all, at an average cost of $12,000 for a family of four, who would get a $16,000 deduction. For those who choose to add insurance for services not provided in the basic plan, for example, cosmetic plastic surgery, the additional out-of-pocket cost would not be tax deductible.

The Healthy Americans Act would: give Americans choice in where they get their health care, modernize the employer-employee relationship to make health care portable from job to job (and continue if you lose your job), promote personal responsibility and preventative medicine, and reform the insurance market so that insurers compete on price, benefits and quality.

There are other elements of the plan that affect all players in health care, from employers to trial lawyers. That’s critical to its chances for legislative and fiscal success, Wyden said. The Healthy Americans Act has been evaluated by the Lewin Group, an independent health care analysis firm. It concluded that almost immediately, the plan would provide better care at less cost than the current way of business.

For more on information the Wyden-Bennett Healthy Americans Act:

The Lewin Group analysis of the Healthy Americans Act is downloadable.

Wyden also addressed the act in an op-ed article in the Dec. 10 issue of the Wall Street Journal, which you can reach online. The article was reprinted in the December 14 issue of The Oregonian.

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