04-20-2018  10:54 am      •     
The Skanner Report
By Helen Silvis of The Skanner News
Published: 08 April 2013


Mark Lindau MD and nurse Maria Buck are among the staff who work at the Children's Community Clinic on N. Killingsworth St. Run by Mardica Hicks, the clinic's patients are mostly on the Oregon Health Plan. many staff volunteer their time to help at the clinic.

Legislators in Oregon's state capitol are working on dozens of bills that will decide exactly what Oregon's health care system will look like in 2014 and beyond. What's for sure is that Oregon's answer to Obamacare will do much more than simply expand health insurance coverage.

"It's more of a whole system transformation," says Christine Stone, a press officer for Oregon Health Authority. "It's not just about insurance. In Oregon it's about our whole healthcare system."

How will Oregon's Obamacare affect you: See this cheat sheet

Under the Affordable Care Act, states can get federal funds to help them extend Medicaid to more low-income people. Most states are enacting reforms to do just that, and they also are creating health insurance exchanges to increase the number of state residents with access to affordable health insurance.

But Oregon's health reforms started far earlier and go a lot deeper.

The state has contracted with 15 Coordinated Care Organizations to provide services for Oregon Health Plan patients across the state.  The goal is to streamline patient services and reduce costs by focusing on prevention and better care coordination.  Oregon health officials asked for a waiver from the federal government, so they could ditch the traditional "fee for service" payment system and still get federal Medicaid funds.  Instead of being paid for each treatment they provide, the Coordinated Care Organizations will be paid according to the number of patients they serve.

Jeff Heatherington, President and CEO of the Coordinated Care Organization Familycare, one of two CCOs working in the Portland-metro area, told health professionals last year that the new payment structure will ensure providers prioritize basic patient care.  

"We have an overabundance of specialists, and we don't need as many as we have today," he said. "We need a system where at least 50 percent of practitioners out there are in primary care."

By focusing on prevention, improving communication among providers, and removing any incentive to offer unnecessary treatments, health administrators believe they will save money. Check out some success stories on the Oregon Health Authority website

"We really feel this will bring better health, better care and lower costs," says Stone.

Sen. Chip Shields says another key to controlling costs is a bill that has just passed the Oregon Senate. If passed by both houses it will require insurance companies to include the public when they want to increase their rates.

 "A big part of making sure health care costs go down will be to make sure insurance companies have to justify their premium increases," Shields says.

The idea behind the Coordinated Care Organizations is that groups of health providers come together to deliver everything a patient needs –seamlessly. Nurses, doctors, hospitals, clinics, diagnostic labs, mental health therapists, dentists, physical therapists: everyone is part of the same treatment plan. And because they are locally managed, administrators say they will be more responsive to their patients.

"Oregon really created this system of primary care where everyone working with a patient will be on the same page," Stone says.  "Our health care system is ahead of the curve."

Incubators at Legacy Randall Children's Hospital

Of course, expanding access to health insurance is also a big part of the Oregon story. Current plans call for 90 percent of Oregonians to be covered by 2016. And if legislators vote as expected, the Oregon Health Plan will expand to include 200,000 more low-income people. They'd join the 600,000 Oregonians currently enrolled in the Oregon Health Plan.

At the same time, people without health insurance and business owners who employ fewer than 50 people, will be able to buy affordable healthcare insurance through the new health insurance exchange—Cover Oregon.

What's more, financial assistance to pay for health insurance is not just for people at poverty level or just above. Everyone earning up to 400 percent of the federal poverty will be eligible for a tax break. 

 "They'll be able to access financial assistance to pay for the plans," says Lisa Morawski, communications manager for Cover Oregon.

 "How it works is you can take the credit during the year. It can be paid directly to the insurance company and come off your monthly premium. Or you can take it all at once when you file your taxes."

The exchange website will let you plug your income and family size into a calculator that tells if you're eligible for help.  You can also compare plans for cost and services. And when more data has been gathered you will see quality measures too. Morawski says 160,500 individuals are expected to sign up for health insurance in 2014, along with 56,900 small business employers. 

Created in 2011, a year before the Affordable Care Act passed, the Cover Oregon exchange will open for business in October 2013. The health plans you can buy there are set to start in January 2014.

 Other bills under discussion in Salem include bills that would require healthcare providers to work with school health centers, provide dental care, and cover naturopathy, acupuncture, chiropractic and massage treatments. 

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