How you will know if Oregon is bending the health care cost curve?

Dr. John McConnell of OHSU’s Department of Emergency Medicine is the person who leads the evaluation of health care data for Oregon in the affordable care act era. He spoke at the Oregon Institute of Occupational Health Sciences (formerly CROET) this week.

Oregon is testing a new model of health care delivery named Coordinated Care Organizations (CCOs) that is funded by a $1.6B grant from the Department of Health and Human Services.  Oregon’s pledge is that it guarantees to reduce the rise in Medicaid health care costs from 5.4% per year as it is now, to 3.4% per year.  This is called ‘bending the curve’ and it is experiments like this that are designed to change the model for delivering health care in ways that will save money … and if we don’t bend that curve by 2017 … Oregon has to pay back some of those grant funds to the federal government.  And the CCOs get paid less if they fail to produce the changes, so they have an incentive to cut costs.  Dr. McConnell and his team are collecting the health care cost data to answer that question.  Oregon’s 16 new CCOs in Oregon are identified in the map of Oregon in the picture below.

How will coordinated care organizations bend the curve?  By ‘thinking different.’  Here are 4 facts about the Oregon experiment(s) from Dr. McConnell’s presentation:

  • Each of the 16 CCOs is independent so Oregon is essentially conducting 16 different experiments under the CCO umbrella.
  • CCOs have the freedom to pay for services that would have been refused by regular Medicaid – like for Emergency Medical Technicians (paramedics) to treat a non-urgent problem when they arrive at a person’s home instead of bringing the patient to the Emergency Room where the same treatment is many times more expensive but no more effective.  Before CCOs(and anywhere outside Oregon), the paramedics had to take the person to an Emergency Room to be paid for their services.
  • Oregon’s $1.6B CCO experiment is the largest in the affordable care act’s portfolio of grants
  • There are over 30 quality measures (called metrics) to be sure that health care effectiveness and satisfaction does not decline under this CCO experiment.  If the quality metrics decline, the federal government will shut down the experiment in the CCO where it was failing to protect the patients.

To learn more about this CCO experiment and how the quality metrics play out, click here to go to Dr. McConnell’s website.

Dr. McConnell’s talk was co-sponsored by the Oregon Health Workforce Center (OHWC), because the OHWC is playing a part in bending the curve by developing and disseminating prevention programs designed to improve health and safety and wellness and well-being in industry where half of the 3+ million Oregonians work.  The OHWC is federally funded, but not funded by the large grant to Oregon.  Nonetheless, the OHWC is one of many organizations that can play an important and possibly pivotal role in bending the curve.

2 responses to “How you will know if Oregon is bending the health care cost curve?

  1. Great topic – and a way in which Oregon continues to lead in health care innovation. Fingers crossed that this experiment works as it should!

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