Coordinated Care Organizations Could Advance Public Health Priorities

After doing some strategic planning, the state’s public health director, Dr. Mel Kohn, sets out his six top priorities
The Lund Report

September 26, 2012 -- The new coordinated care organizations provide enormous opportunities to further the state’s public health agenda, but the new organizations are more likely to be successful in counties with strong existing public health departments, the state’s top public health officer told The Lund Report.

Oregon Public Health Director Dr. Mel Kohn said that it’s too early to say if public health considerations are playing a key role in the new organizations, but he singled out Lane County as very forward thinking, in part due to the strong leadership shown by the county’s pubic health officer, Pat Luedtke.

Coordinated care organizations (CCOs) got under way in August and represent a new way of delivering healthcare by focusing on prevention and integrating physical, mental and oral health under one umbrella. Roughly 500,000 people, formerly on the Oregon Health Plan, have joined one of the 13 CCOs around the state. There are three pending applications for CCOs as well.

Kohn wouldn’t say which public health departments could stand to improve, and wouldn’t comment on where he thinks it might be tougher for public health to be incorporated into these CCOs.

“I have not done a map around the state,” Kohn said, adding that he’ll likely have a better sense of where public health priorities are represented by the CCOs – and where they aren’t -- in the next few months, noting that the new organizations are preoccupied now with getting themselves up and running.

But, his office recently completed some strategic planning and set six priorities. They are, in no particular order, he said:

  • Tobacco prevention. This is still the leading preventable cause of death and disability. “We’ve just got to invest in it and make it a priority,” he said, adding that the CCOs “have a role to play” especially in the clinical setting.

  • Obesity. Being overweight has become a significant problem for Oregonians and is the leading driver of many diseases.

  • Heart disease and stroke. These remain leading killers and are heavily intertwined with tobacco and obesity.

  • Suicide. Oregon has “more suicide deaths than we have motor vehicle crash deaths,” he said – and the rates are slowly increasing.

  • Family violence. Kohn said there’s a lot of research showing that exposure to violence, especially in early childhood, is a major driver of many other problems.

  • Community resilience after emergencies. This is a relative new priority for public health professionals and stems from the 9-11 attacks.

Kohn said the CCOs already established have shown a “great deal of interest” in these priorities, but stressed that local support for any initiative is key, as much of change occurs “outside of the doctor’s office.”

He cited the recent success for the campaign to get fluoride into Portland’s water as an example of how community efforts can push through policy changes, and believes fluoridation “will have a very positive implication for the areas served by the CCO in these water systems.”

Kohn doesn’t have a specific timetable as to when he’d actually judge whether the CCOs have been successful on the public health front, but said the new organizations need a year or two under their belt before he could make any definitive comments. And, it will take at least a decade before the transformation process moves toward improving health of the population.

Nevertheless, Kohn believes the CCO model is absolutely the way to go.

“This is a community government process that has health as its outcome – better health as well as better care and lower costs.”

(This is the first in a series of articles on how the coordinated care organizations are expected to focus on public health issues. We welcome ideas, as well from our readers at The Lund Report).

Contact Miriam Widman

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