Gary Oxman, an at-large member of the group and retired public health officer with Multnomah County, says public health should take its cues from what he called the “spiritual vibe” of Oregon’s Coordinated Care Organization model, where experimentation combined with clearly measured outcomes is something that the legislature “has gotten used to in the CCO movement.”
Oregon’s 15 CCOs, in existence for just two years, have in place a core set of metrics for the initial years of implementation with funding tied to meeting specific outcomes. The Lund Report recently reported the Oregon Health Authority’s list of how each CCO is doing and funding received, based on those outcomes.
“State and local public health are coming from different places,” Oxman said. “We can come together around outcomes.”
But what are the desired outcomes? The workgroup discussed how rural counties often have different issues and priorities from urban countries. An urban county might list HIV treatment which not only reduces morbidity but also reduces transmission of the disease as a priority but that may not be a significant issue uniformly throughout the state. Among its priorities, the group discussed immunizations, prescription drug overdoses, tobacco use, obesity and environmental health priorities such as guaranteeing safe drinking water and requiring all restaurants and hospitals to pass inspection.
Tammy Baney, Deschutes County commissioner, said one of the concerns and the reason for the creation of the committee is to determine what Oregon can afford with existing funding. “Can we fund it enough to have outcomes?” she asked the group. She also pointed out that federal grants fund much of Oregon’s public health and those federal grants come with their own priorities.
The group discussed how not every county can afford its own epidemiologist. Baney says Deschutes County, for example, is seeking a Robert Wood Johnson grant for cross-jurisdictional sharing of a regional epidemiologist for Central Oregon with Deschutes County taking the lead.
Baney said efficiency gains also might be found by counties collaborating on reporting requirements. “Can we structure better?” she asked the group. “If you can pull it off on your own, great. If not, how do we add structure?”
Carrie Brogoitti, public health administrator for Union County asked “will the structures we’re creating create better health outcomes?” She cautioned that the workgroup not create “change to change.”
“I don’t think that saving money in an underfunded, less-than-optimally funded system is the right thing to do,” Oxman said. “Not sure the issue is savings. We’re got an underfunded public health system.”
Oxman said public health needs to document its accomplishments. “We in public health need to have the courage to say…if you give a million dollars, we’ll reduce overdose death by two-thirds.”
He also pointed out that some current activity is not sharply focused on outcomes. “If the prenatal care index goes up, it doesn’t matter if it’s not tied to pregnancy outcomes.”
Oxman suggested the group leave the funding questions for the legislature. “Give policymakers a menu of things they can buy. You can go back in two years and see if the overdose rate has gone down and decide whether to continue to fund it based on the outcome. Here’s what you’re buying. Here’s what we can deliver.”
Jan can be reached at [email protected].