Concerns Cloud Transformation Team

As the group’s final meeting approaches, key questions remain unanswered

March 10, 2011--Those hoping to get a clearer picture Wednesday night of what Oregon's healthcare reform legislation might look like were sorely disappointed, as the Health System Transformation Team raised more concerns about process and received few concrete answers from the Oregon Health Authority and Governor John Kitzhaber’s staff.

Some team members even dismissed Kitzhaber’s oft-repeated “triple aim” objectives for healthcare – better health, better care, lower costs – as impossible to achieve, especially with the massive state budget cuts coming down the pike.
“Every business student knows that you can’t maximize all three at the same time,” said Terry Coplin, the CEO of Lane Individual Practice Association. “We’re going to have to compromise on the other two” – quality and outcomes – “if we’re going to meet the budget demands.”
Rep. Mitch Greenlick (D-Portland) was more succinct. “The triple aim is nonsense,” he said.
The bulk of the team’s work on Wednesday involved building on the draft legislative concept presented at last week’s meeting, as well as examining a host of concerns about the concept submitted by team members to Health Authority staff.
Health Authority Director Bruce Goldberg said that his staff condensed an overwhelming amount of feedback into four pages’ worth of complaints and requests for specificity.
The comments included criticisms of vague definitions to concerns regarding the speed of implementation.
Team members worked in small groups on more clearly defining the scope of accountable care organizations (ACOs) – the re-imagined managed care organizations that will be the linchpin of Oregon’s new healthcare system.
Representatives from the smaller groups shared a wide variety of ideas with the team as a whole, many centering around how ACO governance and geography would be defined.
“We want to make sure that communities have the authority to put forward the best solution possible for them while the state provides guidelines,” said Rep. Val Hoyle (D-West Eugene).
Gina Nikkel, the executive director of the Association of Oregon Community Mental Health Programs, added that the state should consider a “request for information” process involving public forums in communities around the state to gather input on local and regional healthcare needs.
“We need statutory guidance on the authority and decision-making structure of these organizations,” said Glenn Rodriguez chief medical officer for quality at Providence Health & Services. “We should build on managed care organizations, and realize what we’re building is a public-private partnership.”
He also expressed his concern. “While we’re talking about a lot of aspirational things, I’m not sure we’ve talked enough about how these entities would actually do this.” He urged the team to devise a ‘logic model’ for how ACOs would implement the triple aim objectives.
A number of team members had questions about how the evening’s work and feedback would be incorporated into the legislative concept. Goldberg said that a process was “not determined yet,” but would be by next Wednesday’s meeting.
“Let’s get some details to get people reacting to some concrete ideas,” said Eileen Brady, the co-owner of New Seasons Market and an Oregon Health Policy Board member. She wanted to see “more meat on the bones” of the legislative concept soon – especially because the team only has until March 23 to complete its work.
To Learn More
Read prior coverage in The Lund Report of the Health System Transformation Team here.
Health System Transformation Team website:
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Anything short of consciously beginning the process to establish a single payer system is just nibbling at the systemic issues infecting health care in Oregon. Should we not be looking at Vermont's example, and emulate what they're doing? With the existing federal legislation, no state can simply adopt single payer today, but can begin movement in that direction with implementation in 2014 or soon thereafter. Without the ultimate solution of single payer as a goal, frustration like that experienced by Transformation Team members is inevitable.