Oregon Praised for Transforming Healthcare System

Capitol Dental opens a pilot project in Sweet Home to avoid emergency room visits for dental problems.

National health reform leaders praised Oregon for its pioneering efforts to experiment with coordinated care organizations, and the 16 Oregon CCOs shared what they’re learning about community health improvement plans, reimbursement reform, integrating dental and mental with physical health and other topics at a two-day summit held last week. .

“You can’t separate the body parts. You have to treat the person as a whole,” said Bonnie Corns, project manager for the Yamhill Community Care Organization, a single-county CCO with children comprising 65 percent of its membership.

As a result, 65 percent of Yamhill’s community advisory council is not connected to healthcare. Instead, they represent the family of members, educators and those connected to Head Start and early learning hubs.

Meeting Yamhill members where they are goes beyond schools and pre-schools, Corns said. A rural fire department is doing follow-up visits after hospitalizations, checking blood pressure and providing immunizations. Yamhill CCO also is working with senior and disability services to bring more community health workers into homes.

Co-located pediatric and dental clinics have proven successful in Colorado, especially if the medical practice hires the hygienist, and the hygienist works full time, said Patricia Braun, a pediatrician and clinical associate professor of dental medicine at Denver Health.

Kiim Whitley, COO of the Intercommunity Health Network CCO in Lincoln, Linn and Benton counties said transportation barriers in rural communities make it difficult for children and adults to get to a dentist. High emergency room use for dental problems prompted Capitol Dental to co-locate a dental hygienist five days a week and a dental van on Tuesdays at the Sweet Home Family Medicine site as a pilot that will be expanded to 10 rural clinics over the next three years.

But the Sweet Home dental access is not just for IHN members. Anybody in the community should have access to “womb to tomb” care that “puts the mouth back in the body,” said JoAnn Miller, director of Community Health Promotion for Samaritan Health Services.

Marko Vujicic, chief economist and vice president of the Health Policy Institute of the American Dental Association said ER visits for dental reasons have doubled in the U.S. in

10 years – a trend completely against the grain of Triple Aim.

“Once you reward someone for keeping people out of the hospital, the culture shifts,” Vujicic said, suggesting that providers want to “remove the handcuffs of fee-for-service” to provide better care.

Allison Leof, senior policy analyst with the Center for Evidence-based Policy at Oregon Health & Science University, gave a sneak preview of a soon-to-be-released report on alternative payment methods in Oregon.

The top two findings: “it’s all about relationships,” and “reform decisions need to be made at the local level and involve all stakeholders,” Leof said, adding that the report will look at theories around episodes of care, bundled payments, pay-for-performance, payment penalties, shared savings, shared risk and capitation.

Panelists shared initial results of pilots in Josephine County and more fully implemented payment reforms in Central and Eastern Oregon among the Medicaid population.

“We’re not making money but we’re losing less money. We feel that’s a great accomplishment for this year,” said Maryclair Jorgensen, director of health plan administration and contracting at St. Charles Health System with four hospitals in Central Oregon. “Even for 2015, we don’t plan to do much differently.”

Are the payment reforms ready for non-Medicaid populations? “We’re certainly poised and ready for Medicare and commercial plans,” Jorgensen said.

Sean Jessup, director of Medicaid programs for Moda Health, oversees the operational and financial performance of the Eastern Oregon Coordinated Care Organization, by far the physically largest COO representing 12 rural and frontier counties, an area the size of New York state. But even with the unique geography and its special need for 12 separate advisory councils, one for each county, Jessup said he’s “taking lessons we’ve learned from the CCO to larger employers.”

Jan can be reached at [email protected].

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