Policy Expert Berwick Praises Oregon’s Coordinated Care Reforms

The former administrator of the Centers for Medicare and Medicaid was the keynote speaker at the annual CCO Summit in Portland, and the model is spreading to public employees, the private sector and other states.

Gov. John Kitzhaber received an assist Wednesday in his efforts to transform the healthcare delivery system from national health policy mogul Dr. Don Berwick, who praised Oregon’s works in reforming its Medicaid delivery system through coordinated care organizations to bring down costs while directing the most at-risk patients to more appropriate care.

“You are so far ahead of others right now that you’re going to be the pioneers who’ll face obstacles that others haven’t found,” Berwick said. “This is extremely important what you are doing. This is pace-setting.”

The speech from Berwick was a high mark of the two-day coordinated care summit at the Oregon Convention Center, which called together healthcare officials from across the state, particularly those heavily involved in the state’s novel locally-controlled CCOs, which were founded in 2012 to run the state’s Medicaid system, better known as the Oregon Health Plan.

Berwick, who like Kitzhaber headed a health policy research institute, the Institute for Healthcare Improvement, ran unsuccessfully for the Democratic nomination for Massachusetts governor earlier this year, on a platform that included single-payer publicly funded health insurance. Both men are also medical doctors; Berwick has a background as a pediatrician. He earlier served as an administrator of the Centers for Medicare and Medicaid, but resigned after Republican senators blocked him from an official confirmation.

He has long been a critic of the American healthcare system, which he said is by far the most expensive in the world but ranks 47th in outcomes. He told the audience Wednesday that a full third of all U.S. healthcare dollars are wasted because of high administrative costs, a lack of coordinated care as well as outright fraud.

“It blows away any other concern,” he said.

Berwick echoed Kitzhaber’s earlier remarks that getting healthcare costs under control through more coordinated care would free up money for a full range of services, including social services, education and infrastructure. Kitzhaber’s budget, which he credited to savings on healthcare for Medicaid and the Public Employees Benefit Board, now includes full-day kindergarten, for example.

“Healthcare is confiscating opportunity from the view of public finance,” Berwick said, but added that it’s also increasingly the leading drag on the private sector and working people as well. “Every single dollar that you take for healthcare is coming from laborers.”

Despite advocating for single payer as a Massachusetts gubernatorial candidate, Berwick said reform on the finance side had been achieved with the Affordable Care Act, and the greater concern for the American healthcare system lay in reforming how care is coordinated and delivered.

He also took a shot at the increasingly lucrative hospital systems, which he said were driving up costs through consolidation of medical services and using their increasing heft to demand greater and greater payments from consumers and insurers without improving care.

At a later session, Carol Backstrom, a healthcare policy advisor to the National Governors Association, said health officials from three states had recently visited Portland to learn how they can adopt Oregon’s CCO model for their state Medicaid systems, although she didn’t mention which states.

“Nothing is going to happen at the federal level for a while because of Congress but a lot is happening in the states,” Backstrom said.

Robin Richardson, a Moda Health vice president, told the same group that his company was expanding the coordinated care model for the private sector in the states it operates, including Washington and Alaska.

Moda Health operates the CCO that covers most of Eastern Oregon, and has a private coordinated care model based in the Willamette Valley, which has been offered to public employees.

“There’s a lot of duplication in the system,” Richardson said. “There’s been a real willingness of providers to want to do the right thing.”

Chris can be reached at [email protected].

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Dr. Don Berwick came with in .001" to endorsing single payer or universal health care then knuckled under to omnipotent insurance industry.