Public Health See Opportunities in Oregon Health Plan Reform

Public health officials think public public health departments should be part of a coordinated care organization's governing board
The Lund Report

October 27, 2011—As the final meeting of the governor-appointed workgroups approaches in late November to determine the criteria for coordinated care organizations, public health officials are questioning how they’ll fit into the new healthcare delivery model for the Oregon Health Plan.  

Many worry that the legislation spurring the reform, House Bill 3650, lacks strong language about the role of public health, leaving them out of the loop. 

“We wish it was stronger,” said Charlie Fautin, the director of Benton County’s health department and the president of the Oregon Public Health Association. “It should not be an afterthought.”

Fautin and his colleagues think public health should play an active role in the CCOs, which will be responsible for coordinating the physical, mental and dental health care of the Oregon Health Plan population in geographic regions throughout the state.

“The public health department should be part of the governance of CCOs with active participation and input,” Fautin said, referring to the group of people most likely to oversee these new structures. 

Public health is uniquely situated to deal with prevention, outreach, health equity concerns and chronic diseases. 

“We have a starring role in population health,” said Lillian Shirley, the director of Multnomah County’s health department who sits on the Oregon Health Policy Board.

The reform legislation references many aspects of the public health system such as the role of community health workers, who will make home visits to people with multiple chronic diseases to remind them of medical appointments and to take their medications regularly.

Public health, through outreach, relies on community health workers and interpreters, who have strong ties to their community. “Cultural competency is part of our daily business,” Shirley said. 

According to Fautin, “[one] concept in transformation is to tie some, or all, of the payment to outcomes, evidence and data.”

Public health departments routinely conduct health impact assessments to determine the health impacts of a particular program. And, data-driven and evidence-based healthcare and outcomes is already a unique feature of public health.

“Public health agencies are the ones that can really help with community assessments,” said Muriel DeLaVergne-Brown, director of Crook County's Health Department...  

For the reforms to the Oregon Health Plan to successfully save money and provide efficient and effective care, Fautin believes the new delivery approach should focus on the health of an entire population of people, whether they are in the Oregon Health Plan or not.

As an example, public health has a strong focus on reducing chronic disease, such as obesity, smoking and diabetes, and can help save direct and indirect medical costs.

“If we’re really predicating this transformation on reducing health costs and health expenses, only a piece of that is reducing patient cost,” Fautin said.

DeLaVergne-Brown, who agrees, said that the social determinants—such as a person’s income, education, whether they can afford healthy food and have safe drinking water -- have a direct effect on an individual’s health and the care they’ll need. “That’s what’s really driving the costs,” she said.

The public health departments in Central Oregon are now discussing how they can be involved in a new coordinated care program providing care to Oregon Health Plan patients in Crook, Jefferson and Deschutes counties, she said. “We have to always be asking the question of where do we belong at the table?”

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Public HEalth Departments HAVE to be integral to this process for CCO's to have any chance of success. Communithy HEalth physical and mental health providers need to be included. Money-Hungry CEO's like Dave Ford and Jeff Heatherington need to be on the poutside looking in when all this shakes out.

Much of what we consider medicine in this country is the unaddressed outcome of a social challenge. Public Health and Wellness are obviously critical. Unfortunately our politics and funding priorities are not aligned with our desired outcomes (Triple Aim). I applaud the CCO Oregon group (CareOregon, Providence, Kaiser, LIPA) for seeking a broader, healthier vision. The COHO plans, not so much. Heaven help us all if the WVP, DCIPA, Familycare 's of this world survive a shakeout.

Public Health ought to be at the core of these reforms--not outside hoping to get in. AND their current funding streams ought to be included in the global budget. A significant portion of the investment in disease prevention ought to be coming through the public health system--not from insurers. The enrollment churning that occurs in the insurance market works in direct contravention to the goals of public health--and the stability of the insurance market. Insurers can't realize the long term economic benefits of investing in prevention when they know that their enrollees today are likely going to another insurer in a few short years. Prevention ought to be carved out of what we consider insurance.