Transformation Team Tackles Health System Redesign

The group, chartered by Oregon Health Policy Board, has nine weeks - and limited funds - to make a model for integrated care
The Lund Report
February 3, 2011 – A group of Oregon legislators and healthcare industry stakeholders known as the Health Systems Transformation Team gathered Wednesday night at Willamette University’s Putnam Hall to begin work on a monumental task: restructuring the state’s entire healthcare delivery system. In the next nine weeks.
Speaking at the head of the group’s immense, 40-person table, Governor John Kitzhaber reminded the team, chartered by the Oregon Health Policy Board, of the state’s “triple aim objectives” – better, health, better care, lower cost – and urged those present to “get out of stakeholder silos. …We’re all Oregonians. We share a common state, and we share a common destiny.”
In case the group wasn’t motivated by inspirational words, he added a warning: “The consequences of failure are pretty profound.”
Kitzhaber also reiterated relevant facts from his 2011-13 budget, released Tuesday, including the Oregon Health Authority’s impending 39% reduction in revenue due to the expiration of one-time federal stimulus funds on July 1.
Federal funds and waivers will play a key role in implementing systemic change. Mike Bonetto, Kitzhaber’s health policy advisor, revealed that the state had submitted an application to the Center for Medicaid and Medicare Services’ Innovation Center last week for a planning grant to design an improved integrated healthcare system for dual eligible individuals: people who receive Medicare and Medicaid services.
The goal, Bonetto added, is for the selected states to create a model for integrated patient care that can quickly and easily be replicated in other states – a goal that mirrors the Medicaid system redesign mentioned in the Transformation Team’s charter.
“I’ve had conversations with [Health and Human Services Secretary] Kathleen Sebelius and [CMS head] Donald Berwick, and they seem interested in our proposal,” said Kitzhaber.
He and Dr. Bruce Goldberg, the director designee of the OHA, then took questions from the team, whose inquiries about physician assistants, managed care organizations and the social impacts of medicine reflected the varied backgrounds and expertise of those at the table.
One of the most basic yet provocative questions came from Rep. Tim Freeman (R-Roseburg), who noted that in similar team-based processes in which he’d taken part, “one of the solutions left on the table was doing nothing. Is that one of the solutions [for this group]?”
Goldberg replied, “That’s certainly on the table right now … but there are consequences to not doing anything.”
A series of slides narrated by Goldberg zeroed in on the financial reality facing the Oregon Health Authority. The sum of the 2009-11 biennium General Fund and one-time stimulus funds and the projected 2011-13 caseload growth is $3.16 billion.
There is $2.3 billion proposed in the Governor’s budget for the 2011-13 biennium, leaving an $850 million gap that the Transformation Team must make up through reducing provider payments and benefits, changing the Oregon Health Plan delivery system, and, of course, designing an all-encompassing system transformation.
The sticky work of breaking down stakeholder silos began with a directive from the team’s facilitator, Diana Bianco of Artemis Consulting, to break into small groups and start brainstorming how to face the coming year’s cuts while preserving health care access and quality.
A wide range of ideas were brought back to the team at large, including moving the chronically ill into community-based facilities to reduce up-front hospital costs; not covering brand-name drugs where effective generics exist; and decreasing reporting requirements for mental health providers.

The team’s ideas will be taken up by staff, with assistance from Bianco, and presented next Wednesday night in a more polished format as a starting point for further work on designing new models for integrated care.
Doctors, dentists and policy directors continued spirited conversations long after the meeting concluded. Sen. Laurie Monnes Anderson (D-Gresham) said she appreciated the opportunity to hear input from all the industry’s key players at once.
“At first I was skeptical,” said Monnes Anderson, “but after the small group session, I found that getting all the stakeholders’ perspectives was extremely helpful.” Even better, she added, was that the great majority of the issues at hand could be resolved without legislation.
“We just need all the stakeholders to come together like this and work out their differences.” They’ve got nine weeks…and counting.
Health System Transformation Team website:
Centers for Medicare and Medicaid Services’ Innovation Center:

Prior coverage in The Lund Report



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The real problem is that our medical delivery system is focused almost entirely on "Sick Care" masking the symptoms of disease with pharmaceuticals, and not really addressing the unhealthy habits that lead to the diseases that cripple our state health care system. Our biggest issue is that our health care professionals don't get any education in health and nutrition, and are often victims of our environment at the same percentage as, or higher, than the rest of the population. in essence 'The Blind Leading the Blind". It's been my experience that most doctors are to pre-occupied with the rules&regulations of managed care, or just too arrogant to take a look at a more effective way of doing things. I truly think that most of them got into medicine to help people, but with managed care they are in survival mode, and they are at the mercy of insurance companies and our manage care system. I don't really think there is a way to code a prescription for putting someone on a program that could put them on a path towards getting healthy, and what is less draining on our health care system than a "HEALTHY" person! This is what I do for a living, but it is frustrating to me that someone who needs "Health" can only get their drugs paid for, but not a health program if there is a food program involved. There has never been a drug that has created health for anyone!!! Anyone put on a drug regimen will continue down a slippery slope needing more and more care as their condition worsens. This is only the opinion of someone who shows people a better way on a daily basis. David M