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New Report Says Oregon Health Reform Is Working

Oregon’s health care reform efforts appear to be working, according to a new report on outcomes and finances.

The report looks at how Oregon’s system of Coordinated Care Organizations are doing under the Oregon Health Plan.

That population ballooned last year by more than 400,000 people as part of the Affordable Care Act. Nobody was quite sure whether they’d swamp the system.

Lori Coyner of the Oregon Health Authority said most of the CCOs got incentive money for meeting their goals.

“Thirteen of the 16 CCOs were awarded over 100 percent of their quality pool funds, which was very exciting to us," she said. 

"Especially given the large increase in the Oregon Health Plan, we were not certain what it was going to look like at the end of this first year, but the Coordinated Care Organizations have done lots of work to make it happen," Coyner added.

The report shows a decrease in emergency room visits and that costs are being held down.

The state said some of the challenges include fewer cervical cancer screenings for women and more people asking for alcohol and drug treatment.

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OHSU Achieves $500 Million Goal For Cancer Research, Phil Knight To Match

Oregon Health & Science University has reached its $500 million fundraising goal for the school's cancer research campaign.

Nike co-founder Phil Knight and his wife, Penny, pledged in September 2013 to match the raised funds for a total of $1 billion for the OHSU Knight Cancer Institute.

"These last 22 months have shown what is possible when people of vision focus on a single goal," said Knight in a statement. "We are more convinced than ever that cancer will meet its match at OHSU, and we are proud to play a role in this history in the making."

OHSU says that more than 10,000 donors contributed, including Columbia's "Tough Mother," Gert Boyle who donated the largest gift from an individual — $100 million — to the campaign last summer. The largest gift came from the state of Oregon, which invested $200 million.

"This is an amazing accomplishment and a testament to the great science happening at OHSU." said Gov. Kate Brown in a statement. "I'm proud of Oregonians for coming together to support the Knight Cancer Challenge. This bodes well for our state's future, not just for cancer research and care, but also our ability to take on the big challenges of our time."

The school will use the money to hire 25 researchers and an additional 225 to 275 scientists and physicians dedicated to early cancer detection.

Achieving the fundraising goal is touted as the largest documented challenge pledge to succeed, according to researchers at the Indiana University Lilly Family School of Philanthropy.

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VA To Give Benefits To Vets Exposed To Agent Orange

The Department of Veterans Affairs announced Thursday it will expand benefits to reservists who were exposed to the herbicide Agent Orange.

Oregon Democratic Sens. Ron Wyden and Jeff Merkley have lobbied the VA for years to get health care and disability benefits for these veterans.

Last week, the senators blocked the confirmation of a top VA official, arguing the agency needed to extend benefits to the C-123 veterans who were members of the Air National Guard and used C-123 aircraft stateside.

“These C-123 veterans deserve medical care and benefits for their exposure to the hazards of Agent Orange,” Wyden said. “I’m very pleased that the VA has decided that turning a cold shoulder to these veterans is the wrong thing to do and they have changed course.” Sen. Merkley says the VA was slow to act, but the outcome is a victory. “The health issues or injuries that come from Agent Orange don’t happen immediately, they happen years later,” he said. “When our citizen have served in the military and stood up for our nation we have to absolutely stand up for them.”

The planes the veterans used had been contaminated from carrying Agent Orange in Vietnam, and exposure largely took place after the Vietnam War ended.

The reservists were largely based in Ohio, Massachusetts and Pennsylvania between 1969 and 1986, according to the agency.

"Opening up eligibility for this deserving group of Air Force veterans and reservists is the right thing to do," said VA Secretary Robert McDonald in a statement. "We can now fully compensate any former crew member who develops an Agent Orange-related disability."

According to the VA, Agent Orange has been associated with various cancers, Parkinson’s disease and other health issues.

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Consumer Group Says Proposed Health Insurance Rate Hikes 'Unjustified'

Health insurance companies haven’t justified their proposed increases for next year, according to an analysis by Oregon Public Interest Research Group.

The insurance company with the largest enrollment, Moda, is asking for a 25 percent increase next year. LifeWise wants 37 percent and PacificSource is after 42 percent.

The companies say those numbers are justified. They point to all the previously uninsured people who signed up for insurance last year and used a lot of services.

OSPIRG receives a federal grant to look into these increases. The cost spike is likely temporary, said Jesse O’Brien, a health-care advocate with the consumer group.

“The cost of providing medical service to those individuals who’ve been blocked from coverage for many years is very likely to go down in future years as their conditions require fewer acute interventions and become more manageable,” he said.

The Oregon Insurance Division is holding public hearings on the proposed new rates this month. It’s expected to decide final rates by July 1.

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Oregon Senator Calls For Better E-Cigarette Tracking

Oregon Senator Ron Wyden has asked the US International Trade Commission to start tracking imports of electronic cigarettes.

Wyden says we know little about how many e-cigarettes are coming into the country, who is manufacturing them, or the ultimate public health implications.

He says it’s time to collect information and impose new regulations.

Stefen Stockwell of Rosecity Vapsters in Portland says he’s not against new regulations, especially for imported products, “The juice is of way poor quality," he said.

"We make our own juice in shop here using all medical grade materials, and food grade flavorings and concentrates. We have a clean-room environment and it’s a very strict process for making juice. We’ve been regulating this all within the industry ourselves for the last couple of years.”

Wyden says the e-cigarette market last year amounted to about $2.5 billion dollars, with 90 percent of products coming from China.

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Clark County’s E-Cig Law Goes Into Effect Monday

New rules that would regulate e-cigarettes like tobacco cigarettes go into effect Monday in Clark County, Washington.

The new ordinance prohibits smoking e-cigarettes in public places. One exception to the law is that e-cigs can be smoked in dedicated vaping shops.

Theresa Cross, health educator, with the Clark County Public Health Department, said one hope is to curb the rising use of e-cigs among young people.

“The second hand vapor that comes off of these devices is not just simply water vapor," she said. "It does contain toxic substances and those are harmful to human health. Not to the degree second hand smoke from a lit cigarette would be, but it is harmful and we’re wanting to protect the public’s health.”

Last week, Oregon Gov. Kate Brown signed a law that bans the sale of e-cigs to minors and prohibits use in indoor public places.

The portion of the law that prohibits selling e-cigs to minors went into effect immediately. The indoor vaping portion goes into effect January 1, 2016.

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Is it Grief Treatment, or Handing Out a ‘Grief Pill’?

In 2012, a panel of psychiatrists working on the Diagnostic and Statistical Manual (DSM) of Mental Disorders voted to remove the “bereavement exclusion” from major depression diagnoses.    

The DSM guides psychiatrists, family care physicians and other prescribers of medicine in treating mental health conditions.

The “bereavement exclusion” kept doctors from diagnosing grieving patients with depression until at least two months passed following a death. That two month waiting period also kept doctors from prescribing anti-depressant medication to their patients.   But now that the DSM has been changed, doctors can prescribe anti-depressants to patients during that time.  

Since this change to the DSM, there has been intense debate in mental health treatment circles about the use of anti-depressants in people who are grieving. One of the strongest voices against prescribing anti-depressants during this time frame is Dr. Donna Schuurman; the CEO of the Portland based Dougy Center, the National Center for Grieving Children and Families.   Schuurman says prescribing anti-depressants to bereaved patients amounts to giving them “grief pills.”  

“We are moving in the bereavement world towards making grief a mental disorder,” Schuurman says.  

Schuurman says people are prone to seek “quick fixes” to deal with loss, sadness, anger and other emotional adversity. She adds that by changing the DSM, the mental health community can now make it easy for people to take an anti-depressant pill instead of dealing with their grief.   “

Grief is a normal response to loss,” Schuurman says. “Losses of all kind. Whether it’s loss of relationship, losses through death, loss of hope…We’re all going to face losses throughout our lifetimes, and ultimately, the big loss, which is our own life. [But the change to the DSM] means that people who have a death are more likely than not to be diagnosed with major depressive disorder and the major treatment for that is anti-depressants.”  

Lack of Grief-Training    

One of the concerns Schuurman – and other grieving experts have -- is a perceived lack of grief training.   “Most therapists, most mental health workers, psychiatrists, and school counselors – people who regularly deal with children for example, have little or no training in grief or loss,” Schuurman says.  

That lack of training could lead some counselors and psychiatrists to make referrals for depression, when in fact the underlying issue is grief. The mental health community has long struggled with the question of whether “down” behavior in a patient experiencing a death is indicative of grief or depression.   “Grief and depression are not the same thing,” says Dr. Katherine Shear, the Marion Kenworthy Professor of Psychiatry at Columbia University’s School of Social Work. “And it’s very interesting because a lot of people do confuse them.”  

Jerome Wakefield of the NYU Silver School of Social Work and Department of Psychiatry agrees that the conditions are different. When the changes were initially made in the DSM, Wakefield told NPR he was concerned people grieving would be given medication to fight depression.  

“To a lot of us this just seems like a gross error of psychiatric classification that might allow patients to be given medication, to be diagnosed, to be seen differently than for what they really may going through,” Wakefield told NPR.    

Timing is Essential  

While Dr. Katherine Shear of Columbia University agrees with Schuurman and Wakefield that grief and depression are two different emotional conditions, she disagrees with her colleagues when it comes to treating depression in grieving patients with medication.  

Shear makes a strong argument that depression can actually keep people from properly grieving.   The emotional role of grieving, Shear says, is for people to re-define their relationship with the person they lost.   “You have to re-envision your life moving forward in a way that still has the possibility for joy and satisfaction,” Shear says.  “And that all has to happen during a period after the person dies. But one of things that can slow that process really badly is if an episode of major depression is triggered.”  

Shear gives this example of productive grief: a man lost his wife of many years. Shear’s daughter was close to the wife. Shear and her daughter went to visit the man at this home.   “He took one look at my daughter and he burst into tears,” Shear says. “And she started to cry, and it was a very emotional moment, and then the intense emotion receded. And they started talking about the teacher and some of the wonderful things, and he actually seemed to enjoy that conversation again.”   That, Shear says, is grief. There are intense emotions of sorrow in the person’s passing and joy in remembering the person.  

Shear gives another example of a woman who lost her husband. Shear went to visit the woman at her home.   “And I went over to talk to her,” Shear says. “And she kind of looked at me and said, ‘I don’t know what’s wrong with me, but I just don’t feel much of anything.’”

That numbness Shear describes is a sign of depression, and that depression can keep people from grieving.

Essentially, Shear says, those patients never imagine their lives without the person who passed, because they are unable to reimagine their relationship with the person who died.   “We have to be able to move on,” Shear says.   Donna Schuurman agrees that grieving helps people move on from loss – and both Schuurman and Shear say grief – or expressions of grief-- is often taboo conversation. But while Shear says doctors need anti-depressants as a tool in their kit to help people get to a place to grieve, Schuurman believes it will now be used as a grief-pill to shortcut the feelings of loss and sadness.  

“We want quick fixes,” she says. “The point of life isn’t to be happy, the point of life is to find fulfillment, which often doesn’t necessarily lead to happiness.”

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Zip Code May Be More Important To Health Than Genetic Code

A couple of hundred health experts gathered at the Nutrition of Girls and Women conference in Portland on Thursday to discuss the generational effects of poor nutrition on women of child-bearing age.

Most of us understand we inherit our genes from our parents. But what scientists now know is that those genes can be turned on and off by environmental factors, such as stress and what a person eats.

Dr. Kent Thornburg, director of the Moore Institute for Nutrition and Wellness, told conference attendees that environment is particularly important for women of child-bearing age — to the point where their zip code may be more important to their health than their genetic code.

"During development, before you're born, that's when you're more susceptible to environmental changes like nutrition and stress from your mother," he said.

"That changes your genes and that can last for the rest of your life," he added.

The head of the Oregon Health Authority, Lynne Saxton, told the conference she's worked with children who are a foot short for their age because of poor nutrition. And while the state has expanded tax credits and opened new food pantries, she said, more work is needed.

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Oregon Coordinated Care Organization Threatens To Sue The State

One of Oregon's coordinated care organizations, FamilyCare, has notified the state it intends to sue over the way health insurance rates are set.

Under Oregon's health care experiment, the federal government has given the state flexibility to sets rates.

For example, last year Portland-based FamilyCare had its rates reduced by about 9 percent. The head of the CCO, Jeff Heatherington, says that translated to a loss of more than $4 million a month - and the state won't tell him why it reduced the rates.

"If the Oregon Health Authority would actually just open up their books and say, 'Look, this is how we did it,'" he said, "we could all look at it and have a discussion.

"But the first thing they did is bury everything deep and won't answer questions."

A spokeswoman for the Oregon Health Authority said the agency can't comment on potential litigation.

The economics of Oregon's 16 CCOs might become clearer at the end of the month, when the state is expected to release financial details.

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