Oregon’s health care industry is at a pivotal crossroads.
Hospitals and health care providers learned lessons during the COVID-19 pandemic about capacity, how much strain the system can withstand and inequities in care and access. For now, state lawmakers, and health care executives and experts are looking ahead to the next chapter of Oregon’s health care industry — and it’s one filled with challenges. Those include a workforce shortage, pay parity for providers and Oregonians’ access to health care for all, said state lawmakers and health care experts on Tuesday. They spoke in a virtual series of panels focused on health care and health policy in Oregon for State of Reform, a Seattle-based organization that hosts a news site and annual health conferences in 11 states.
“We need to be intentional about capturing these lessons learned,” said Becky Hultberg, president and chief executive officer of the Oregon Association of Hospitals and Health Systems, a trade industry group.
Health equity and workforce needs were problems that became crises during the pandemic. Hospitals have stepped in to fill some of the gaps in the public health system, but in the long-term, the state needs more conversations about the “appropriate role” for different parts of the system, Hultberg said.
Uniting Health Care Visions
Unity across different sectors of health care was a prevalent theme throughout panels.
Hultberg said a unified vision for health care is sorely needed. The state has a mix of pressing issues, including its cost-growth target, which is a state goal to rein-in rising health care costs to 3.4% annually per capita. Other state issues include ongoing work for an eventual public option health plan and the regulation of mergers and acquisitions in the health care industry. Bills passed in the last regular session moved both of those issues forward.
“Sometimes our policy right now is contradictory,” Hultberg said.
In a separate panel, Rep. Rachel Prusak, chair of the House House Care Committee, was asked about Hulberg’s comments regarding a seeming lack of a comprehensive vision for health care. Prusak, D-Tualatin/West Linn and a nurse practitioner, said her committee had more than 150 bills sent its way in the regular 2021 session.
With that volume, she prioritized bills based on equity and public health. With that frame, Prusak said, Oregon can move forward with a vision of providing Oregonians universal access to culturally appropriate care that meets all their needs, including behavioral and mental health.
That focus led to different initiatives, including legislation that will provide medical coverage to people regardless of immmigration status, expand telehealth services and require providers and insurers to collect data on race, ethnicity and gender identity from patients so the state can identify disparities.
Other panelists stressed the need for health care to operate as a system across sectors, rather than through individual areas, or “silos” of health care.
“We have focused on silos for too long,” said Sen. Kate Lieber, D-Beaverton. Lieber, the Senate’s assistant majority leader, said the traditional silo approach means all parts of the system will advocate for “their little piece of the pie.”
That approach extends beyond clinical health care.
Policymakers are looking for ways to tie other social determinants of health, like housing, to health care. For example, the Oregon Health Authority is working on its next five-year Medicaid proposal, which seeks more flexibility from the federal government to use funding to help people with housing.
Housing and related issues, like access to food and nutrition, play an important role in health well before a person ends up in an emergency room or clinic.
“If you don’t know where you’re sleeping at night or living, how do you stay healthy?” said Sen. Dick Anderson, R-Lincoln City and vice-chair of the Senate Committee On Human Services, Mental Health and Recovery.
Workforce Crisis
Policymakers and advocates agree the state has a workforce crisis and needs a long-term plan that puts enough qualified people into roles across the industry.
“If we're going to have a sustainable health care system in the future, we have to address the workforce pipeline,” Hultberg said, calling it a “workforce crisis.”
Liebersaid the workforce crisis is an immediate need and the state needs to “really stabilize the workforce that we have or we’re not going to have a system to invest into.”
Prusak said the workforce is a critical need and health care partners and the state need to look at how to make the workforce more team-based and resilient, and address issues like the administrative burden for clinicians.
Cost And Access
The state’s also grappling with soaring health care costs, and lawmakers are concerned about different levels of care for people based on how good their insurance is.
“We have a health care caste system, and it’s really impacting our health care outcomes,” said Sen. Deb Patterson, D-Salem, and chair of the Senate Health Care Committee, who spoke in a separate panel.
“We must work together or the broken system will bankrupt our state,” Patterson said.
But to save money in the long-term, the state may need to spend money elsewhere.
For example, if Oregon wants to bring down the cost of health care, the state will need to make investments in preventative and maintenance care, such as oral health, said Rep. Raquel Moore-Green, R-Salem and vice-chair of the House Behavioral Health Committee.
That ties into other social areas, too. For example, a child with untreated cavities cannot sit through a class in school, Moore-Green said.
Provider Medicaid Rates
Anderson said efforts to bring specialty care, including behavioral health, to rural areas will fall flat without increased reimbursements for providers and incentives to draw more people to jobs.
Noting the high number of behavioral health visits a single patient needs for treatment, Anderson said, “My people would just like to have one without the travel.”
Prusak said reimbursement rates can make certain types of practices difficult, such as behavioral health and long-term care.
“Now we have behavioral health providers fighting for that parity,” Prusak said. “The wages we pay our workers are so important.”
Regardless of the provider type, Prusak said, “we have to start treating them like the professionals they are and pay them what they deserve.”
Future Capacity
Oregon’s hospital capacity challenges won’t diminish simply from a drop of COVID-19 cases.Now, the system has pent-up demand from people who have postponed medical care due to the pandemic.
“It’s going to take a long time for us to get back to what you would consider normal operations,” Hultberg said.
There are “thousands of elective” cases in communities. With deferred care, that also means sicker people in hospitals, Hultberg said.
For now, Oregon hospital leaders are thankful they weathered the delta variant surge. At times, Hultberg said, hospitals were concerned they would enter into a state of collapse.
“We walked right up to that line,” Hultberg said. “We didn't go over it."
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.
