Oregon health-care law aims to be model for nation
3/7/2012SALEM, Ore. -- Pregnant with her seventh child and desperate to kick a meth addiction, Madeline Hutchinson turned to a program from the local Medicaid provider that connected her with a mentor and other support she says helped her get off drugs.
Emmanual, now 2, was born healthy.
"We need mentors. We need advocates," Ms. Hutchinson said. "We need someone that's going to come along and say, 'This baby needs to be clean. And we're going to show you how.' "
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Oregon has a slew of preventive care programs, and not just for addicted moms. But there hasn't been a state push -- until now.
Gov. John Kitzhaber, a Democrat, last week signed a law to create regional entities, called coordinated care organizations, to establish programs such as the one Ms. Hutchinson credits with turning around her life.
Mr. Kitzhaber says the plan will improve care, cut costs, and serve as a model for the rest of the nation. But critics doubt the potential for big savings and say the program could even increase costs.
The coordinated care organizations will look after Medicaid patients in their area. Local organizations will determine their exact models.
But each will be a holistic approach that addresses every aspect of health -- mental, medical, and dental -- with a special focus on people with mental illnesses, addictions, or chronic conditions such as diabetes, heart disease, asthma, and kidney failure. The idea is to target the costliest patients and provide up-front care that can prevent emergency room visits and other expensive interventions, potentially saving millions.
Mr. Kitzhaber -- a former ER doctor who has championed a symptom overhaul -- believes the law could boost health and save money.
Officials say that if all 50 states adopted Oregon's changes, the U.S. budget would save more than $1.5 trillion over 10 years -- $300 billion more than Congress' failed "supercommittee" over the same time period.
"I'm convinced … the federal government is going to have to do something drastic about the cost of health care," he said. "And it's not going to be driven by how you keep people healthy. It's going to be driven by how do you keep from defaulting on the national debt, which is two completely different conversations."
Mr. Kitzhaber presented his idea to the Obama Administration, and he caught its attention. In some ways, Oregon's effort is an attempt to pick up where Mr. Obama's health overhaul leaves off. While Mr. Obama expanded access to care, his Affordable Care Act leaves it largely up to the states to find a plan to lower costs and improve quality.
But there is no guarantee the Oregon law will do exactly what Mr. Kitzhaber wants.
A report by the Congressional Budget Office found that projects experimenting with coordinated care for Medicare patients did not provide conclusive evidence of savings.
"On average, the 34 programs had no effect on hospital admissions or regular Medicare expenditures," the report states.
And the ability to usher in widespread cost savings across the health-care system will depend on whether the program can expand beyond Medicaid. Even if it works in Oregon, there's no guarantee other states would achieve the same results.
Oregon state Sen. Fred Girod, a conservative Republican and a dentist, said he doesn't think the plan would save money because he says it will increase consumption of health care. "Are we going to get more for less?" Mr. Girod asked. "I've been in the legislature for a long time. I've been promised that I don't know how many times, and I have yet to see it."