Street roots., October 14, 2011, Image 1

Oregon races
the clock to
restructure its
low-income
health care
system to cut
nearly a
quarter o f a
billion dollars
from its
budget
* * 8 - B Y A M A N D A W A L D R O U P E
STAFF W R ITE R
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of doctors, nurses, medical assistants, and a
utumn Bolds begins the day’s huddle by ' /
behavioral health specialist
telling Dr. Rachel Solotaroff, the medical .
Both clinics, and a handful of others around the
director of Central City Concern’s Old Town
state, are blazing the trail in providing this type of
Clinic, that her patient schedule that afternoon has
care to patients — health care in which a variety of
providers addressing a spectrum of health needs
changed dramatically.
Solotaroff will see eight patients that afternoon.
communicate and work together. Care that is
Bolds, a panel manager on Solotaroff s patient
coordinated.
Oregon is adopting this model of care for its
team, is responsible for coordinating Solotaroffs
state Medicaid program, the Oregon Health Plan,
patients, and she quickly launches into briefing
Solotaroff and Magadalena Juan, a medical
in what are the most ambitious changes to the
program since it began providing health care to
assistant, on each patient and their health.
Oregon’s poor in 1994.
She goes through each patient chart, quickly
By July, it is expected that the physical, mental
saying why he or she is coming for a visit, what
and dental health care provided to 600,000
medications the patient is on, and whether pap
Oregonians oil OHP will be restructured in this
smears, blood tests and other routine check-ups
new coordinated system, with all providers —
are up to date.
including doctors, nurses, mental health
Juan scribbles notes, and Solotaroff asks some
counselors, dentists, and other medical
clarifying questions. The rapid pace pauses briefly
professionals — communicating and working in
as the three discuss, in the case of a couple
tandem. Its goals are to increase access and quality
patients, whether they have or need mental health
of health care - and create savings, $239 million
providers, and if a particular concern the team has
worth, by the legislature’s budget
might be discussed with the patient at that time.
The changes are being ushered in by House Bill
Ending with a high five, the day’s huddle is over
3650, called tlie Health Transformation Bill, which
after a short 20 minutes.
passed the Oregon State Legislature after intensive
Solotaroff says these daily meetings are hugely
political negotiations in late June.
beneficial in helping her and the team prepare for
The cornerstone of the changes is the
each patient visit, knowing what to expect, and also
coordinated care organizations, or CCOs. Although
what to anticipate in terms of providing the best
HB 3650 gives no definition of what a CCO is,
possible health care to the Old Town Clinic’s low-
many describe them as being regionally-based
income and homeless patients.'
geographic organizations that will be flexible
‘‘The idea is that your work of the day is not
enough to address specific health needs within a
your schedule, but the population of patients you
community and working multiple medical providers
serve,” Solotaroff says.
to coordinate care.
Across town at southeast Portland’s Richmond
They will have a governance structure with
Clinic, Dr. Nick Gideonse has similar daily
H
groups involved in providing cate. And each CCO
will be given a lump, “global” budget to pay for the
care of all its patients..
The expectations are high.
“Hopefully, they will create flexibility to do care
differently and save money in the process,” says
Rep. Tina Kotek (D-Portland), who helped
negotiate and write HB 3650. “Our hope is that
there will be higher quality of care, more timely
interventions, and more appropriate care, just by
virtue of understanding the individual better.”
“The idea is SO good,” says Solotaroff. “My really
optimistic hope is that they’re outcome oriented,
and that the outcomes matter to the population
(providers are) working with.”
But no one is sure how CCOs will be structured,
or how exactly they will operate.
“That’s the magic question,” says Mary Monnat,
the executive director of Life Works NW, and a
member of a governor-appointed workgroup to
hash out criteria for CCOs.
“There’s not a lot of flesh to the bone,” agrees
Solotaroff.
And the clock is ticking.
The Gov. Kitzhaber’s signature on HB 3650 was
barely dry when a whirlwind of activity began to
implement the new law: The governor appointed
133 people to serve on four workgroups made up
of health care workers, policy makers, advocates
and consumers to develop a more detailed plan of
creating CCOs, establishing qualify control
measures, the methodology for the budget, and
how to integrate care for the roughly 60,000
people on both Medicaid and Medicare. They met
See ORDERED, page 4
tlnsidej
The challenger
An a rtis t with
An unlabeled man
Mary Nolan talks
with Street Roots
about her intentions
to unseat Am anda
a smile
J. Neal Carr stays
connected online
Leon Rosselson: still
singing fo r the
excluded
Fritz
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and in person
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