Street roots
March 2, 2012
Social determinants of health ‘intrinsic,' but left out in Salem
Health care reform falls short o f incorporating social-service providers — fo r now
BY AM A NDA WALDROUPE
patient’s housing and sociological
condition can have a direct affect on a
his or her health care, but a bill in
Salem to incorprorate those providers into
the new health care reform failed to make
the books.
As a result, the legislature has left
unanswered a critical question in the state’s
new health care structure: Will health
providers serving Oregon Health Plan
patients work with social-service providers
to address a patient’s sociological and
psychological barriers to health care.
Senate Bill 1522 would have required
oordinated care organizations, which are
currently developing to provide care to
Oregon Health Plan patients by July, to
incorporate and pay for addressing a
patient’s sociological and psychological
barriers to getting quality health care and
becoming healthy.
Coordinated care organizations (CCOs)
are the backbone of the reforms the
Legislature has made to the Oregon Health
Plan’s delivery system (see, “Just What the
Legislature Ordered,” Street Roots, Oct. 14).
CCOs are foreseen as locally driven
organizations made up of patient teams -
including doctors, nurses, behavioral health
providers, community health workers, etc.
Those providers will coordinate and
integrate the physical, mental and dental
health care of Oregon Health Plan patients,
who receive health care through Medicaid.
The hope is that better coordinated care will
keep people out of the emergency room,
lower costs, and provide better healthcare.
But the Oregon Primary Care Association
abuse, access to transportation, socio
economic status, rural isolation, race,
ethnicity, and other factors that are often
called the “social determinants” of health.
“They are part of a person’s health
situation,” Pratt says. “They are intrinsic, ’
not an add on.”
“This is where the rubber meets the
road,” Doug Riggs, the OPCA’s lobbyist told
the committee. “These are the most
vulnerable patients.”
Pratt uses the example of people who are
homeless and diabetic. People with diabetes
have to manage their weight, diet, and also
take daily medications that have to be
refrigerated. All of those things become
extremely difficult, if not impossible, if
someone does not have a home.
In general, caring for those patients is
more time intensive and costly because of
the variety and complexity of the issues
they face. They also tend to be unhealthier,
Pratt and others say, which leads to a
disparity in health among populations
simply because they have more barriers to
accessing healthcare than other populations.
The OPCA was joined by almost 30
organizations calling for Senate Bill 1522’s
passage. But it died in the Senate’s
Healthcare, Human Services and Rural
Policy committee after two hearings.
Legislators worried that the bill was
unnecessary.
“The goal of CCOs is to take care of
these people,” said Sen. Alan Bates
(D-Medford). “I don’t think we need to call
it out any more than we are.”
Without the bill, some worry that a
segment of Oregon Health Plan patients will
continue to be unhealthier than other
be absolutely necessary to address a
patient’s social and psychological needs, in
addition to their medical ones.
“It’s going to be a really primary piece of
what these CCOs are going to do,” he says.
“Frankly, that’s where the state sees the
opportunity to
improve health and
save money.”
Although Senate
T h e s o c ia l iitle r v e x itio n s a r e
Bill 1522 did not pass,
he thinks there is
g o in g Io b e c r it ic a l/ '
ample opportunity for
— ED B L A C K B O X
people to influence
E X E C U T IV E D IR E C T O R O F C E N T R A L C IT Y
C O N C E R N IN P O R T L A N D
the development of
CCOs. Each CCO will
have a “community
advisory committee”
made up of stakeholders from the
community who are not involved in a CCO
as providers. That, he says, provides an
opportunity to pressure CCOs to take a
certain course of action when it comes to
determinants of health.
“Many, many more details are going to be
worked out at the local level,” Joondeph
says. “There’s a lot of opportunity for
people to be engaged and to steer the
course of how any particular CCO goes.”
He thinks it is highly likely that CCOs will
begin forming strong partnerships with
social service agencies to the effect of
“social service-izing the medical world.”
“It goes beyond patching a person up,” he
says.
Ed Blackburn, the executive director of
Central City Concern, agrees. “The social
interventions are going to be critical,” he
says.
Central City Concern’s programs are built
(O P C A ) , w h ic h r e p r e s e n t s t h e s t a t e ’s s a f e t y
p o p u la t io n s . A n d w i t h o u t a l e g i s la t iv e
o n t h e a s s u m p t i o n t h a t p r o v id in g all t h e
net clinics, sponsored Senate Bill 1522 out
of the concern that addressing those
barriers would get lost in the shuffle of
making sure that CCOs are able to
adequately provide care by July.
“A great majority of patients that our
clinics serve have behavioral and socio
economic barriers to health,” says Jennifer
Pratt, the OPCA’s deputy director of policy.
“It’s a critical issue.”
Behavioral, socio-economic and
sociological barriers to health include
homelessness, issues related to substance
mandate, it will be up to each individual
CCO whether it chooses to address barriers
to health, or works with social service
providers to better address those concerns.
The OPCA is planning to convene a
workgroup to talk about the organization’s
next steps and influence the development of
CCOs when the Oregon Health Authority
begins drafting and writing the
administrative rules and regulations for
CCOs this summer.
Bob Joondeph, the executive director of
Disability Rights Oregon, says it’s going to
social services one might need — whether
it’s housing, medical care, substance abuse
treatment, detox services, drug free
housing, etc. — can make providing health
care to those people more effective.
“We know we can reduce incidents of
hospitalization ... and reduce conditions that
are exacerbated by those (psychological and
social) conditions,” Blackburn says.
“Someday, we’ll not see (health care and
social services) as separate.”
STAFF WRITER
A
Police seek help in
homeless men’s shooting
STAFF REPORTS
he Portland Police Bureau and Crime Stoppers is
asking for your help finding the shooters in an
attack on two homeless men sleeping in Southeast
Portland.
In the early morning hours of Feb. 22„ shortly after 5
a.m., police were called to the 100 block of Southeast
Belmont Street where two men who had been shot while
they slept under the Morrison Bridge.
The victims, 57-year-old Carter “Joe” Hickman and
43-year-old Albert “Allen” Dean, both were treated at an
area hospital and are expected to survive.
The suspect is described as a white male wearing dark
clothing, and was in a black or dark blue-colored, newer
style Volvo station wagon with a large dog in the rear
cargo area of the vehicle.
Detectives would like to hear from anyone with
information about this shooting, anyone who may have
seen this vehicle before or after the shooting, or any
instances where someone has driven up harassing or
threatening homeless people.
Crime Stoppers is offering a cash reward of up to
$1,000 for information, reported to Crime Stoppers, that
leads to an arrest in this case, or any unsolved felony, and
you can remain anonymous.
Leave a Crime Stoppers tip online at www.
crimestoppersoforegon.com, text CRIMES (274637) and
in the subject line put 823HELP, followed by your tip, or
call 503-823-HELP (4357) and leave your tip information.
T
PHOTO BY ROBERT BRITT
The site o f a drive by shooting in which a suspect in a car shot two homeless men while they slept. The men were sleeping near
where the cardboard boxes are. The vehicle drove up along the left side o f the scene above and fired into the men.