SALEM, Ore. (AP) —
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 that she says helped
her get off drugs.
Emmanual, now 2, was born healthy.
"We
need mentors. We need advocates," 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.'"
There's a smattering of similar
preventative care programs around Oregon, and not just for addicted
mothers. But there hasn't been a statewide push — until now.
Oregon
Gov. John Kitzhaber last week signed a law that will create new
regional entities, called coordinated care organizations, which will be
expected to establish programs such as the one Hutchinson credits with
turning around her life.
Kitzhaber says the plan will improve care, reduce costs and serve as a model for the rest of the nation.
But critics doubt the potential for significant savings and say the program could even increase costs.
The
coordinated care organizations will be responsible for looking 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
focus in particular on people with mental illnesses, addictions or
chronic conditions like 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.
Oregon has long been a
pioneer in finding new approaches to health care, and Kitzhaber — a
former emergency room doctor who has championed overhauling the system —
believes the new law could keep people healthier and save money.
Officials
say that if all 50 states adopted Oregon's changes, the federal budget
would save more than $1.5 trillion over the next 10 years — $300 billion
more than Congress' failed "super committee" was trying to save 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,"
Kitzhaber 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."
Long
before the Oregon Legislature passed the law in February, Kitzhaber
took his idea to Washington, D.C., to present it to Obama administration
officials, and he caught their attention.
"There are several
states thinking about this kind of approach," said Cindy Mann, a deputy
administrator at the federal Centers for Medicare and Medicaid Services.
"This is definitely a time when everybody can be learning from each
other."
In some ways, Oregon's effort is an attempt to pick up
where Obama's health overhaul leaves off. While Obama expanded access to
care, his Affordable Care Act leaves it largely up to the states to
find a plan for lowering the cost and improving the quality.
But there is no guarantee the new Oregon law will do exactly what Kitzhaber wants.
A
January 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 stated.
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 that other states with
different cultural and political environments would see 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?" Girod said in a committee hearing. "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."
Proponents dismiss the
CBO report, saying their plans go far beyond the limited experiments
that were studied, and point to data from projects in Oregon and
elsewhere that more closely align with their plans.
A
state-commissioned report found that significant savings were possible
from eliminating duplicated tests, preventing hospitalizations and other
techniques.
Oregon's changes will focus on the neediest,
costliest patients. Many of them are on both Medicare, primarily for the
elderly, and Medicaid, primary for the poor.
Various funding
streams from all levels of government for mental, physical and dental
care will be pooled into a global budget. Each coordinated care
organization will get a share of that budget and will have broad
authority to spend the money as it sees fit. Successful organizations
will be rewarded with additional cash.
Officials around Oregon
have already begun setting up coordinated care organizations and some
are expected to be operational by July.
Supporters of the new law say a project in central Oregon shows that it can work.
After
identifying 144 patients who were frequently visiting the emergency
room — at least 10 times in a year — a group of health providers found
that most had mental health conditions and more than half had no primary
care provider who could treat simple disorders outside the ER.
By
creating care plans, assigning case managers to help patients navigate
the health care system and embedding mental health providers at the
doctor's office, emergency room visits were reduced by 49 percent in six
months.
Robin Henderson, a psychologist who is director of
behavioral health services for the hospital in Bend, Ore., says the
program has promise, "It's an interesting shift in philosophy to start
to look at how you care for the whole person."
Copyright 2012 The Associated Press.