Over the past several months, the state of Oregon has been pursuing an aggressive approach to solving the healthcare crisis that many states are dealing with.
A couple of years ago Oregon was facing a $2 billion deficit in their Medicaid program, with few solutions to repair the situation. The governor was reluctant to take the obvious step of cutting doctors’ pay for fear that many of them would stop accepting Medicaid patients altogether.
The Obama administration cut a deal with Oregon to bail them out. But there was a catch. In order to keep the federal government’s support, the state would have to maintain the growth of its Medicaid spending to a rate that is 2% less than the rest of the country.
So the pressure is on for Oregon officials to identify means by which to deliver smarter, more efficient care — ways that will keep doctors participating in the program and that will ensure that patients get the care that they need.
As an initial experiment, the state implemented a program in a small community where residents were using the emergency room at higher frequencies. In this particular community healthcare services were siloed, and individuals had different plans for both physical and mental health. Implementing a program that gave patients access to community health workers generated approximately $3,000 per patient in savings in emergency room visits alone.
While the Oregon approach is consistent with the theme of accountable care and care-coordination as a key pivot point in attempting to improve the quality of care and reduce costs, the ultimate success of this approach remains unclear.
As one analyzes Oregon’s approach, one sees some parallel to the Republican proposals of block grants to Medicaid. In fact, many in Oregon referred to the government approach as a global budget.
Although there is no argument that coordinated care is essential, the exact costs of training and hiring essential workers to sustain such a system is yet to be determined. The states will face this very challenge, and more, as they are trying to determine the depth of their ongoing financial responsibility for sustaining their Medicaid programs without compromising physician networks and quality of care.
Coming up with the level of infrastructure required to meet its objectives could be a challenge for Oregon. It will be interesting to follow whether the federal government’s annual grant will help create a sustainable framework for Oregon, and for that matter, any other state.
Sreedhar Potarazu is an ophthalmologist and founder and CEO of Vital Spring Technologies.
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