Oregon’s health system transformation started with the creation of Coordinated Care Organizations (CCO) www.oregon.gov/oha. CCOs to serve people receive healthcare coverage under the Oregon Health Plan (Medicaid).
Today 16 CCOs operate across the state but operate locally. They have one budget that grows at a fixed rate for mental, physical, and dental care. The CCOs are governed by a partnership among healthcare providers, community members, and stakeholders in the health systems.
The model continues to show improvements in care while staying within budget even though more than 434,000 additional Oregonians have enrolled in the Oregon Health Plan since January 1, 2014. The enrollment is 1.1 million people, or approximately a quarter of all state residents. So far, emergency department visits, hospital admissions have decreased, and enrollment in patient-centered primary care homes has increased by 56 percent.
The coordinated care model is spreading to other plans and payers. For example, the Public Employees Benefit Board with more than 130,000 public employees includes elements of the coordinated care model.
In other state news, the Harney District Hospital Family Care Clinic www.harneydh.com a Tier 3 patient-centered primary care medical home in Harney County Oregon, with a population of 7,000 has access to five full time family medicine doctors and four mid-level providers. The Clinic is now integrating mental/behavioral health professionals into the clinical setting.
One of the lessons learned is that culture is hard to change. When integrating care, it is necessary to establish a solid team approach to healthcare before integrating mental/behavioral health into the existing care program.
Another project in the state called the “Targeted Primary Care Project” is integrating primary care with behavioral care at the Old Town Clinic and Recovery Center located in Portland. The pilot program provides five clients with targeted primary care through their psychiatric provider working with their Integrated Health and Recovery Team (IHART.
Psychiatric providers in consultation with primary care providers assume responsibility for both the patient’s psychiatric and chronic medical care in terms of metabolic conditions. The IHART team evaluates metabolic monitoring and compares the number of encounters the client has at the clinic prior to the pilot and for three months after the client engages in the pilot.
Go to www.oregon.gov/oha/Transformation-Center/Documents/Health-System-Transformation-Overview.pdf for more information.