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DHS news release

Guest opinion


By Bryan Johnston


This guest opinion was published by the Klamath Falls Herald and News on July 4, 2005.


Length: 605 words


The nurse who visited the Klamath Falls home to check in with the expectant mom was alarmed. The young woman's extended family lived with her, giving her support, but they were all smokers.


The nurse took the pregnant woman's father aside and quietly told him about second-hand smoke's dangers. He growled at her.


But the story ends happily: When the nurse returned some time later she found all the ashtrays out on the porch, signaling that smoking had moved outdoors.


This is among the low-tech but effective approaches that the local Oregon Health Plan contractor, Cascade Comprehensive Care (CCC), employs to improve the health of about 6,300 low-income people and control health-care costs in Klamath County.


CCC, owned by local physicians and Merle West Medical Center, has shown it's willing to go beyond what the state requires to contribute to kids' health so they can learn at school and to a healthy adult workforce.


They achieve their results the old-fashioned way. Although CCC is fully computerized, it prides itself on a personalized hands-on style. This means phoning and surveying patients to see how they're doing, acting on doctors' calls about patients who need special attention, and trying to get walkers to frail patients before they injure themselves in a fall.


By emphasizing prevention, sometimes even if Medicaid doesn't pay for it, CCC has reduced unnecessary hospital days per 1,000 patients by almost a third in the past seven years. It receives daily reports of its patients who visit the emergency room so it can counsel them on the value of a $60 doctor's visit, where feasible, over a $400 ER visit.


Although people sometimes think managed-care plans put up barriers to treatment, CCC has patients seeing their doctors an average of four to five times a year. It also tries to ensure patients appropriately use preventive services they need. For those with asthma, for example, it provides a device to monitor lung capacity so an unexpected inability to breathe doesn't trigger an unnecessary ER visit.


After hospital patients are discharged, a nurse calls them to see how they're feeling on a scale of one to 10 (10 is best). One patient who said she was a 3 was urged to see her doctor right away; luckily she did, and the next day she had needed heart-bypass surgery. She's now doing well.


In another call, a patient with liver trouble disclosed to the CCC nurse what she was ashamed to tell her doctor: She was drinking five 16-ounce glasses of ale a day. She got help for her drinking problem.


CCC offers a $50 gift card for diapers or a car seat to expectant moms who get prenatal care. Its nurses take quilts made by Pelican Piecemakers to new moms. And its pharmacist encourages physicians to use chemically identical but less costly generic drugs (it reports average generics costs of $17.07 versus $90.31 for brand names).


It hired a half-time nurse to concentrate on pre-natal care, figuring the cost was modest compared with that of a premature baby ($80,000 and up). At least partially as a result, of about 1,000 covered births over the past three years, only one was seriously premature (it used to be more).


CCC offers six-week smoking-cessation classes free to its patients and their families and, for only the materials cost, to others referred by local doctors. It's Klamath County's only such class.


It all goes to show that a personal approach can yield great results. Such as those smokers moving their habit outdoors after learning of second-hand smoke's dangers. Now, let's hope they'll also sign up for the free smoking-cessation classes.


Bryan Johnston is interim director of the Oregon Department of Human Services, which contracts with Cascade Comprehensive Care for Oregon Health Plan services in Klamath County.