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DHS news release

January 9, 2006

 

Health plans doing more to serve patients, save dollars

 

This guest opinion is by Lynn Read, acting state Medicaid director in the Oregon Department of Human Services.

 

The guest opinion focuses on CareOregon, a health plan that serves these 16 counties (with number of enrolled patients in parentheses): Clackamas (13,880), Clatsop (2,007), Columbia (2,813), Coos (33), Douglas (794), Jackson (1,689), Jefferson (2), Klamath (1,409), Linn (24), Marion (5,511), Morrow (596), Multnomah (51,500), Polk (553), Umatilla (3,697), Washington (18,603) and Yamhill (1,257).

 

Length: 510 words

 


 

By Lynn Read

 

Even though she was only 22, the woman was a major user of scarce health-care dollars. Raised by a grandparent and foster parents, she had no family or support system. Her medical complications included diabetes, seizure disorders, schizophrenia and depression that led to suicide attempts.

 

Her insurance company counted 200 visits to hospital emergency rooms in a single year.

 

That the ER staff no longer see her is evidence of managed health care's focus changing from primarily cost-control strategies. Her insurer, CareOregon, illustrates how some contractors serving Oregon Health Plan patients are going beyond what the state requires, taking steps to improve health with reduced costs as a byproduct.

 

For this patient, CareOregon found supportive housing, got her in to see appropriate physicians and stayed in touch by phone to help her manage her medical needs.

 

At a time that Medicaid's high cost prompts national debate, and one in six Oregonians is uninsured, it matters.

 

Serving more than 100,000 Medicaid patients in 16 counties, CareOregon isn't alone. In the Salem area, the Marion Polk Community Health Plan gives doctors' offices cash incentives to report when a patient becomes pregnant so the health plan can get them the prenatal care they need.

 

A Klamath Falls-area health plan, Cascade Comprehensive Care, has reduced hospital days per 1,000 patients by a third and shown patients the dramatic cost difference between brand-name and chemically identical generic drugs. A Coos County plan, Doctors of the Oregon Coast South (DOCS), offers free smoking-cessation and healthy-cooking classes to all comers, even if they aren't enrolled in the plan. These are only examples.

 

After recognizing that 12 percent of patients with complex medical needs consumed 60 percent of its budget, CareOregon created a management program using Johns Hopkins University software to identify patients most likely to need high-cost medical treatment within 12 months. (The 22-year-old patient cited above was among them.) It then began increasing its staff of nurses, social workers and counselors who reach out to medically high-risk people by phone.

 

Does the patient need better housing? Help getting a doctor appointment? Transportation to keep the appointment? Someone to talk to? CareOregon helps.

 

They concluded that the money saved by improving patient health more than offset the its cost for additional staff.

 

Staffers might counsel a hospital patient who's been discharged with a confusioning array of medications, equipment and instructions. Or help busy parents struggling to meet the needs of a newly diagnosed diabetic child. Among other strategies are grants to local providers such as to an Astoria clinic to hire a case manager to ensure patients follow physician recommendations; a Southern Oregon hospital to develop a program to reduce patient infections; and clinics to track diabetes treatment needs of farm workers in the Hermiston, Salem, Woodburn and Portland areas.

 

No one doubts that these health plans' voluntary work to improve patient health means kids do better in school, workers are more productive and babies get a better start in life. Or that a 22-year-old woman with multiple medical challenges can stop visiting the ER and contemplating suicide.

 

Lynn Read is acting state Medicaid director in the Oregon Department of Human Services.