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Governor Kitzhaber signs Health Care Transformation bill (July 1, 2011)

Governor Kitzhaber signs Health Care Transformation bill coordinating care to achieve better health at a lower cost

July 1, 2011

As many of you remember, twenty years ago Oregon set out to establish a more effective and equitable way to allocate limited health care resources.

Instead of dealing with revenue shortfalls by simply dropping people from coverage, we tried to keep everybody covered, but establish a priority list of health services to make sure that what people got had the greatest value in terms of improving their health.

When we passed the Oregon Health Plan in 1989, and announced that we were going to prioritize through a health services commission all the health services in the world, a few people we skeptical, and not many believed that it could be done.

But the fact is, we did it and we did it with the help of many of the people in this room. I can see people here that were back there in 1989 and helped make that program a reality.

Two decades ago we embarked on a bold new strategy to address the reality of fiscal limits, and try to maximize the health benefit of resources we had and shift our focus from simply delivering and financing medical care, to actually improving the health of Oregonians.

And through the Oregon Health Plan over a million and a half people in this state have had access to medical care over the last two decades. 

But setting priorities and making a better use of limited resources does not in itself reduce the escalating cost of medical care. Which is growing faster than wages which is a huge burden on our business community, and which is eroding our ability to invest in education and other social priorities.

The fact is, that our current health care system is simply not sustainable. And that became very, very clear earlier this year when the one time money that had propped up our health care system in the last biennium revealing a forty percent discrepancy between the available revenue and the cost of those services.

Now most states, facing the same kind of situation, have responded by simply throwing people under the bus, by simply dropping people from coverage.

Like we did twenty years ago, this state has chosen another path.

Trying to keep people covered, but trying to at the same time, reduce the cost of medical care itself.  Because we believe there is much to gain and much to lose by simply dropping people from coverage and forcing them into the Emergency Room where we end up paying for the cost of their stroke in the hospital, rather than managing their blood pressure in the community.

Today we are embarking on another bold journey to change the nature of our health insurance market and to change the way health care is organized and delivered in this state, to improve the health of our people and do it at a lower cost.

And I want to thank everybody who is here today and many who are not here today – for helping us get us to this point. We would not be here with out you, without your guidance, your patience, your belief, your long hours and your meetings long into the night.

But I want to say that this is not the end. This is just the beginning of some more very, very hard work.

And before I put pen to paper here, I am going to ask for your help one more time. 

We have come together this morning, because the time for action is now, because the cost of healthcare is hurting our families our businesses and our state economy.  And as a state we can no longer afford to pay for an ineffective inefficient health care system with public dollars that could be going to education, or early childhood services.

That is why the legislature passed these bills with such overwhelming bipartisan majorities.

The time is now, our action is clear and this legislation is the important next step towards our shared vision of better care, better health, at a lower cost.

Senate Bill 99, which passed by a dramatic majority in both houses of the legislature, was signed earlier, that will create the Oregon Health Insurance Exchange Corporation, and through this Exchange, individuals and small businesses will gain access to affordable, quality care, and put the power in the hands of consumers and small businesses, creating a local exchange that will be accountable to Oregonians, for choice, competition for value and for transparency.

Through this exchange, people like Rebecca Moulton, who I believe is with us today, and her husband will get the kind of health care coverage that she needs and deserves. She faced, like many Oregonians earlier this year, a very common problem, a health emergency, but without health insurance pay for it.

The exchange will be designed for people like Rebecca and for small businesses that want to provide health insurance to their employees, but simply can’t afford to do so.

House Bill 3650, which I will sign this morning, will set the stage for transforming the way health care is organized and delivered through the Oregon Health Plan. And that was designed for people like Kay Dickerson, who is also here with us today. She is a Hurricane Katrina survivor, who moved to Oregon after her home was destroyed. She deals with diabetes, with post-traumatic stress syndrome, and other chronic conditions that could put her back and forth between the community and the hospital.

Today she is a patient and a patient advocate at Portland’s OHSU Richmond clinic, and she uses a team based approach to medical care and health spurred by medical doctor, Doctor Nick Gideonse who is also with us today.

Through the Coordinated Care Organizations that House Bill 3650 will set up we will begin to deal seriously with the unnecessary costs of health care that actually don’t produce health.  We will work to reduce waste and inefficiency and change the system to begin to emphasize wellness and prevention and the community based management of chronic conditions.

Under a Coordinated Care System, under this new system, your doctor, your dentist, your nutritionist, your physical therapist, your mental health care provider, your community health worker, will all work on the same team in a local Community Coordinated Care Organization.  And they will focus on keeping people healthy, rather than simply waiting until they become sick.

These organizations will operate on a fixed, global budget, and they will focus on patients like Kay, trying to keep her healthy, trying to keep her out of the hospital, trying to keep her engaged and involved in the community.

Now here is where I ask for your help.

We have reached the starting line, not the finish line. And while the bills we celebrate today are indeed historic, this is only the first step. Now we have got to come together, we have got to come together to build the very best Health Insurance Exchange we can and to gather the best thinking we can in this state, in the region and around this country to develop our Coordinated Care Organizations.

To have the Health Insurance Exchange we need, one that truly serves consumers and small businesses, and holds insurance companies accountable, we will have to have a very strong Board of Directors, and we are taking nominations now, and I want to commit to you, absolutely, that consumers and small businesses will have a significant role to play and a significant representation on the Board of the Health Insurance Exchange.

We are also launching four work groups chartered under the Health Policy Board, and they are going to have to work quickly to gain and provide the input necessary for key elements of the Coordinated Care Organizations, including criteria for developing that global budget, for developing outcome measures, for developing metrics for quality and efficiency, and for how we integrate and coordinate care.

Eric Parsons, who is the chair of the Oregon Health Policy Board, Eric I believe is with us today, I want to thank Eric and the board for the leadership they are providing in this effort.

Now my friends, the real work begins. This is going to require an unprecedented level of cooperation, collaboration, and trust, between providers and consumers and payers and insurers.

But we have the opportunity today to do something that no other state has done, something that has eluded our nation for decades.  Producing a health care system that actually produces health, that improves the health of our population at a cost we can afford.

This is not going to be easy, I know that. But I know that we can do it, because we have done it before.

Oregonians are counting on us. And we are not going to let them down. As George Bernard Shaw once said: “Some men see things are they are and ask why, others dream things that never were and ask, why not?”

Why not us, why not now, why not here in Oregon.

 

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