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For Oregon doctor, the future of coordinated health care is already here

Family doctor Nick Gideonse
Gideonse says shift to prevention and better management of chronic diseases improves patient health and satisfaction - and keeps costs down.

May 16, 2011 - As Oregon policymakers consider legislation to improve how the state delivers health care to hundreds of thousands of Oregon Health Plan clients, some local doctors are already pointing the way to better care at lower costs.

Family doctor Nick Gideonse says he was concerned that rising costs and mounting paperwork were making family medicine unsustainable. But a 2006 visit to the Southcentral Foundation's Native Primary Care Center in Anchorage offered a model of coordinated care with an emphasis on prevention and better management of chronic diseases.

"Here I really saw a model that could again feel successful, that put us in alliance with our patients," Gideonse says. "Things like reaching out to patients who weren't necessarily on our schedule, being in a mutually responsible relationship, using basic quality tools to work towards goals that you'd like to achieve, to balance supply and demand — that all these things were really possible. And that was tremendously refreshing to see."

Back in Portland, Gideonse oversaw big changes at his own clinic, including moving to a team-based approach, setting up regular group sessions to help patients manage chronic diseases, and saving room in doctors' schedules to allow patients to make same-day appointments so they can get help right away and avoid expensive emergency room visits. Hospitalization rates and charges have declined significantly for Gideonse's clinic and others like it since 2007, according to a study by CareOregon.

Gideonse who also teaches at Oregon Health & Science University, says now he sees hope for the future of family medicine — and so do his students.

"We have had greater than a 50 percent increase in the number of medical students choosing family medicine — I'd say one of the main primary care specialties — and explicitly saying that they see a survivable future in working in primary care."

The changes didn't happen overnight, but five years later Gideonse says he's happy with the result. "I know I feel much more effective in my work and much more supported. And I would never go back."