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Time is ripe for public health system to lead

October 10, 2012 – Corvallis

Now is the time for Oregon's public health system to plant seed in the fertile environment for change created by health system transformation, according to Bruce Goldberg, director of the Oregon Health Authority.

"There is opportunity for public health. Public health can lead the way," he said, speaking to several hundred people at the annual Oregon Public Health Association Conference at the LaSells Stewart Center at Oregon State University.

During his remarks, Dr. Goldberg outlined why health care delivery has to transform itself, how it is doing so and what the public health system's role can be in this change.

"First and foremost we need to focus on health, reduce waste, improve health, create local accountability and align the financial incentives," Goldberg said.

He displayed a chart as part of his presentation that showed the determinants of health: about 40 percent is the result of lifestyle and behavior and 10 percent due to the medical care we receive.

"You know more than most what makes us healthy, yet we are putting dollars into the 10 percent of that pie," Goldberg said.

The path out of this unsustainable funding and toward the focus of better health is Oregon's coordinated care organizations (CCOs). There are now 16 CCOs, which are community-based and offer primary and mental health care for Oregon Health Plan clients.

Through CCOs, health care can focus on better health by: realigning funding between public and individual health; reducing "siloed funding"; encouraging joint investments in population health, which creates the flexibility to focus on common goals; and having system-wide accountability.

Several public health advocates asked questions of Goldberg to better understand how all this transformation will happen.

"How do you deal with the investment that won't come back for many, many years?" asked Charles Haynie, M.D., F.A.C.S.

"You're right." said Goldberg. "We need to start spending less where we are wasting dollars such as treating mental illness in the emergency department. How do we capture those dollars into longer-term pay-off? We will still need a two-track system of acute care and preventive care but we need to harvest those dollars being spent in an inefficient system."