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Transformation Team Vision provides an opportunity for Oregon

Dr. Bruce Goldberg, Governor Kitzhaber and Mike Bonetto attend the March 23 HSTT meeting.

A bipartisan group of legislators, health care providers and patient advocates has handed off to the Legislature its vision for sweeping changes to Oregon's health system. The plan developed by the Health System Transformation Team calls for reducing reduce waste and inefficiency and making long-term investments in preventive care, while preserving high quality health care for Oregonians.

The recommendations provide a broad-brush outline, allowing details to be worked out by the Legislature and state health officials in consultation with federal health regulators.

At the outset of the Transformation Team's final meeting on March 23, Gov. John Kitzhaber thanked team members "for giving eight weeks of your life to this" and said the outcome "has exceeded my expectations." He pledged to "work diligently with our partners to make sure we get the flexibility" from federal and state laws to carry out the team's recommendations.

Striking a theme that would run through the meeting, Kitzhaber emphasized that the recommendations are a promising start for transforming Oregon's health system into a more accountable, effective and cooperative venture.

"Having been through this a couple or three times, there's still an incredibly heavy lift," Kitzhaber said.

"This has been a phenomenal team effort," said Dr. Bruce Goldberg, Oregon Health Authority director and co-chair of the Transformation Team.

The centerpiece of the plan, titled a "Strawperson Summary" to suggest that it remains a work-in-progress, outlines the functions of Coordinated Care Organizations -- locally-governed networks that would be responsible for the health and care of Oregonians under a transformed health system. The report on its way to the Legislature also covers:

  • The need for flexibility from federal Medicare and Medicaid rules.
  • The need for changes in state law.
  • A timeline for the transformation through 2013; for example, the Coordinated Care Organizations are targeted to be up and running by mid-2012.

A fundamental principle of the proposed transformation calls for global budgeting and changing the way in which we deliver and pay for health care. That means the Coordinated Care Organizations will start with a known amount of money โ€” a global budget --, which they can rely on and choose to spend in a way that best suits the needs of the population they serve. The move will be towards patient-centered care, rather than using a fee-for-service model. That contrasts with the current fragmented health system, which in many areas simply keeps paying for uncoordinated care of patients until the money runs out โ€” and then is forced to cut off services for entire populations.

The Health System Transformation Team: A bipartisan group of legislators, health care providers and patient advocates.

The Transformation Team's final meeting offered a chance for members around its very large table to reflect on what they had in common: a determination to improve health and health care for all Oregonians.

"We came together because of a budget crisis," said Dr. Bart McMullan, president of Regence BlueCross BlueShield of Oregon. "But this is really about people being able to get access to care."

"All of us are agreed about the fact that we do need some change," said Rep. Bill Kennemer, R-Oregon City, one of 11 Transformation Team members who are also in the Legislature. He called Oregon's effort to transform its health system "important and pioneering work."

"Good policy is always made of a combination of substance and politics" โ€” including what is necessary to win majority votes in both the House and the Senate," said Rep. Mitch Greenlick, D-Portland. "That's where we start, always." But despite their political differences, he said, the leaders of both the House and the Senate "want this to succeed."

"We're all going to be under tremendous pressure" to find "that very difficult balance" between needs and resources, said Greg Van Pelt, Providence's regional chief executive for Oregon. His message to legislators: "We are behind you." He also warned: "If we don't take advantage of this opportunity, it could be another decade before we come together again."