Governor Kitzhaber Denies Secret Plan to Transform Healthcare
Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, assures officials he’s behind Oregon’s efforts
February 17, 2011--Oregon’s transformation healthcare plan is falling into place, with draft legislation expected by March 23.
However, Governor John Kitzhaber dismissed speculation about a predetermined “secret plan” at last night’s Transformation Team meeting.
“We’re putting together that secret plan here,” said Dr. Bruce Goldberg, director of the Oregon Health Authority, “and this is a less-than-secret environment.”
That plan must come together before April, Kitzhaber asserted, and cannot be “an endorsement of the status quo. If we don’t do it, this system is going to go off the rails.”
Dr. Donald Berwick, who’s a friend of the governor and heads the Centers for Medicare and Medicaid Services, emphasized the importance of Kitzhaber’s oft-mentioned “triple aim” objectives – better healthcare, better health, lower costs – and praised Oregon for being a “beacon” that could “show our country some solutions.”
Focusing on the dual eligible population, he said, “This population is absorbing a tremendous amount of resources,” said Berwick, “but their condition is impeded because of the system’s fragmentation” of physical, mental and dental healthcare. The solution? Healthcare reform’s current buzzword: integration.
That population, which currently numbers 59,000, represents 14 percent of Oregon’s Medicaid participants, but accounts for 27 percent of its spending.
“It’s really local communities that have the potential for developing real integrated systems of care,” Berwick said. Through this community-based, integrated approach, he added, patients’ health concerns could be addressed and tracked before they became serious enough for hospitalization.
“Hospitals would seek to become empty,” said Berwick. “Prevention has to become lucrative.”
Sen. Alan Bates (D-Ashland) asked Berwick for specific direction. “Do you have specific benchmarks for what a system like this should look like?” he asked, seeking answers about how to best integrate healthcare and long-term care services. For example, he asked, are there any benchmarks for the potential cost per member month for such services, hospital reimbursement rates, or other revenue figures that could help Oregon go down this path.
“The variation around the country is phenomenal,” Berwick responded, which makes it difficult to establish such benchmarks. However, he added, “there’s a lot of debate over those variations, and whether they’re real or not.”
Berwick’s office is studying the cost and outcome differences across different geographic regions of the country to “give us a basis for rulemaking in 2012,” he said, and “help us understand what’s real and illusory.”
First and foremost, though, he said, Oregon’s leaders should pitch ideas to CMS’s Innovation Center, which is stocked with funds to support state pilot projects.
“What are your goals, and how can we help you get where you want to be?” Berwick asked the group. “We’re very open to ideas.”
The 45-person Transformation Team has five more weeks to set benchmarks, meet budget targets, and refining a bid process as well as work on legislation and federal waivers.
Currently, close to 500,000 people receive healthcare service through the Oregon Health Plan, and that figure represents 15 percent of all Oregonians and almost 38 percent of all children. By 2019, Oregon’s Medicaid enrollment is expected to increase b y almost 60 percent, according to the Oregon Health Authority.
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We need the energy equivalent of micro-grids, rather then the consolidation problems we now have with the financial industry and with other major industries.
Monopoly and monopsony are both abominations, subject to too much influence from Key Opinion Leaders (KOP's) who are starting to get in trouble. A search of Biederman Harvard turns up one of the controversies.
Reform is coming to our illness-maintenance system, but it is coming from the bottom up.
It would be better if Oregon could get out in front by carefully auditing how many low-income Oregonians are on debilitating doses of medications that they have been left on, willy nilly.
Oregon has done better than most states in seeing that people are properly medicated for pain.
Long-term use of medications with high side-effect profiles that have been tested for efficacy only for short-term use, this is an issue that is only crawling out of a dark cave. Increased focus by consumers and families is coming on this.
Medscape had an interesting article on this recently. It was a dialogue between a psychiatrist and a family practitioner. Visit the site to see which was more militant about this issue.
Getting ahead with prescription-auditing can employ some of our unemployed, return people to health who have been living with excess disability, and cut unnecessary costs.
If we get to these audits now, we will be better prepared for supply-chain problems if oil-industry blips affect availability. Abrupt withdrawals from some targeted medications are life-threatening.
I am not an expert on the state budget, but it could be that getting our people on appropriate doses would address part of the budget issue.
Dr. Kris Alman wrote:
Dr. Matthies offers a great suggestion. Indeed we need full transparency of pricing that is no longer under the influence of the AMA. See "Bad Medicine: How The AMA Undermined Primary Care in America" by Brian Klepper. http://careandcost.com/2010/12/17/bad-medicine-how-the-ama-undermined-pr...
But, really, how can health care delivery become integrated without a single payer monospony*?
From Wikipedia, *monospony:
In economics, a monopsony (from Ancient Greek μόνος (monos) "single" + ὀψωνία (opsōnia) "purchase") is a market form in which only one buyer faces many sellers. It is an example of imperfect competition, similar to a monopoly, in which only one seller faces many buyers. As the only purchaser of a good or service, the "monopsonist" may dictate terms to its suppliers in the same manner that a monopolist controls the market for its buyers. The term was first introduced by Joan Robinson in her influential[1] book, The Economics of Imperfect Competition. Robinson credits classics scholar Bertrand Hallward at the University of Cambridge with coining the term. A single-payer universal health care system, in which the government is the only "buyer" of health care services, is an example of a monopsony. It has also been argued[2] that Wal-Mart, in the United States, functions as a monopsony in certain market segments, as its buying power for a given item may dwarf the remaining market. Another possible monopsony could develop in
the exchange between the food industry and farmers.
Curious, what is a sub-specialist?
Susan Lanker DC
Kitzhaber's proposed budget cuts 25% from OHSU. And those cuts are going to be directly passed along to students in tuition hikes. OHSU already has the highest in-state tuition for a state (supported) medical school in the country. It's no wonder doctors are having a harder time rationalizing lower paying primary care practice.
How about having state legislators' giving more support to state schools to stop training sub-specialists in excess supply and train family docs is short supply?
Fred Matthies, MD