More than two years ago, I had a vision for a better way to deliver care that would address the whole child by providing medical care, behavioral health and social needs under one roof, with one coordinated team of professionals.
We set out to make it happen. We rented space, modified it to fit our needs, made massive changes to our computer system, and, most importantly, we hired highly skilled behavioral specialists, a social worker and additional staff to support our providers and these complex new work processes. We shared chart notes, work spaces and patients, and we met regularly to share information.
It wasn’t long before we began to realize the magic of truly integrated care. Kids were better cared for, families were more engaged, and health care providers on both the behavioral and medical sides of our team were ecstatic about this rewarding new way to serve the needs of our community.
After just one year, our clinic showed a dramatic drop in our patients making visits to the emergency room and being admitted to the hospital. This is significant, because when people who are publically insured use these emergency services, it can be very expensive for the overall health care system. Reducing the number of E.R. visits and hospitalizations are top financial goals of health care reform. So we consider that success!
Trillium Community Health Plan was a key partner in my clinic’s rapid expansion of services. Their initial transformation grant and ongoing financial support of our integrated care model was pivotal in the early success of our new approach to health care. Both privately insured and publically insured patients—those on the Oregon Health Plan—were benefiting from this new way of delivering integrated services.
About the Oregon Health Plan and its renewal
The triple aim of health care reform is giving better care to more people for less money, and Oregon has proved that it can work—we can save money and provide quality care.
Oregon Health Plan has provided a lifeline to over 1 million low-income Oregonians, nearly 1 in 4 people living in our state—including babies, children, pregnant women and people with disabilities. Data from the Oregon Health Authority shows that for every $1 that is invested in preventative care, $13 are saved.
Last week, federal health officials granted a five-year renewal to the Oregon Health Plan. The decision means that those enrolled in the Medicaid-funded, low-income program won’t see any changes in their health care until Congress takes action to repeal or replace the Affordable Care Act—and maybe not even then.
The renewed waiver includes support of coordinated care models like ours at Eugene Pediatrics and Thrive Behavioral Health.
Unfortunately, there remains a very significant budget gap facing the state’s health care system, so the exact details of Oregon Health Plan funding and how our clinic, among others, will be paid is not yet known.
What happens next?
This is the question that keeps me up at night. What will happen, not only to my clinic and the families we serve but to countless others across the state, if the Affordable Care Act is dismantled? Doing so without a replacement plan would eliminate expanded Medicaid eligibility rules that extended coverage to 350,000 Oregonians.
It would be truly unfortunate, and potentially disastrous, if we lose the gains we’ve made over the last several years in making preventative care available to more Oregonians.
I am optimistic that Congress will be able to create a viable solution and that it will be a collaborative effort that includes, not only government officials but also doctors, insurance companies and, most importantly, patients.
As one who takes care of kids on the Oregon Health Plan, and for all clinics like mine that are willing to make a leap and develop new and better ways to meet the health care needs of our community, I will remain hopeful that we can figure this out.
My hope is that soon, I will sleep a little better.