The state of Oregon and the Obama administration just announced the approval of a federal waiver to allow innovation in the state’s Medicaid program. The feds agreed to chip in $1.9 billion over five years to get the program off the ground.
The AP reporter covering this story wrote, “Gov. John Kitzhaber’s plan would invest in preventive care to keep patients healthy so they don’t need expensive hospitalizations.”
Maybe I’m too rigid about this word prevention, but I just don’ believe people understand how this new approach would actually save money. I think when most people read the word prevention, they think of screenings for high cholesterol and similar diseases. These interventions do NOT save money — ever.
Further down in the article the reporter writes: “The Oregon plan would create “coordinated care organizations” to manage all mental, physical and dental care for 600,000 low-income patients on the Oregon Health Plan, the state’s Medicaid program. It would focus particularly on the sickest patients with the highest costs, especially people with chronic conditions such as diabetes and asthma or with mental health concerns.
Ohhhh. It’s not prevention, it’s taking better care of patients with chronic disease. Yeah, I suppose we could say that working with a patient with severe emphysema to try to keep him from having such bad disease flares he feels better and stays out of the ER longer is prevention. But I think a better word is something like stable or stability, not prevention.
I couldn’t find many other details about the plan, even from The Oregonian website. It sounds like they’re going to do some sort of PCMH thing. I’ll be fascinated to see how much of their up front investment is in primary care physicians vs. the other bells and whistles of the PCMH.
Of course I really wish them well in their journey to deliver compassionate care at a lower cost. Oregon had its innovative moment in the sun about 20 years ago with the Medicaid coverage list (which was also led by Dr. Kitzhaber). I hope this initiative works and has more staying power than their previous effort.