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By 2033, the Oregon Legislature is poised to declare, we will live in a state where, among other things:
- All Oregonians have timely access to quality and affordable health care.
- Health outcomes are improving.
- The health care system is far less complex than it is today, easier to navigate for individuals, and a more enjoyable practicing environment for providers.
- Hospitals and clinics have pathways to sustainability.
- Employers can afford to offer health insurance, and employees can afford to use it.
- Total health care system cost trends are below the national average and consumer access to care is above it.
House Concurrent Resolution 202 heralds Oregon’s achievements—for example, the state’s high health insurance rate—while describing a grim state of affairs: for example, skyrocketing health costs. It sets some central goals that describe what transcending those circumstances would look like.
“This is just more useless legislation,” wrote a Bend man in opposition, noting, not inaccurately, that the resolution doesn’t technically do anything at all.
But mostly all are on board with a concept that former Gov. John Kitzhaber and his health care sustainability work group drafted as a kind of lodestar for policymakers and other leaders as they steer Oregon’s health care system through one of the most uncertain periods in memory.
“I’m reminded of one of my favorite passages from Ernest Hemingway’s novel The Sun Also Rises, where Bill Gordon is asking Mike Campbell how he went bankrupt, and Mike says, ‘Two ways, gradually, then suddenly,’” Kitzhaber told lawmakers recently. “That’s our health care system. We’re past the gradual part, and things are about to get sudden.”
Betsy Boyd-Flynn, executive director of the Oregon Academy of Family Medicine, tells WW the health system has been in “reaction mode” for some time now, and that the budget pressure will only grow in the coming years. Thus, she sees the resolution as a genuinely useful document.
“If we can articulate a shared vision, a shared goal—that this is what we want our health care system to look like, this is what we’re shooting for—then we can evaluate all the difficult choices we’ve got between now and then against that goal,” she says.
She adds, “We’re going to have to undo some stuff and it’s going to be really painful,” but a clear sense of purpose will make this effort more tolerable.
As she noted in testimony to lawmakers, Boyd-Flynn experienced the effects of a straining health system personally when her longtime Northeast Portland family medicine clinic announced in recent weeks it would close.
With news like this trickling out, concerns that Oregonians could be losing access to health care only grow.
Only a few days ago, Providence Medical Group restricted parts of its network to members of the largest Medicaid plan in the Portland area. The state’s largest employer—its parent organization, Providence Oregon—has lately announced multiple rounds of layoffs, posted massive financial losses, and shuttered several medical facilities.
Providence Oregon CEO Jennifer Burrows is one of the many system leaders who have been taking part in Kitzhaber’s health care sustainability committee. Asked in a phone interview with WW where her system feels the most acute strain, she pointed to changing revenue streams. Government insurance programs pay less than commercial ones, and “as more people have aged onto Medicare, we’ve not found ways to live within the rate that Medicare gives us as health care organizations,” she said.
Meanwhile, Burrows said, Oregon’s Medicaid insurers have generally used the 10%-per-member rate bump they got this year from the state to shore up their own budget, rather than passing on the funds to providers.
“We need to figure out how we work together, smarter, to live within the dollars that are available,” Burrows said.
Asked what Providence’s role in this was, she committed to remaining at the negotiating table, but noted that the system could only transform with the collaboration of all entities. Pressed for specifics on Providence’s own efforts to manage costs, she noted its pending deal with Compassus, a third party she said has tools and techniques to help it run home and hospice care more efficiently.
It’s difficult, however, to imagine this kind of deal being one that everyone can agree on. Compassus is a Tennessee-based for-profit hospice company controlled in part by private equity interests. Noting studies showing that many patients are often served quite poorly by profit-seeking operations like these, the Oregon Nurses Association has pushed to stop the deal, and state regulators have spent roughly a year reviewing it, preventing it from going into effect in Oregon, at least for now, even as the partnership kicks in elsewhere.
Burrows described Oregon as a notably tough operating environment. “I think there are many things that we all look at as cost-of-care drivers,” she said. “We haven’t aligned—as a health care system, as a legislative body, as the health authority—to make sure that we are all pushing on the same things to improve the cost of care.”
She added, “We don’t mean to be, but we are working at cross purposes to each other.”
