Oregon Governor John Kitzhaber hopes his so-called health care transformation will save hundreds of millions of dollars. To make his point, he’s fond of telling this story: There’s a heat wave. A 92-year-old woman suffers congestive heart failure. She’s whisked off to the emergency room where a team of highly paid medical professionals saves her life.
“Under our current system that we have in Oregon and in the United States today, Medicare will care for the ambulance and the $50,000 to stabilize her in the hospital,” Kitzhaber says. “It won’t pay for a $200 air conditioner which is all she needs to stay in her home and out of the acute care system in the first place.”
Kitzhaber envisions a health care system that would pay for that air conditioner. Oregon lawmakers are poised this month to take the next step in making that sort of transaction a reality.
This isn’t an air conditioner. It’s a shiny red Dodge Caravan.
But much in the same way that a relatively small investment keeps the hypothetical woman in the governor’s story out of the hospital, this minivan is helping to keep real live drug addicted mothers on the road to recovery.
“I’m on call 24 hours a day, 7 days a week. So at 2 in the morning, when they really want to use, if they call me, I’ll go meet them,” says Debbie Hall, a mentor to high risk pregnant women in Marion County.
She and three other mentors take mothers and their kids to medical appointments, school and to job interviews. The goal is to help the young women shake their drug addiction and eventually give birth to a healthy child.
Hall knows what the women are going through. She’s a recovering addict herself. “Crack cocaine was my drug of choice,” she says.
The other three mentors are also former drug addicts. Hall says that powerful connection is part of what makes them qualified to do this work. She says, “I still have shame and guilt and humiliation and embarrassment and all the things that we bring to the table when we’re trying to get clean, I had it too.”
Now here’s the thing about those minivans. There’s no billing code in the Oregon Health Plan for “minivan” even if it helps prevent the costly care needed for a drug addicted baby. So WVP Health Authority, the Salem-based agency that leases them, set aside a portion of its Medicaid reimbursements designated for front-office expenses and used it instead for on-the-ground services like transportation.
It’s that kind of flexibility with health care dollars that’s at the heart of Governor Kitzhaber’s proposed “health care transformation.” And the chance to shape the overhaul is bringing lobbyists and health care professionals by the droves to the capitol this month. Crowds at legislative health care meetings have spilled out into the hallways.
Waiting for his turn to testify is Kelly Morgan. He’s the CEO of Mercy Medical Center in Roseburg. And he says flexibility would give health care providers like him more options.
“Everything now is pretty well siloed, from a financial standpoint,” Morgan says. “We have the pool of money for medical, we have the pool for dental, and we have the pool for psychiatry and for mental health.”
Mercy and several other Roseburg health agencies are forming one of the Oregon’s first Coordinated Care Organizations. That’s Governor Kitzhaber’s term for the partnerships that will form to spend the newly mingled health care dollars.
And that brings us back to the governor’s story about the air conditioner. Just about everyone in the capitol has heard it, including Republican State Representative Jim Thompson. He co-chairs the House Health Care Committee.
He says he shares the governor’s sense of urgency in reigning in the cost of medical care. But Thompson says it’s a steep hill to climb. “We have to take the present health care system and almost totally rearrange it overnight to make it work,” he says. “We don’t have a long transition period. We don’t have a plan B once we launch this thing.”
Still, Thompson thinks there is enough support in the legislature for the overhaul measure to pass this month. If it does, a consultant hired by the state predicts the effort could save billions of dollars over the next decade.
And that would buy a lot of air conditioners and minivans.