Counting down to 2014

Doug Koekkoek, M.D.
Chief medical officer, Oregon Region

July 17, 2013

It seems hard to believe, but the first large waves of change from health reform will come to our hospitals and clinics in a mere six months. Oregon’s Medicaid expansion begins in January, immediately bringing 40,000 new members who were on the waiting list for the Oregon Health Plan.

As the expansion proceeds, up to 240,000 adults, most of whom are currently uninsured, will be covered by Oregon Health Plan. (This estimate may drop, however, as the economy improves and more people join employer-sponsored insurance plans.)

So what does this mean for Providence?

The most dramatic changes will come to primary care clinics, particularly in the Portland metro area. Not all of the newly insured patients will be served by Providence, but we do expect to see up to 4,000 new Medicaid patients in the first quarter alone.

These changes affect hospitals as well. The better our clinics can accommodate the influx, the more we can prevent patients from seeking care in emergency rooms. If early intervention and preventive care opportunities are missed, hospital costs will rise.

PMG has been preparing for this by embracing team-based care, including instituting the medical home model in many of its clinics. It’s also analyzing patient loads, bringing on new providers, and determining how many patients can be seen by an advanced practice provider or managed through telemedicine.

This coordination is taking place inside Providence as well as within the six coordinated care organizations to which we belong. In one of those, Health Share of Oregon, Providence carries a capitated risk. In the others, Providence providers may be reimbursed at levels that don’t cover the cost of delivery, which is an added incentive to manage population health. (To learn more about Health Share, read the provider FAQs.)

Between Medicaid expansion, the individual insurance mandate, the availability of subsidies and potential immigration reform, Oregon’s uninsured population may decline dramatically over the next few years. As a Mission-driven organization, this is exciting even as it creates potential capacity issues as these people move into coverage. Coverage coupled with new ways of paying for care – such as global budgets, quality incentives and bundled payments for specific episodes – allow us to focus on providing superior care for our state’s most vulnerable people.

Video: Health reform in 5 minutes