The big news last week revolved around Governor Kitzhaber's successful, last-minute trip to Washington, D.C. where he negotiated final terms of a deal that will bring Oregon almost $2 billion in federal money over the next four years to finance health care reform. The first installment — $620 million — is expected to arrive in Oregon by July 1.
As The Oregonian put it in its lead story on the successful trip: "Kitzhaber saves Oregon budget and his reputation in health care deal with Obama Administration." Both points are true. Oregon needs the money to fund reform. And, Kitzhaber, a former emergency room doctor who thinks, lives and breaths health care policy, had almost no choice but to succeed in D.C.
What remains is a question about whether the new federal money can be used to fill budget holes or must be devoted to new health care reforms. But that question, as important as it may be to budget analysts, ignores the basic policy point — the money will go to reform and that will mean that the reforms have a better chance for success here.
Without the money, Oregon would have faced a tough time moving ahead on the keystone of the reform effort — the plan to create Coordinated Care Organizations (CCOs) around the state to bring responsibility for low-income, Medicaid services closer to where people live. CCOs also are supposed to emphasize coordination between and among health care providers, as well as a renewed focus on prevention.
Critics say health care coordination and prevention already exist, so there may not much ground to gain as the governor suggests. To be sure, smart health care providers in Oregon aren't waiting for new orders from the governor to get about the business of providing better care or talking about how to work together and prevent certain chronic conditions from emptying state coffers.
Dr. Bruce Goldberg, the director of the Oregon Health Authority who traveled to D.C. with the governor and participated in the successful negotiations, makes a strong case that CCOs will work. In an April 6 speech to the Portland City Club, he said:
"Put simply: Coordinated Care Organizations give us the means to have patient-centered care that is focused on improving health and lowering costs at every point in the health care system. From the point where you see a health care provider to the way the bills are paid for. From the personal level to the population level. A Coordinated Care Organization is a network of all types of health care providers who have agreed to work together in their local communities to serve people who receive health care coverage under the Oregon Health Plan. Together they are accountable for two important things — the health of the people they are entrusted to care for and for the budget to deliver that care."
With all the good news of last week's developments, there also are huge challenges on the horizon. The first is making good on the pledge of reform, which will begin officially August 1 when the new Coordinated Care Organizations get up and running around the state.
The second is what happens four years down the road when the federal money dries up. Pick your analogy. There is either a steep cliff or a tall mountain as Oregon then will have to fund for itself without the lure of the federal money.
To Kitzhaber, this is a challenge — or a climb — worth accepting.
The author, CFM partner Dave Fiskum, has lobbied health care issues more than 30 years at the Capitol in Salem. He was there when Governor Kitzhaber first proposed the Oregon Health Plan more than 15 years ago and he was there last week when it was announced that the new money was coming to the state.