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Entries in Alan Bates (2)

Wednesday
Oct242012

Banking on Health Care Coordination 

A lot rides on the success of health reform ventures such as coordinated care organizations (CCOs), but not everybody knows what they are, including some of the people responsible for making them happen.

The Oregon Business Association honored 11 Oregonians this year for their contributions to CCOs, which are just being formed after winning legislative approval in 2011. One of the honorees said the task of CCOs is to fill in the white spaces between existing parts of the health care delivery system.

Senator Alan Bates, D-Ashland, talked about filling in the white spaces to ensure greater coordination in delivering health care services to improve patient outcomes and save money. He gave an example of a man who underwent extensive medical treatment for physical ailments, while his underlying psychological issues weren't diagnosed or addressed.

CCOs call for unprecedented levels of coordination between health care providers that are competitors. People seem to be playing well in the sandbox together now, but how it ultimately works out remains unknown.

Just as important is whether CCOs can help stem the tide of rising medical costs for low-income Oregonians as budget pressures build at the state and federal levels to find cuts in Medicaid and Medicare.

The predecessor term to CCOs — accountable care organizations — was first used in 2006 by Elliott Fisher, Director of the Center for Health Policy Research at Dartmouth Medical School, during a discussion at a public meeting of the Medicare Payment Advisory Commission. The term quickly gained credibility, reaching its pinnacle in 2009 when it was included in the federal Patient Protection and Affordable Care Act.  

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Monday
Jul302012

Kitzhaber's 10-Year Budget

It has not gotten as much publicity as education, health care, early learning and prison sentencing reform, but Governor Kitzhaber has proposed another initiative that could be even more significant — a 10-year budget. Oregon currently operates on a biennial budget and some lawmakers in the past have pushed for annual budgets.

In typical Kitzhaber fashion, he has provided a lot of written material on his ideas for transforming the state's budget-making process. A host of documents exist on many state websites, including the governor's. Despite that, those toiling on the 10-year plan are doing so mostly out of the glare of publicity.

If the credentials of two of these leaders matter _ the state's chief operating officer, Michael Jordan, and long-time Kitzhaber aide Steve Marks _ then the process should produce results. Their goal is laudable _ take a longer than usual view of budget and program issues and install a performance-based approach to state budget-making. 

Consider the principles Kitzhaber and his team have enunciated:

         *  Any budget-making operation should start "with the amount that is available to spend."  State law already requires a governor to recommend a two-year budget balanced to existing revenue, without new revenue proposals, but few governors in the last 20 years have lived within that limitation.

         *  "The people who recommend budgets should be separated from the people who receive the money."  Such an arms-length relationship makes sense, at least in theory. On the other hand, budget-making is always a political process and various interests who get money show up at the Capitol every session to influence those who recommend budgets. In a free society, lobbying will occur on all fronts, including the state budget.

         *  We "should make budget decisions based on getting the best measurable results for the money available."  Speaking of turning government upside down, this will do it. Most current state programs are based on categories such as busyness and workload. For state workers, so many clients generate so many positions. Kitzhaber wants to budget based on buying results.

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